Yohnny 11 year old Shih-tzu with Cushing-like problems [Archive] - Canine Cushing's Information and Support Forums

Jayessi

02-25-2020, 04:24 AM

Dear group,

Am so happy to have found you. I need some help. I am still healing and getting back on my feet after losing my other dog to heart failure and other health issues and now faced with another health problem with his brother Yohnny. It is a little overwhelming so am looking for support and guidance.

My boy Yohnny has high cortisol but the LDDS test did not show Cushings. Vet says he is a mystery and she does not know what to do other than do the LDDS test again. He has enormous apitite, thin fur, and now recently it seems his breathing has changed.

He has symptoms that made my vet think he may have cushings - enourmous appetite, thin fur, pot belly. Did LDDS test but came back negative. So he does not have cushings my vet says.
She has also done abdominal ultrasound and all looked normal.

About the same time this happened he also also was diagnosed with a tumor in his testicle ( he has had Cryptorchidism all his life) so they removed both his testicles - no metstases.

He is obsessed about food and when we go out all he wants to do is eat poop. I have him onleash and have to walk right next to him to stop him from eating dog poop. I miss it somethimes bcs he knows I don't like it so he is sneaky. which means I have to de-worm him often. bc god knows what is in the tummy of his.

I have hear stresss can cause high kortisol. I know I was super stressed during my other dogs ickness and death, do you guys think he is stressed? He does not act strees, but he is a low key dog so it is hard to say.

He also has athritis. Has take caartegen shots but other than that he is fine. I just find him not so happy and more reserved.

Sorry if this post is all over the place. I do have results from tests but cannot find a way to post them.

labblab

02-25-2020, 09:58 AM

Hello, and welcome to you and little Yohnny. First of all, I’m so sorry about your loss of Yohnny’s brother. It seems terribly unfair that you are faced with all of this new worry at a time when your heart is already hurting so badly. But we’ll do our best to offer our thoughts and suggestions in our effort to help.

As far as posting lab results, the easiest thing for you to do is just go ahead and type any abnormal results directly in a reply here. We only need to see results that are too high or too low, along with the normal reference range for that particular value. It’ll also help if you’ll type in the three cortisol values that made up the LDDS test.

When you say that Yohnny’s cortisol level is high, I’m guessing that his resting, or baseline, cortisol level was high on his LDDS. That would be the first of the three values. However, you’re correct that a high baseline cortisol level cannot be used alone to diagnose Cushing’s. Just the stress of being at the vet and being tested can raise that value, for instance. And yes, while Yohnny may have been reacting to your own stress during his brother’s illness, I don’t think that type of transitory stress would produce all the ongoing symptoms you are describing.

I have a couple of suggestions to offer to you. If you live outside of North America, though, I’m not sure whether or not the first suggestion is possible for you. It would be to conduct an alternative diagnostic blood test: an ACTH stimulation test. We understand that the injectable substance needed to conduct this test can be difficult to obtain in other parts of the world right now. But this is why I’m making the suggestion. Here’s an excerpt from an article about interpretation of the LDDS written by a noted American endocrinologist, Dr. David Bruyette:

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

So if Yohnny is in the early stages of Cushing’s, there’s a small possibility that the LDDS is simply not yet registering the disease. Another possibility is that Yohnny may be suffering from the effects of elevations in adrenal/sex hormones other than cortisol. I wouldn’t know whether or not his testicular tumor might play into this or not. However, there has been much conjecture in recent years about the presence and significance of other elevated adrenal hormones. The name that’s been given to this situation is “Atypical Cushing’s.” Many questions remain and more research is needed. The vet school at the University of Tennessee at Knoxville has taken the lead in related research here in the U.S., and they will process blood samples submitted from elsewhere. However, again, the testing agent that’s required is the one that’s used in the ACTH stimulation test. For your information, though, here’s a thread on our Resources forum that discusses “Atypical Cushing’s.”

https://www.k9cushings.com/forum/showthread.php?198-quot-Atypical-Cushing-s-quot-Congenital-adrenal-hyperplasia-like-syndrome-Hyperestrinism

Given Yohnny’s very puzzling situation, one last suggestion I can offer is to talk with your own vet about the possibility of consulting directly with Dr. Bruyette about any other diagnostic options. Your vet may have other specialists with whom he/she can talk, but Dr. Bruyette has a worldwide reputation re: his Cushing’s expertise, and has now established a consulting service whereby he will review case studies submitted by other vets at a reasonable cost. Here’s the homepage for his consulting service:

https://www.veterinarydiagnosticinvestigation.com/

So in closing, it’ll help us if you can first tell us more about any specific abnormal lab results. And in the meantime, once again, welcome!

Marianne

Jayessi

02-25-2020, 12:29 PM

Dear Marianne,

Thank you so much for your swift reply, your understanding and help and the warm welcome. It means a lot to me as I am feeling overwhelmed and sad.

Here are Yohnny's abnormal lab results:

Chemistry 11.102019
Creatinine 38 (44-159)
ALT 149 (10-125)
ALP 608 (23-212)

Urine 16.10.2019
Cortisol/Creatinine ratio 155.2 (<33)

Serum/urine 04.12.2019
Alkaline phosphatase 591 (14-147)
Cortisol/Creatine ratio 117.5 (<33)

LDDS test 13.11.2019
before admin 88.0
2nd sample 11.5
3rd sample 22.4
(24.8-124.2)
“Did not indicate hyperadrenocorticism”

—When you say that Yohnny’s cortisol level is high, I’m guessing that his resting, or baseline, cortisol level was high on his LDDS. That would be the first of the three values.

No they were not. As you can see 88.9.

Thank you for your suggestion to do ACTH test. Live in Sweden so I think this is possible here. I find it strange that my vet has not suggested this. Could there be a reason for this? She says that Yohnny is a mystery and the only thing she has suggested is another LDDS test in a month or two.

Thanks for the info on “Atypical Cushing’s.” and the tip about talking to my vet about the possibility of consulting directly with Dr. Bruyette. I will certainly talk to her about it.

Are there any other tests I should be asking for? Urinalysis? Super Chem Blood Test? What about the Ultrasound of adrenal glands?

In conjunction with removing his testicles the vet did do an abdominal ultrasound and said there was nothing irregular.

Thank you for any input you have or guidance.

with appreciation.
Amanda

Joan2517

02-25-2020, 02:35 PM

Welcome from me too, Amanda. We suspected that my boy Gable had Cushing's for years, but the LDDS test did not confirm it. We got the diagnosis finally after the ACTH test.

Jayessi

02-25-2020, 05:12 PM

Thank you Joan. And thank you for sharing your experience.
So is the ACTH test done for all the different kinds of Cushings?

Squirt's Mom

02-25-2020, 06:26 PM

Hi Amanda!

Welcome to you and Yhonny!

Yes the ACTH is used to test for Cushing's, both the pituitary based and the adrenal based forms. However, I would pursue the test for Atypical that Marinanne mentioned instead of the simple ACTH if it is available to you there.

I'm glad you found us and look forward to learning more as time passes!
Hugs,
Leslie

Jayessi

02-26-2020, 03:04 AM

Hi Leslie and thanks for response and suggestion. Can I ask why you would do the test for Atypical? When talking with my vet I am going to need to explain why I am asking for this. Also, are there any other tests I should be asking for? Urinalysis? Super Chem Blood Test? What about the Ultrasound of adrenal glands? Thanks. Amanda

lulusmom

02-26-2020, 10:23 AM

Hi Jayessi and a belated welcome to the group. I don't have much to add to the great information you've already received but wanted to ask about the urine cortisol creatinine ratio (UC:CR) and make a few comments. The ratio for both tests are quite high so I am wondering if you collected the urine specimen at home or whether your vet collected it? The reason for asking is that whenever I see a ratio that high, it's usually because the urine was not collected at home under relaxed conditions. If collected by the vet whether by free catch or cystocentesis, a high ratio is to be expected as even the stress of an office visit can cause a significant increase in circulating cortisol. If you did not collect the urine, the test result would be invalid and your vet should kindly refund or credit your account. I agree that if your dog has cushing's, the negative LDDS is likely because the disease had not progressed enough to break the communication between the pituitary and adrenal glands. An acth stimulation test is usually the next the step. However, it appears that it's been several months since the last LDDS so if the stimulating agent for the acth stimulation test is not available in Sweden, a repeat LDDS test could be done at any time. As far as testing for atypical cushing's, I am the odd person out and don't recommend spending the money on that. The reason is because the treatment for atypical cushing's is melatonin and lignans which is available over the counter in the US and can be given as a trial without an atypical diagnosis. These supplements may be available over the counter in Sweden and if so, you could actually try that regimen without incurring the cost of testing. Just be aware that if melatonin and lignans is effective, it can take several weeks to a few months to see any improvement. If no improvement in 4 months, chances are they aren't going to work. I know that what you are experiencing is frustrating and costly but it is not an uncommon experience. Many members have gone through the same thing.

labblab

02-26-2020, 10:30 AM

Hi again, Amanda. I’m going to jump back in and give you a quote from an article published by a researcher at University of Tennessee at Knoxville that perhaps best answers your question about testing for “Atypical Cushing’s.” As you’ll see, Dr. Oliver is describing dogs who exhibit Cushing’s-like symptoms and also elevated cortisol on urine creatinine: cortisol tests, but who test negative for elevated cortisol on the LDDS and ACTH stimulation test for cortisol alone.

HYPERESTRINISM IN DOGS
Jack W. Oliver, D.V.M., Ph.D.
Director, Clinical Endocrinology Service
The University of Tennessee

The Clinical Endocrinology Service at the University of Tennessee utilizes steroid hormone profiling in the diagnosis of adrenal disease. Many of the cases received have had preliminary diagnostic workups with either ACTH stimulation or low dose dexamethasone suppression testing that has been negative, but signs of Cushing's disease persist. Many of these atypical Cushing's-like cases will have abnormal levels of adrenal intermediate steroids and sex hormones. Included in the atypical cases are a considerable number of dogs that have hyperestrinism (elevated estradiol levels), with and without increased levels of other steroids. The dogs with hyperestrinism typically present with some or all of the following clinical signs: “Cushingoid” appearance, presence of chronically elevated levels (usually extremely elevated) of serum alkaline phosphatase, hepatomegaly, steroid hepatopathy on biopsy, PU/PD, dilute urine, panting, haircoat problems and skin biopsies that indicate presence of an endocrinopathy. The talk will focus on case presentations that associate clinical signs presented by dogs with primary hyperestrinism (elevated serum estradiol levels), including the association of high estradiol with increased alkaline phosphatase, and the fact that sex steroids can cause elevated cortisol/creatinine ratios. Treatment concerns will be addressed, such as mitotane and trilostane resistance. Other potential treatments for hyperestrinism will be discussed.

Unfortunately, Dr. Oliver passed away a few years ago. But other researchers at Univ. of Tennessee are still carrying on related research.

https://vetmed.tennessee.edu/vmc/dls/Endocrinology/Pages/default.aspx

Also, there’s a lot of other helpful information, on this thread:

https://www.k9cushings.com/forum/showthread.php?198-quot-Atypical-Cushing-s-quot-Congenital-adrenal-hyperplasia-like-syndrome-Hyperestrinism

As far as other additional testing for Yohnny, you’ve mentioned that an abdominal ultrasound has already been done? If so, we’d hope that the adrenal glands were seen on that scan. Sometimes during the early stages of Cushing’s, the glands may still look normal, though. As far as other testing, a urinalysis can be very helpful — Cushing’s dogs typically exhibit very dilute urine with low specific gravity.

Marianne

labblab

02-26-2020, 12:37 PM

I see that Glynda and I were typing at the same time, and I just wanted to add this note. She’s absolutely right that there are still a lot of question marks about the meaningfulness of an “Atypical Cushing’s” diagnosis, and the added expense of the more involved blood test may not be worth it for many people. The added problem for you is that a blood sample would have to be shipped to the U.S., if that’s even possible. However, given Yohnny’s puzzling situation, I just wanted you to know about the research that’s been done thus far.

If your vet can indeed get the necessary ACTH stimulating agent, then a basic test of Yohnny’s cortisol response probably remains your best bet. If not, a repeat LDDS may be the next best option.

I hope I haven’t confused you with all this extra information. Please feel free to ask any more questions that we may have brought to your mind!

Marianne

Jayessi

02-26-2020, 01:10 PM

Hi Lulusmom and thank you so much for taking the time to write.

Regarding the urine cortisol creatinine ratio (UC:CR). I collected them myself at home on our regular morning walk. I am pretty sure he was not stressed.

I am seeing vet next week so trying to get info and come prepared when I talk to her.

Basically why it has been several months is that the vet does not really understand what is wrong with Yohnny. Because I read a little about the LDDS test Iand saw it is not 100% test I asked her about this. But she said no if he has cushings it should show on the test. She has not discussed ACTH test or any other test with me. So I am wondering if I should look for another vet?

I will consider everyone's input so I am glad you are giving yours about testing for atypical cushing's, even though others don't agree. At this point I am gathering as much info as I can.

Again, thank you.

Jayessi

02-26-2020, 01:18 PM

Thank you so much Marianne for this info. and follow up of my question. I am going to have to read it a few times as it is hard to wrap my brain around all those fancy words but it is something I can also show my vet. Will read the links too.

Yes, he did an abdominal ultrasound in conjunction with removing his testicles. But I am not sure if she actually looked at the adrenal glands because she has not written anything about it in the report. She may have said it to m but I do not remember. I will ask her. This is what she wrote in her US report (it as my translation of swedish so please excuse me if it does not make sense)

bladder moderately filled aneloic urine normal wall, spleen homogeneous parenchyma normal ecogenicity, kidney approximately 4.2 cm normal bark/marrow, ventricle empty normal wall, liver overview: homogeneous parenchyma normal echogenicity, gallbladder thin-walled anechoic bile, right kidney same as left, small intestine normal motility sparing filling. Summary no deviating findings

I am definitely going to ask for a urinalysis.

THANK YOU!!!

Jayessi

02-26-2020, 01:22 PM

Noted Marianne. I really want to do all that is possible for my boy. Even though we are still reeling from nine months of serious vet bills during the his bother's illness.
I think I am going to try and sum up all the suggestions in a post in this thread that I will be talking to with the vet and would be really grateful if you can have a peek at it so that I hve understood correctly.
with deep gratitude. /amanda

Jayessi

02-26-2020, 01:33 PM

I have one more though that I cannot understand. The vet said she had talked with experts at the Swedish veterinary university and also with IDEXX who do the LDDS test.
She said sshe thinks there is "no correlation between urine creatinine and blood creatine".

She noted that in the blood test they took for the LDDS test the cortisol was in normal range 88.9 (24.8-124.2) while in the two urine tests it was very high 115 and 117.5 (<33)

What could that mean?

labblab

02-27-2020, 09:26 AM

I think it’s good that your vet has already consulted with specialists at the university as well as IDEXX. That shows that she’s both interested and willing to learn more about what may be going on with Yohnny. I’m not exactly sure as to why his urine cortisol test was high but his blood cortisol test was normal. However, we do know that they are measuring cortisol levels in two different ways, and the LDDS is the test that is more specific for Cushing’s. The LDDS is the test that is generally considered to be the best choice for testing for Cushing’s here in the U.S., too, even where the ACTH stimulation test is available. This is because the LDDS is less likely to miss diagnosing Cushing’s in dogs who truly have the disease (fewer “false negatives”). There are a few situations, though, when a Cushing’s dog will test negative on the LDDS but positive on the ACTH. That’s why, if you have the option to do an ACTH, it would be a good idea. However, if your vet has already talked with the vet school and IDEXX and the ACTH has not been mentioned to you, my guess is that there is difficulty in performing that test there in Sweden. IDEXX does provide analysis for the ACTH here in the U.S. So I’m assuming it would have been discussed with your vet if it’s also available in Sweden. But you’ll find out by asking your vet.

As far as the ultrasound, the adrenal glands can be hard to see clearly unless very high powered equipment is used. Many general practice vets here in the U.S. don’t have equipment that’s powerful enough, so referral has to be made to a specialist’s office. That may also be the case with your vet — she couldn’t see Yohnny’s adrenal glands very clearly on the earlier ultrasound. So that will be another thing to ask about: whether or not another ultrasound performed at another location might be helpful.

All in all, it sounds as though what your vet has done so far has been reasonable. The question will just be whether or not there are any additional tests available to you that might be helpful.

Marianne

Jayessi

02-27-2020, 04:14 PM

Thank you Marianne. This is very helpful. Thing are getting clearer :)

/Amanda & Yohnny

Jayessi

03-03-2020, 05:20 AM

Hi!

I was recommended to read up on this thread that discusses “Atypical Cushing’s.”

https://www.k9cushings.com/forum/showthread.php?198-quot-Atypical-Cushing-s-quot-Congenital-adrenal-hyperplasia-like-syndrome-Hyperestrinism

But could not open any of the links in the first post of that thread.

Is it just me or are they not working anymore?

Thank you!

Budsters Mom

03-03-2020, 08:20 AM

The links open for me. You might want to check your settings in your browser. Check the box allowing links/pop ups from websites visited and see if that helps.

labblab

03-03-2020, 08:34 AM

I think I see what you mean — the links now all connect to the same homepage of the U of Tennessee veterinary school instead of to the individual articles that are listed :-(((((.

I’ll check on this today and try to reset those links as soon as possible!

Marianne

labblab

03-03-2020, 10:37 AM

OK, I’ve now updated all the links in the first post in that thread. I suspect links in other replies on that thread will need updating, too. I’ll work on that later today. But at least the first post should now be OK!

Jayessi

03-05-2020, 06:39 PM

Thank you! It is working now :)

Jayessi

03-05-2020, 07:03 PM

Here are results of Yohhny's bloodtest and urinalysis. Vet has decided to hand us over to the internal specialist at vet hospital and do abdomnial ultrasound there. Posting abnormal results below.

Any input much appreciated.

BLOOD CHEM

Creatinine 29 (44-133)
ALT (GBT) 152 (25-122)
Alkaline phosphatase 1092 (14-147)
GLDH 27 (1.18)
Cholesterol 12.6 (3.6-10.3)
Fructosamine 157 (177-314)
Thrombocytes 659 (143-448)
Eosinophils (absolute) 40 (70-1490)

URINALYSIS

Color dark yello
Clarity clear
Specific gravity 1.024
Ph 7.0
Urine protien 3+
Glucose neg
Ketones neg
Blood neg
Bilirubin 1+
Urobilinogen norm
Leukocyte neg
White Blood Cells <1/HPF
Red blood cells <1/HPF
Bacteria cocci none
Bacteria rods none
Squamous epit cells <1/HPF
Non-squamos eit cells <1/HPF

labblab

03-06-2020, 10:06 AM

I’m very relieved to hear that Yohnny will now be evaluated by an internal medicine specialist, with a repeat ultrasound at the hospital. I am not a vet myself, so I am only guessing when I look at all his lab results. But I do wonder whether or not there might be a primary liver problem that is at the root of his symptoms. The elevations across all the liver markers, the low creatinine and fructosamine, and the bilirubin in the urine all suggest to me that there may be more abnormality in his liver function than you’d expect to see in Cushing’s. But once again, I’m far from an expert, and it will be very helpful to have a specialist’s opinion regarding the best diagnostic path forward.

Whatever you find out, please let us know. You and Yohnny are now part of our family, so we’ll be right beside you here to learn more, and to offer our support!

Marianne

Squirt's Mom

03-06-2020, 10:51 AM

Marianne posted while I was comparing labwork previously posted and I have to agree with what she said....my concern would be something going on with the liver. So I too am glad Yhonny is seeing an IMS and hope they will have a definitive answer plus viable solution to help your sweet boy start to feel more like himself. Please keep us updated on what you learn and how he is doing.

Hugs,
Leslie

PS...ditto to ya'll being part of the family now regardless!

Jayessi

03-06-2020, 09:58 PM

Thank you Marianne. I am hoping to get some more answers soon and it is comforting to know a family here.

Jayessi

03-06-2020, 10:00 PM

Dear Leslie. Thank you. I also hope this step will help us with our boy. I really appreciate your support. Hugs back. Amanda

Jayessi

03-15-2020, 08:36 PM

Marianne. Quick question. I got an appointment with IMS but not until March 30. Should I be ok waiting until then? Just worried that whatever problems he has might get worse...

labblab

03-16-2020, 01:47 PM

I do wish I could give you an accurate answer, but I cannot since I don’t really know what’s wrong. I know how frustrating it is to have to wait to see either a vet or a human doctor, for that matter! But I hope that in Yohnny’s case, the wait will be worth it. Are you seeing any outward changes right now, either for better or for worse? If he’s remaining pretty much stable, I’d hope that means that the wait will not be adding to his problems.

Marianne

Jayessi

03-17-2020, 02:57 PM

Thank Marianne. I realize I was asking a question that is impossible for you to answer just based on the test results. I have not seen any changes so am just trying to breath and hope that I actually can go to the vet on the 30th now with pandemic situation. I hope you and yours are safe and ok. It is a hard situation.

Jayessi

03-26-2020, 01:00 PM

Dear friends. Hope you and your pups are holding up during these difficult times.

After many months of not knowing what is wrong with him we get to see and internal medicine specialist tomorrow at one of Swedens largest vet hospitals.

Yohnny has suspected Cushings, although it is not diagnosed. He has done the LDDS-test but it was negative.

He has not done ACTH-test or abdominal ultrasound so that will be two things I will be asking vet about.

Is there anything else I should be asking about? I have a golden opportunity and don’t want to miss anything.

It has been suggested here that he might have underlying liver issues (Thanks Marianee and Leslie)

Thank you any other last minute input you have, and prayers. Hugs to you all and your pups.

Abnormal bloodtest results are:

Creatinine 29 (44-133)
ALT (GBT) 152 (25-122)
Alkaline phosphate 1092 (14-147)
GLDH 27 (1-18)
Cholesterol 12.6 (3.6-10.3)
Fructosamine 157 (177-314)
Thromocytes 659 (143-448)
Eosinophils 40 (70-1490)

Urinalysis:

Color dark yellow
Clarity clear
Specific gravity 1.024
Ph 7.0
Urine protien 3+
Glucose neg
Ketones neg
Blood neg
Bilirubin 1+
Urobilinogen norm
Leukocyte neg
White Blood Cells <1/HPF
Red blood cells <1/HPF
Bacteria cocci none
Bacteria rods none
Squamous epit cells <1/HPF
Non-squamos eit cells <1/HPF

labblab

03-26-2020, 06:10 PM

I’m so relieved you’ll be seeing the specialist tomorrow!! I really don’t have any more suggestions to add, but I surely do wish you good luck with the appointment. Please stay very safe, yourselves, and we’ll be so anxious to hear what the specialist has to say.

Best wishes for finally getting some answers!
Marianne

Jayessi

03-26-2020, 06:34 PM

Thank you, Marianne. I was originally scheduled for March 30 but the hospital called and wanted to re-schedule me to April 24th! Because of pandemic they had to only focus on emergency cases. I was devastated to have to wait another month after waiting so long already. I took a chance and called the other hospital we have and they booked me in tomorrow! I guess they are handle in things better? Anyway, I am just so relieved I got in. Thank you for your well-wishes. Will let you know when I have more info. /Amanda

Jayessi

03-28-2020, 12:10 PM

Saw vet yesterday. No diagnosis yet. Vet sent a thyroid test along with new blood and urine tests. Ultrasound showed that both adrenal glands where enlarged (the left one slightly more) and that liver also was enlarged and had structural changed (reactive). Once vet has results next week we will no more. Now all I do is try and stay calm and enjoy my boy every chance I get.

labblab

03-28-2020, 12:26 PM

Thanks so much for this interim report. Bilaterally enlarged adrenal glands and an enlarged liver can all be caused by Cushing’s, so perhaps we’re headed more directly down that road. We shall see!

Jayessi

04-03-2020, 08:49 AM

Here is update on Yohnny:

(let me know if anything is unclear am translating swedish vet terms to english)

He has high liver values and proteinuria. Thyroids tests done came back negative.

Proteinuria show leakage in kidneys. Vet gave us Fortekor (hypertension medicine) which he started to take 2,5 mg per day today april 3.

He will go back in for his second LDDS test in two weeks as cushings is strongly suspected. They will also do a hypertension check-up and a Cystocentesis for protein/crea quote.

At this point they are trying to find out if he has atypical Cushings or Cushings that is in early stages.

Vet also mentioned some kind of hormon test (on hte blood) they could do - but we will wait to see what the result of the LDDS test is.

I asked vet if the proteinurea and kidney issues and the suspected cushings are part of the same problem or different issues - she said they where most probably seperate issues. But I have read that proteinurea and hypertension is commin in cushngs dogs. Isn't it?

Abnormal test results

Blood

Trombocyter-Sys 677 x10*9/l 148 - 484
ALP-Profil 16,6 ukat/l < 1,4
ALAT-Profil 2,3 ukat/l < 1,2
Cholesterol 13,1 mmol/l 3 - 10,3

Urine
U-Densitet-Profil 1,025 > 1,03 ulli
U-Volym 4 ml 5 10 ulli
U-Färg gul ulli
U-Protein 3 0 - 0
U-Protein/krea kvot 1,4 < 0,5

Ultra sound
Liver sightly enlarged with slightly rounded edges. Both adrenal glands moderatly (close to substantially) enlarged bilateral with normal echogenicity and no vascular invasion so suspect central hyperadrenocorticism, or possibly inflammation rather than other neoplasm.

Any thoughts or input much appreciated. Thank you.

Harley PoMMom

04-03-2020, 01:52 PM

He will go back in for his second LDDS test in two weeks as cushings is strongly suspected. They will also do a hypertension check-up and a Cystocentesis for protein/crea quote.

I strongly recommend that only the LDDS test be done at that time because this test is sensitive to stress, if those other procedures are performed this could add more anxiety to Yohnny which would make his cortisol rise and could make the LDDS yield a false positive. Is it possible for other things to be done at a another time?

Hugs, Lori

Jayessi

04-03-2020, 03:49 PM

Hi Lori. That is a good point you make. Thank you. I will talk to vet about this. Your input is much apprieciated. /Amanda

Jayessi

04-03-2020, 03:56 PM

Lori. Would you recommend I just go in with him for the LDDS tests and then take him home in between? That is what I did the first time (we have taken LDDS test one but it was negative) but now I took the option of leaving him there as they were going to do the other things too.

Harley PoMMom

04-03-2020, 06:22 PM

Lori. Would you recommend I just go in with him for the LDDS tests and then take him home in between?

Since you took him home between draws the first time the test was given I would definitely do that again.

Jayessi

04-04-2020, 03:47 AM

Thank you Lori. /Amanda

Jayessi

04-04-2020, 06:58 AM

Question about FORTEKOR. Yohnny was prescribed 2,5 mg yesterday by vet bcs he has protien in urine and leaking kidneys. So he has taken two tablets so far. This morning he threw up twice, and the second time he fainted for 2 seconds. I called hospital and the emergency vet said I should stop with Fortekor and that my primary vet will call me on Monday.

Anybody else been prescribed Fortekor or have expereince with this?

They have not checked Yohnnys blood pressure.

Squirt's Mom

04-04-2020, 09:45 AM

I didn't know what that drug was so I looked it up....it is a heart medicine so I am confused why it was giving for kidney issues. My Squirt was incontinent and was given a drug called Proin....she reacted badly to it tho I didn't realize it was the medicine until she had a stroke, which I believe was also caused by the Proin. So I wanted to know if Fortekor and Proin were the same drug but they are not. I wouldn't give any more of this to Yohnnie at all as it seems his body does not like it at all. I would want to know more about why that drug was chosen, if he does have a heart issue as well as kidney issue, and have his BP checked because high BP will have a detrimental effect on the kidneys.

Jayessi

04-04-2020, 10:23 AM

I didn't know what that drug was so I looked it up....it is a heart medicine so I am confused why it was giving for kidney issues.

Me too! She said it was prescribed for the "protein in the urine, which might be due to high blood pressure."

I didn't know what that drug was so I looked it up....it is a heart medicine so I am confused why it was giving for kidney issues. My Squirt was incontinent and was given a drug called Proin....she reacted badly to it tho I didn't realize it was the medicine until she had a stroke, which I believe was also caused by the Proin.

That is so scary. How is Squirt doing now?

QUOTE=Squirt's Mom;211753] I wouldn't give any more of this to Yohnnie at all as it seems his body does not like it at all. I would want to know more about why that drug was chosen, if he does have a heart issue as well as kidney issue, and have his BP checked because high BP will have a detrimental effect on the kidneys.[/QUOTE]

He does not have heart issues. But BP has not been checked so will put this on the list of things to ask for.

Thank you!

Squirt's Mom

04-04-2020, 11:05 AM

My beloved Squirt passed in 2014 from simple old age, nothing to do with Cushing's. She was a little over 16 years old.

labblab

04-04-2020, 12:27 PM

Hi again! I wanted to stop by and add some clarification about the Fortekor (benazepril). It’s among a class of medications known as ace inhibitors, and we’ve seen it prescribed both for high blood pressure and also to help stabilize proteinuria in dogs. I don’t know how it actually works in that regard, but we’ve had other dogs here who’ve had it prescribed for that reason. I think that in many cases, the dogs have also been diagnosed with high blood pressure, but perhaps not always. Given Yohnny’s fainting spell, however, it makes me wonder whether the medication might have actually dropped his blood pressure or heart rate too low. Ace inhibitors can also elevate potassium levels, and that may have caused a problem for him, too. We’ll see what the vet has to say on Monday. In the meantime, here’s a blurb about its use:

Benazepril (brand names: Fortekor®, Lotensin®, Apex®, Benazemav®, Benefortin®, Bexepril®, Nelio®, Prilben®, Vetace®) is an angiotensin-converting enzyme (ACE) Inhibitor used to treat heart failure, high blood pressure, and various types of kidney diseases such as chronic kidney disease and protein-losing glomerulonephropathies. It may also be useful for treating idiopathic kidney bleeding.
Its use in cats and dogs to treat cardiovascular and kidney disease is ‘off label’ or ‘extra label’.

For the treatment of proteinuria, in addition to an ace inhibitor, other options we’ve seen include supplementation of omega fatty acids and also moderate reduction in dietary protein. But once again, we’ll see what your vet recommends going forward. There are other ace inhibitors besides benazepril, and perhaps an alternative may suit Yohnny better.

And yes, it’s our understanding that both hypertension and proteinuria can be secondary to the effects of Cushing’s, so I’m not sure why the vet is suggesting that they’re not connected. Perhaps she’s just awaiting a confirmatory Cushing’s diagnosis before making that association.

Marianne

Jayessi

04-05-2020, 03:41 AM

My beloved Squirt passed in 2014 from simple old age, nothing to do with Cushing's. She was a little over 16 years old.

My condolences. I am guessing that is her on your profile pic? She is so cute!

Jayessi

04-05-2020, 04:00 AM

Hi Marianne and thank you for clarifications.

So proteinuria can be caused by Cushings - but may not necessarily be helped if dog is diagnosed or treated for Cushings?

I am trying to advocate for Yohnny and preparing questions for vet. If you have time could you look at these?

1. Can we check his blood pressure? Especially before giving him a medicine that can bring down blood pressure?

2. What other options are available for treatment of proteinuria? (include supplements/diet)

3. Should we do LDDS test it earlier so we can hopefully can get a diagnosis earlier? (First one was in November)

4. I asked about the ACTH test for Yohnny since you and others have mentioned doing this text too and IMS vet said that one is done when cortisol is low. So she did not seem to think it was an option for Yohnny. Should I ask about this again and if so what shall I say?

5. I know that as little stress as possible is important when doing the LDDS and ACTH test. So I will take Yohnny back and forth to vet (rather than leave him at vet all day) and ask them to do other testing after test or at another date. This is optimal yes? Is there any veterinary paper that writes about this? I would like to have "something" bcs me vet didn't seem to be aware of this.

6. This question is about being a dog mom and trying to do what is best. Just want to hear what you would do. Very few vets in Stockholm are proactive (and I have met a lot of vets) but I did meet one IMS vet that was amazing that took care of Yohnnys brother but she has unfortunately moved out of the country but has recommended an IMS vet for us close to where we live. I am thinking of contacting her for an appointment instead of the vet we saw on the 27th of march. What would you do?

Sorry for all these questions, am having a hard time wrapping my head around this disease even though I am reading through articles. I am feeling lost and in need of both emotional and factual support.

Thank you and hugs
Amanda

Harley PoMMom

04-05-2020, 06:26 AM

Hi Amanda,

There is no need to apologize for asking questions, that's part of being an excellent advocate for your Yohnny!

5. I know that as little stress as possible is important when doing the LDDS and ACTH test. So I will take Yohnny back and forth to vet (rather than leave him at vet all day) and ask them to do other testing after test or at another date. This is optimal yes? Is there any veterinary paper that writes about this? I would like to have "something" bcs me vet didn't seem to be aware of this.

Here are a few that I found, hopefully this is what you're looking for and if not I'll try to find others. :)

“Basically, any kind of stress can potentially cause an adrenal response and increase production of corti*costeroids” Dr. Chapman said. So, the acute stress associated with hospitalization and drawing blood can affect the pet’s cortisol levels for the LDDS test, but will not alter the results of the ACTH stimulation test. Patients should be kept as quiet as possible to help reduce the effects of acute stress on LDDS test results. https://www.americanveterinarian.com/journals/amvet/2019/january2019/whats-new-with-cushings-disease

To encourage acclimatization and minimize stress, the LDDST routinely was performed after at least 1 day of hospitalization, with no other procedures scheduled during the test. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5980256/

The LDDST is more sensitive but also less specific and affected more by stress. https://www.ncbi.nlm.nih.gov/pubmed/21596349

6. This question is about being a dog mom and trying to do what is best. Just want to hear what you would do. Very few vets in Stockholm are proactive (and I have met a lot of vets) but I did meet one IMS vet that was amazing that took care of Yohnnys brother but she has unfortunately moved out of the country but has recommended an IMS vet for us close to where we live. I am thinking of contacting her for an appointment instead of the vet we saw on the 27th of march. What would you do?

Sorry for all these questions, am having a hard time wrapping my head around this disease even though I am reading through articles. I am feeling lost and in need of both emotional and factual support.

Thank you and hugs
Amanda

Since you felt that this other vet took excellent care of Yohnny's brother, if this were me, I would seek out the IMS she recommended.

Hugs, Lori

labblab

04-05-2020, 10:01 AM

Amanda, I think all of your questions are excellent ones! Lori has given you some very useful quotes re: the LDDS and the effect of stress on that test. As far as the preferability of performing the LDDS vs. the ACTH, I cannot argue with first repeating the LDDS. This is because, of the two tests, it is more likely to produce a positive result if a dog does have Cushing’s. However, if Yohnny *again* tests negative on the LDDS, I’d want to give the ACTH a try since he has so many symptoms that are consistent with the disease. Since the two tests are measuring different aspects of adrenal function, occasionally one will be negative while the other is positive. Here’s a quote by noted endocrinologist, Dr. David Briyette:

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

So as you can see, it’s only a small chance (5 - 10%) that a dog with Cushing’s will test negative on the LDDS, and that’s why the LDDS is preferred by most specialists to be run first. But in Yohnny’s case, if he tests negative again, I’d want to give the ACTH a try. As far as the ACTH and low cortisol, yes, it’s true that the ACTH is the preferred test for Addison’s disease — your vet is right about that.

Regarding Cushing’s and proteinuria: if Cushing’s is the underlying cause, you definitely want to treat the Cushing’s to keep the condition from worsening. However, Cushing’s treatment alone may not resolve the existing proteinuria, so the two conditions may be treated in tandem. We’ve had several dogs here who have received both treatments. One note about that: I mentioned earlier that Ace inhibitors can elevate potassium levels. Vetoryl (trilostane), the medication that you’d undoubtedly use to treat Cushing’s, can also elevate potassium. So when the two medications are prescribed at the same time, you do have to regularly check blood chemistries to make sure that the potassium level isn’t getting too high. But we’ve had dogs here who have done fine with both.

Overall, aside from performing other tests at the same time as the LDDS, I think the steps that the new vet has recommended are reasonable. And who knows, maybe she intends to do the other tests after the LDDS has concluded (drawing additional blood at the end of the test, for instance, and drawing the urine afterwards). If so, that should be fine and shouldn’t affect the LDDS results. But I totally understand why you don’t want to leave any stone unturned. I’d be the same way if Yohnny were my own. If you’d always wonder whether you would have had more confidence in the recommendations of the other vet, and consulting with the other vet is possible, then you may well wish to do so. I definitely suppprt you 100% whichever way you choose to go!

Marianne

Jayessi

04-05-2020, 11:53 AM

Hi Amanda,

There is no need to apologize for asking questions, that's part of being an excellent advocate for your Yohnny!

Here are a few that I found, hopefully this is what you're looking for and if not I'll try to find others. :)

https://www.americanveterinarian.com/journals/amvet/2019/january2019/whats-new-with-cushings-disease

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5980256/

https://www.ncbi.nlm.nih.gov/pubmed/21596349

Since you felt that this other vet took excellent care of Yohnny's brother, if this were me, I would seek out the IMS she recommended.

Hugs, Lori

Dear Lori! This is great! I totally trust people in this forum, but when talking to a vet I find it can "help" to present stuff other vets have said.
I am so touched that you spent time looking for me. <3

Jayessi

04-05-2020, 11:58 AM

Amanda, I think all of your questions are excellent ones! Lori has given you some very useful quotes re: the LDDS and the effect of stress on that test. As far as the preferability of performing the LDDS vs. the ACTH, I cannot argue with first repeating the LDDS. This is because, of the two tests, it is more likely to produce a positive result if a dog does have Cushing’s. However, if Yohnny *again* tests negative on the LDDS, I’d want to give the ACTH a try since he has so many symptoms that are consistent with the disease. Since the two tests are measuring different aspects of adrenal function, occasionally one will be negative while the other is positive. Here’s a quote by noted endocrinologist, Dr. David Briyette:

So as you can see, it’s only a small chance (5 - 10%) that a dog with Cushing’s will test negative on the LDDS, and that’s why the LDDS is preferred by most specialists to be run first. But in Yohnny’s case, if he tests negative again, I’d want to give the ACTH a try. As far as the ACTH and low cortisol, yes, it’s true that the ACTH is the preferred test for Addison’s disease — your vet is right about that.

Regarding Cushing’s and proteinuria: if Cushing’s is the underlying cause, you definitely want to treat the Cushing’s to keep the condition from worsening. However, Cushing’s treatment alone may not resolve the existing proteinuria, so the two conditions may be treated in tandem. We’ve had several dogs here who have received both treatments. One note about that: I mentioned earlier that Ace inhibitors can elevate potassium levels. Vetoryl (trilostane), the medication that you’d undoubtedly use to treat Cushing’s, can also elevate potassium. So when the two medications are prescribed at the same time, you do have to regularly check blood chemistries to make sure that the potassium level isn’t getting too high. But we’ve had dogs here who have done fine with both.

Overall, aside from performing other tests at the same time as the LDDS, I think the steps that the new vet has recommended are reasonable. And who knows, maybe she intends to do the other tests after the LDDS has concluded (drawing additional blood at the end of the test, for instance, and drawing the urine afterwards). If so, that should be fine and shouldn’t affect the LDDS results. But I totally understand why you don’t want to leave any stone unturned. I’d be the same way if Yohnny were my own. If you’d always wonder whether you would have had more confidence in the recommendations of the other vet, and consulting with the other vet is possible, then you may well wish to do so. I definitely suppprt you 100% whichever way you choose to go!

Marianne

Thank you Marianne. I now understand a little better. And get a little teary that there are such lovely people like you helping me. The quote from Dr. David Briyette is useful, and the other info you have shared. Have a nice Sunday.

labblab

04-05-2020, 12:20 PM

Awww, you're very sweet to say that, Amanda! Over the years, Lori and I have received so much help and support from our members here, ourselves. We're just grateful to have an opportunity to pass on the info we've learned.

Also, I made a typo in my earlier reply. The doctor's name is Dr. David Bruyette, not Briyette. Oops! Anyway, here's a link to an article that he has written about interpretation of the LDDS test, and that's where I got the quote that I gave you earlier.

https://www.dvm360.com/view/clinquiz-interpreting-low-dose-dexamethasone-suppression-test-results

Jayessi

04-05-2020, 04:16 PM

Harley PoMMom

04-05-2020, 04:40 PM

I do want to share my experience with checking the blood pressure on a dog as my angel Harley did have high blood pressure. What I would do was schedule this procedure when the office didn't have many appointments because Harley would get excited seeing a strange dog. Also I made arrangements with the staff that when we arrived we would be put in a room right away. Harley had anxiety at being at the vets and I believe he suffered from what is known as "white coat effect" meaning that his blood pressure rises at the vet's office.

Once we were in the room, no one would come in that room for about 15 minutes so that I could try to calm him down a bit. When the tech came into the room she would talk very calmly and softly to Harley and they would take 3 readings and get an average from that. Another tip I did was when we were home I would often take his paw in my hand like the tech does when she is taking his BP so he would get accustomed to this kind of handling. Harley took Amlodipine for his BP.

Hugs, Lori

Jayessi

04-06-2020, 04:08 AM

Jayessi

04-06-2020, 07:33 AM

Update after talking with vet:

Vet really wants to give Yohnny something to help his kidney´s as she is worried about irreversible damage to them. She said there are alternatives to Fortekor but they are not as good. She asked me to wait 2-3 days to make sure Yohnny is totally ok and then give him half a tablet (vet had prescribed 1 whole tablet) and see if there is any reaction.

I asked vet if she would be doing the BP test and cysto for protein/creatine after the LDDS test and she said no, they have time in-between the LDDS test to do this. When I asked about the stress this might cause she said that the LDDS tests other kind of stress so it would not be a problem.

I feel totally confused and don't know what to do. Shall I do as vet says? Or say that I am not going to leave him at the hospital but instead come in for each blood draw - and that they do the other test after LDDS text is done?

Not sure if I am being too critical of this vet or if I should trust my gut feeling. also feel like a really lousy avocate. help please.

/Amanda

labblab

04-06-2020, 01:12 PM

Amanda, don’t ever doubt that you are great advocate for Yohnny! Because you *are*!

I’m really sorry the vet is making the testing situation so awkward for you. In reality, probably taking his blood pressure wouldn’t be that big an issue. I’d worry more about the cysto, but it may be the case that even that may not skew his LDDS results significantly. But given all the hurdles you’ve had to confront in terms of a diagnosis, I know you want this test to be as accurate as possible. If it’s not a hardship to you to take Yohnny back again on a second day, perhaps you’d feel comfortable just saying as much to the vet: that you understand that she doesn’t think the test will be compromised, but you want Yohnny to be stressed as little as possible after all that he’s been through. Therefore, you prefer that the diagnostics be spread over two days.

As far as taking him home between the blood draws, you know him the best of anybody. I know several of our members have said that this keeps their dogs as calm as possible. For my own dog, I’m honestly not sure whether or not just leaving her there would not be better. This is because it’s actually the driving to the vet and the coming and the going in-and-out of the waiting room that seem to get her the most agitated. It’s about a 20 minute drive, and she starts pacing and getting anxious in the back of the car just as soon as we start off in that direction. Same thing when we enter the reception area. So in truth, my dog might actually be calmer just taken back and forth between a cage during the day of the test. It’s really hard for me to know. In Yohnny’s case, you know him the best of anyone, though. So whichever way you think he’d be stressed the least amount, that’s the way I’d want to go.

Marianne

Harley PoMMom

04-06-2020, 02:21 PM

Oh Amanda, YOU are an excellent advocate for Yohnny!! Do not ever doubt that! If this were me, I would insist that no other procedures be done while the LDDS test is being performed. Stress can skew this type of test, as stated in those articles I linked to, and stress can cause blood pressure to rise so doing both of those on the same day, I believe, should not be done. The cysto could possibly be performed after the LDDS test is done.

I also believe that since his LDDS test results were negative the first time that this shows that taking him home in between draws may be a good idea, could be that this is less stressful for him, but only you know him best so go with your gut on this one.

Hugs, Lori

Jayessi

04-06-2020, 04:25 PM

Jayessi

04-06-2020, 04:28 PM

Squirt's Mom

04-08-2020, 12:05 PM

I've been away from things for a few days but have been trying to read and keep up with our sweet Yhonnie. I want to second what Marianne and Lori have said....you are doing a great job being an advocate for him. Trust your gut, stick to what you believe is best for your baby boy, and know you are not alone...we are right by your side even tho you can't see us.

Hugs,
Leslie

Jayessi

04-23-2020, 11:27 AM

Jayessi

04-23-2020, 11:29 AM

Dear Marianne, Lori, Leslie and anyone else who might be reading this post :)

Yohnny did his second LDDS test last week her are results and what vet has diagnosed and prescribed. Just want to check we are on the right path.

LDDS test 
Cortisol 274 nmol/l < 120 ulli 
Cortisol 4 h 47,5 nmol/l < 40 ulli 
Cortisol 8 h 53,2 nmol/l < 40 ulli  
Urine U-Protein/crea quot:
1,7 < 0,5 JEEK 

Blood Pressure  Average : 122/50 (75) 121 
Sys/Dis (MAP), pulse 
Animals position: Lying down on chest 
Stresslevel (1-5) : 2 
All measurements (minimum 5):  
Sys/Dis (MAP), pulse
 133/48 (78), 120
 124/49 (75), 119
 131/46 (76), 117
 109/51 (72), 123 
112/54 (75), 128  

ULTRASOUND GUIDED ASPIRATION OR BIOPSY: 10 ml of urine through cystocentesis without complications  

What vet said

Vet discussed results with specialist since the LDDS was only very slightly increased and therefore she did not want to start any treatment risking that values become too low instead. But specialist said there was enough other indications to diagnose Cushings and that there was new findings that dogs with Cushings can have a glomeruli problem (Yohnny has protein in urine) without having high blood pressure.

Next steps
Yohnny has been prescribed 10 mg Vetoryl once a day and a follow-up with urine and blood test in two weeks.
Any thoughts or comments?

THANK YOU!

labblab

04-23-2020, 11:49 AM

Hi Amanda! Given all of Yohnny’s symptoms and the elevated result on this LDDS, I do feel comfortable with the plan to move forward with starting the Vetoryl. I’m not sure whether you’ve ever told us how much Yohnny weighs, but the current recommendation is to follow an initial dosing formula that does not exceed 1 mg. per pound, or 2.2 mg. per kilogram. So as long as the 10 mg. dose falls within that guideline, I do agree that this is the place to start. And performing followup testing in two weeks is perfect.

I don’t know whether the vet mentioned this, but Yohnny’s LDDS result is consistent with the pituitary form of Cushing’s. Also, I know we expressed some concerns about checking the blood pressure and performing the cysto on the same day as the LDDS. Even if they were indeed performed on the same day, given all of Yohnny’s symptoms, I cannot argue with assuming that the elevated LDDS result is accurately pointing towards Cushing’s. So I think you’re on the right path, and I will be so anxious to hear how he responds to the Vetoryl.

Good luck to you both!
Marianne

Jayessi

04-24-2020, 04:46 AM

Thank you Marianne for getting back so quickly.

He weighs 18lbs (8.2 kg) so it is well below the dosage, which would be 18 mg if I am counting correctly. Vet did not mention but thanks to all the good info in this group I have understood this.

After I talked to vet I read this:

ACTH stimulation monitoring tests are performed between 4 and 6 hours after the morning dose given WITH FOOD. Some vets prefer to perform the test from 2 to 4 hours after the morning dose. Whatever timing a vet chooses, each and every test must be performed at the same time, every time. NEVER fast your dog for this test as results will be invalid.
The 1st ACTH stimulation test should be done 10-14 days after starting treatment. A dose increase is rarely done at this time as cortisol is expected to drift downward over the next few weeks.

Vet did not mention ACTH test in the 2 week follow up. What she did say is that I could collect a urine sample in the morning and that he be fasting in case any blood samples need to be taken. She did not mention anything of the above. I am going to point this out and am also thinking of asking to see the specialist she consulted with instead, as she seems to have had more experience with Cushings.

The BP test and cysto was done after the LDDS test. I asked for this.

/Amanda

labblab

04-24-2020, 08:44 AM

Given Yohnny’s weight, yes, that starting dose is definitely well within the guidelines. So that is good. But also, yes, I encourage you to clarify the planned monitoring testing protocol with your vet. It may be that she’s intending to hold off until the 30-day mark to test the cortisol. Although Dechra officially recommends that the first cortisol test be performed at the 10-14 day mark, some clinicians do wait until a month has passed to do so. Perhaps since Yohnny has been started out on a relatively low dose, that’s what she has in mind. But you’ll definitely want to find out for sure.

You may have read that Dechra has now also endorsed an alternative testing method to the ACTH. It simply involves taking a resting cortisol sample right before the morning dose of Vetoryl is given. In that situation, fasting is OK since the test would be performed ahead of dosing with breakfast. This “pre-pill” testing method is pretty much the norm now in the U.K., and it may also have gained popularity in Sweden. So all in all, you’ll indeed want to clarify what type of testing will be done, and when.

You’re doing such a good job, though, Amanda. Knowing that the cysto and BP check were done after the LDDS gives me even greater confidence in that positive result. So once again, I do think you’re on the right track in terms of treatment.

Jayessi

04-25-2020, 03:22 AM

Thank you Marianne, for both info and encouragement. I am starting to wrap my head around this a little more and calming down thanks to you and the other who have supported me.

I am pretty sure the vet I am seeing is not familiar with the ACTH test for the 10-14 day check-up and definitely not the pre-pill test because then she would have prepped me for both of these.

But I read up about both of these after she called :( so I have decided to wait with initiating the Vetoryl until I have talked with her again and the plan is clear. Would you agree?

For example, she told me that Yohnny should be fasting "just in case they need to take some blood tests."

Sigh...she has not done a bad job so far...but Yohnny should have the best right? I am really considering changing to the specialist she talked to - or to the specialist I was recommended.

/Amanda

labblab

04-25-2020, 01:06 PM

You can see what she says when you question her further. Perhaps you’ll feel more comfortable about her plans after that. But if not, that’s reassuring to think you have the option of moving on to one of the specialists.

As far as monitoring bloodwork in addition to the cortisol, it’s true that it’s recommended that basic blood chemistries be routinely checked as well. After starting Vetoryl, checking the levels of potassium and sodium in the body are particularly important because Vetoryl can also lower the level of aldosterone, another adrenal hormone. Aldosterone controls the potassium/sodium balance, so it’s good to make sure that those levels are remaining within normal limits. I don’t know that fasting is necessary for those particular results, but it’s true that you want a dog to be fasted for certain other results on a blood chemistry panel such as cholesterol and glucose. For this reason, it may be best to perform the blood draws for monitoring ACTH stimulation tests and chemistry panels on different days, depending upon which blood chemistries you’re most concerned about monitoring accurately. On the other hand, I believe a pre-pill cortisol test and blood chemistries can both be done on fasted samples.

So yes, I think it makes sense to hold off on starting treatment until you feel comfortable with knowing which vet will be following Yohnny from this point onward, and which testing protocol you’ll be using.

Marianne

Jayessi

04-28-2020, 03:24 AM

Hello.

Talked to the vet I am seeing.

Her plan is to do only be looking at clinical signs and take a urine test to check the protein (that I will be bringing in with me) when we go see her at the 10-14 day mark of him starting Vetoryl and do ACTH or Pre-Vetoryl Cortisol Monitoring at the 4-week mark instead. Unless I have noticed something that makes me think he is not feeling well - then they may do an ACTH at the 10-14 day mark.

She said this is according to the latest findings and that it takes a while for his body to adjust to cortisol so that is why they wait for the 4-week mark to do test.

Does this sound right to you?

Amanda

labblab

04-28-2020, 10:12 AM

Given the low dose of Vetoryl that Yohnny is starting out on, I personally do feel comfortable with this plan. As I wrote earlier, the formal recommendation is to go ahead and test the cortisol at that two-week mark, but I have indeed seen clinicians hold off until the 30-day mark for the first testing as long as the dog is looking and behaving well. Your vet is correct that the cortisol level can continue to drift downward during the first month of treatment even while a dog remains on the same dose. For this reason, no dosing increases are recommended until after the first 30 days, regardless of the interim results. The earlier test is really one for safety’s sake — to make sure the dose doesn’t need to be lowered. But as I say, since Yohnny is starting off on a very low dose, anyway, I would feel OK with your vet’s plan, especially since she will still be physically examining him earlier. If either you or she think that something looks amiss, you can and should go ahead and test at that time.

Marianne

Jayessi

04-28-2020, 12:17 PM

Thanks for confirming Marianne. I feel good about moving forward. Will start Yohnny on Vetoryl tomorrow. Hugs and hope you are doing ok in these difficult times, Amanda

Jayessi

05-13-2020, 10:11 AM

Update on Yohnny May 13

Today he did a check-up after being on 10 mg of Vetoryl for 14 days (he weighs 8.2 kg).
Because of pandemic, I was not allowed in but vet interviewed me outside.
Basically all is well so far. He has not had any adverse reactions. I have not seen any changes to positive or negative.
Vet said heart and lungs sound good, not lowering of the heartbeat.
I have noticed his arthritis has gotten worse and the vet noticed when she did her exams. So he will be back on his painkillers again (Vetrimox).
We go back in 14 days for pre-Vetoryl cortisol test.
His protein urea was down from 1.7 to 1.6. I cannot figure out what number he should have. In a previous test I have, it says 3. Are there different ways of putting a value on protein/creatin?
So I guess all in all so far so good.

Amanda & Yohhny

Harley PoMMom

05-13-2020, 12:44 PM

When my Harley had the urine protein:creatinine ratio test (UPC) the reference range was less than 0.5.

Jayessi

05-14-2020, 05:19 AM

When my Harley had the urine protein:creatinine ratio test (UPC) the reference range was less than 0.5.

ok. Thank you. So 1.6 sound very high :(

Jayessi

05-14-2020, 08:47 AM

Dear friends,
Can someone help Cushing's and proteinuria? I am trying to understand better. it seems that it can be common in dogs with Cushing's and can both be resolved with treatment - and not be resolved. Am I understanding correctly?

Yohnny went in for check-up yesterday after being on 10 mg of Vetoryl for 14 days (he weighs 8.2 kg). His protein urea was down from 1.7 to 1.6. But it still sound high to me. What is your experience?

I read that it is common for dogs with Cushing's disease to have urinary tract infection (UTI). However, because of the immunosuppressive action of excess cortisol, these dogs may not show clinical signs of UTI or have an active urine sediment (1,2). Therefore, a urine culture is recommended in all dogs with newly diagnosed Cushing's syndrome and again at 6-month intervals while on treatment with trilostane or mitotane.
Should I be asking my vet to do this?

2) Because of the renal issues and overt proteinuria, should we address dietary therapy in these dogs?
Do any of you address this with your vet? or are you implementing dietary therapy?

Thanks for input. Amanda & Yohhny❤️

Squirt's Mom

05-14-2020, 08:56 AM

With a UPC result of 1.6 I would want to know the GFR (glomerular filtration rate) and have a relatively new test called the SDMA run. Before the SDMA we didn't know the kidneys were in trouble until around 75% of function was lost because what we relied on was the BUN and CREAT. The SDMA tells us much sooner if kidney function is decreasing. The GFR tells us how well the organs are filtering and excreting toxins via the urine. These two things will give you a much better idea of Yhonny's kidney status than the UPC, BUN, and/or CREAT.

To learn about kidney function and the tests used check out the IRIS website - http://www.iris-kidney.com/guidelines/staging.html

Jayessi

05-14-2020, 10:44 AM

Jayessi

05-30-2020, 10:03 AM

Hello dear friends!

Yohnny did his Pre-Vetoryl Test this morning. Result was 96. And the protein in his urine is done from 1.6 to 0.9.
He is himself again and much more alert. ❤️ (And he had a haircut-see pic :)
Going back in a month for another PVT.
I think it is time to celebrate a small victory? Right?
/Amanda

labblab

05-30-2020, 10:15 PM

Oh Amanda, yes!! Let’s definitely celebrate your good news! :D:D:D

That’s an excellent result on Yohnny’s Pre-Vetoryl test (around 3.5 ug/dL for our American readers), and all the other news is so good, as well!

Thanks so much for sharing this update with us, and I’ll be hoping that the good news continues from this point onward.

Great job, mom!
Marianne

Jayessi

05-31-2020, 06:07 PM

Jayessi

06-24-2020, 11:36 AM

Just keeping you in the loop with Yohnny.
Good news :)
He did his second Pre Cortisol Vetoryl Pill Tes today after 2 month on Vetoryl and this is his result:

Cortisol-Vetoryl 76,1 nmol/l 30 - 200 emås

Also his U-Protein/Crea quote is now 0,5 (Earlier it was up at 1.7 and then 0.9 after a moth of Vetoryl)

I am happy. They did find a small heart murmer (Level 1 of 6) so wanted to ask if it is ok to give supplements for this? Just to help his heart a a little. My understanding is to stay away from fats, but would it be ok to give CoQ10 oil?

Thanks in advance. /Amanda

labblab

06-24-2020, 06:36 PM

Hi Amanda, and thanks for this excellent report! I’m so happy for you two! ;)

As far as the CoQ10 oil, I’m afraid I don’t know anything about it so I can’t make a recommendation one way or the other. I doubt that the fat from the oil would present any problem, but I just don‘t know whether the supplement itself would be a help in this situation. If the vet recommended it, though, I’d think it would be fine.

Continued best wishes to you both!
Marianne

Squirt's Mom

06-26-2020, 09:08 AM

Great update on Yhonny! Always nice to hear good news! The CoQ10 should be fine to use and can help with any heart issues, along with other conditions. Here is a link to an article written by Drs. Steve Marsden, Shawn Messonnier, and Cheryl Yuill.

https://vcahospitals.com/know-your-pet/coenzyme-q-10

Jayessi

10-26-2021, 03:02 PM

My boy Yohnny is on Vetoryl 10 mg per day taken in the morning. He ways 7kg/15 lbs. He is 13 years old. He started Vetoryl April 29, 2020 and has improved and been doing good.

His most recent Pre Vetoryl Tests have been 148/138/149 (30-200) but this latest one was different: 51 (Sep 14, 2021)

U-Proteine/krea was high before Vetoryl (1,4 to 1,7) and then since Vetoryl between 0,5 and 0,9. But agian, the latest one was 1,2 (Sep 14, 2021) Should be < 0,5

Also from Sep 14 blood test:
ALAT-BM 1,7 ukat/l < 1,2
ALP -BM 12,8 ukat/l < 1,4
Kreatinin -BM 52 umol/l < 135

He has been doing great until Sunday when he seemed to have less energy than usual, also yesterday walking very slowly. And today he threw up his lunch. Poop is good.

He ate a small dinner at 4 pm and this has stayed in his stomach. But now when I was going to offer him a little more food (He eats small portions 4 times a day) he just tasted it and left the plate. This has NEVER happened. He usually has a ravenous appetite and finishes food in seconds. But he did want banana.

I called vet (animal hospital internal medicine) and her opinion was to see if it might be something temporary. If not I should wait and skip one dose of Vetoryl tomorrow morning. Of course if he gets worse I should go to the hospital.

His tummy seems a little swollen and more sensitive to touch than usual He did have the typical potbelly but this has got better - but now seems to be back a little.

I am of course worrying and would love some thoughts/comfort/advice from this group. I think my vet is competent but I also read about all the mistakes vets have made. He has some symptoms mentioned for low cortisol: vomiting (once), lethargy, reduced appetite, But not diarrhea, weakness, collapse.

Input welcome so I can either calm my nerves a little - or get ready to go to hospital.
Thanks ❤, Amanda

Kevin

10-26-2021, 05:53 PM

Lack of appetite, vomiting, lethargy... all pretty clear signs to stop Vetoryl until you can figure out whats going on. Pretty sure Vetoryl says to stop w/ these symptoms. Much better to deal with higher cortisol for a few days than an Addisons crisis. Might just be getting too high a dose. As time goes by, it seems we find that smaller doses of Vetoryl do the job. Others on the forum will be more equipped to dive into those numbers.

Good luck Amanda. Hope you get it figured out. You came to a good place.

Jayessi

10-26-2021, 06:01 PM

Thanks Kevin.

labblab

10-26-2021, 07:39 PM

Welcome back, Amanda. As you’ll see, I’ve merged your new question into your original thread so we can have Yohnny’s whole history here for us to refer to.

Many thanks to Kevin for his prompt reply to you, and I agree with him 100%. From the sound of things, I would guess that Yohnny’s cortisol is now dropping too low for his comfort. Even though he’d been doing quite well earlier and his Vetoryl dose had stayed the same, he may be responding differently now to that same dose. It is not unusual for doses to have to be changed over time, and this most recent monitoring test shows a significant drop in his cortisol level (down to about 1.8 ug/dL for our U.S. readers).

So I totally agree with Kevin, and I would not want to restart his Vetoryl again until he is once again eating and behaving normally. Even at that point, reducing his dose, at least temporarily, would likely be the safest thing to do. It’s possible that something else may be going on, but I do think that low cortisol is the most likely culprit until proven otherwise. Hopefully giving him a break from the Vetoryl will allow him to normalize quickly. But if not, as your vet suggests, a trip in to be examined will be important.

Please keep us updated as to how he’s doing tomorrow, OK?
Marianne

Jayessi

10-27-2021, 05:54 AM

Hi Marianne! So nice to be greeted by you!

Thanks for confirming this. I have read about Addison crisis and got scared he was/is having one. But I guess that is not the case here?

He has slept pretty well, he ate some banana around 5:30 - when I got hungry ;) - but at 9 am breakfast he did not want his regular breakfast or banana (which he usually loves) instead he opted for a few treats.

We then took a short walk, he peed and pooped (normal) and now he is resting again. He did try and throw but not much in his stomach. He is very tired.

He did not get his Vetroryl this morning. What should I expect/look for today and tomorrow? Obviously if he gets worse - more lethargic, vomiting, shaking etc - I will go to ER. But anything else? How long does it take to normalize?

One more thing, looks like his potbelly is back slightly. Can this be the case when this happens?

Thank you, Amanda

Jayessi

10-27-2021, 03:05 PM

Update 8 pm local time. Yohnny has been sleeping all day except for when I have fed him. He ate a little cooked white fish this afternoon and about half an hour ago he actually seemed a little more hungry and ate a slightly bigger portion fish and drank some broth. But he still seems very tired and weak. He barely wants/is able to walk. But he did wag his tail a little for the first time since he got sick. Carried him out for a pee. Is this still what to expect? He has now been 36 hours without Vetoryl. What if he is the same tomorrow? Feeling anxious.....

labblab

10-27-2021, 06:05 PM

After this much time, I would let your vet know that Yohnny is still doing poorly. If his adrenal function has been oversuppressed by the Vetoryl, simply stopping the Vetoryl may not be enough help for him right now. He may need some supplemental prednisone pills, at least temporarily, to make up for the lack of cortisol coming from his own adrenal glands. He may also be suffering from a lack of aldosterone, which is another adrenal hormone. If his aldosterone level is too low, that can throw off his blood chemistries, most especially potassium and sodium. Again, sometimes a supplemental replacement is needed until the adrenal glands rebound to normal production.

So I would definitely contact your vet and let her know that he’s not doing well. She may want to see him personally, or she may prescribe a steroidal supplement that you can get for him yourself. Either way, I think she needs to know he is not doing well. I’m so sorry!

Marianne

Jayessi

10-27-2021, 09:18 PM

Thank you so much Marianne. I will be calling my vet first thing in the morning (in 5 hours) Amanda

Jayessi

10-29-2021, 01:14 AM

Update: Took Yohnny to vet yesterday morning. They admitted him. He could barley stand or walk. They gave him painkiller and intravenous drip. Did ultrasound and xray and bloodtests. Results came back with anemia, elevated kidney levels (could be dehydration), elevated liver values, and elevated "sedimention rate" (not sure this is correct translation). He is staying, he is stable, and they are going to do more tests today to see how they compare to yesterday. They did a needle test on his liver and will have the result of that today too. I am so worried adn want him home. Will give you numbers and more info when I have it. he has had an enlarged liver since he was diagnosed with Cushings. Now they see that part of the liver looks ”different” vet is hoping to find out what the ”difference” is due to.

labblab

10-29-2021, 10:45 AM

I’m so sorry he’s feeling poorly! Absolutely you did the right thing by taking him in. I know how much you want him back home again, and hopefully this is a problem that’s only temporary. We’ll anxiously await additional news whenever you’re able to tell us more.

Sending healing hugs to Yohnny, and comforting hugs to you. We know how hard this must be for you, and we’ll stay right here by your side.

Marianne

Jayessi

10-29-2021, 01:35 PM

Marianne! POSITIVE UPDATE. Yohnny is home :)! Vets are not totally sure what the issues were, but he has his energy and appetite back and is standing and walking again.He had a strong systemic inflammation. He may have eaten something. His arthritis coupled with systemic inflammation could be the reason he did not want to stand or walk. Vets do not think it had to do with his Cushings. But they will meet with his cushings vets next week so we will see if there is any connection. Once again thank you for your wonderful support Marianne. I hope you have a wonderful weeked.

labblab

10-29-2021, 03:27 PM

That’s great news!!!! I’m so happy for you two!!!

I am curious whether they did check Yohnny’s cortisol level there at the hospital. Of course, something totally different may have been going on. But we have witnessed this same chain of events with other dogs who have been overdosed with Vetoryl: near total collapse and then a swift miraculous recovery once they receive IV fluids to restore their blood chemistries, as well as supplemental steroids if needed. So I’m still left wondering whether or not oversuppressed adrenal function may have played some part in this.

It’s very good that they’ll be consulting with his Cushing’s vet next week. In the meantime, I’m hoping they’ve told you to keep him off the Vetoryl until they do have the chance to consult. If Yohnny was my dog, I would want to let him bounce back from this ordeal and hear from the specialist before restarting the medication.

But for sure, this is very good news to take us into the weekend!
Marianne

Jayessi

10-30-2021, 05:13 AM

Thank you Marianne. We are both enjoying very much being together at home today. Vet told me they check his "salts" due to his Cushings. Not sure what that means though. He has been off Vetoryl since Wednesday.

This is summary from vet:

Due to Yohnny not currently on vetoryl, no cortisol levels were taken to see check his medication dose.

A general blood sample was taken which showed mild anemia, elevated liver values, high blood platelets and a strong systemic inflammation.

The platelets and liver values correlate to Yohnny's cushings and there is nothing that worries me. The proteins that show liver function, as well as Yohhny's bile acids - which also show the function, were completely normal. So Yohhny's liver works well.

The anemia is difficult to say what it is caused by, Yohnny has had some low red blood cells before. Inflammations in the body can cause some low red blood cells. I think these should be followed up.

The red blood cells are not so low that they affect how Yohnny feels. He has fine mucous membranes and a normal pulse so the heart does not need to pump faster.

What stood out in the blood test was thus the strong systemic inflammation picture.

Ultrasound of the abdomen showed an altered area in the liver. The liver was also large, which it can become in Cushing's disease. A sample was taken from the changing part of the liver, the sample was unfortunately not diagnostic but to know for sure what the change in the liver is requires that you open the stomach and take a biopsy. I consider it unlikely that it is the change in the liver that is behind the deteriorating health as Yohnny got better so quickly on drip and pain relief. Had something malignant (cancer) in the liver caused his bad health, one does not expect such a treatment response.

Ultrasound examination of the heart showed that the heart is working fine, he has a leaking valve but there is nothing that currently affects him in any way and he therefore does NOT need to take any medicine for his heart disease. He therefore also has no increased risk of anesthesia.

In conclusion, it is difficult to say what made Yohhny so bad. How he was feeling probably correlated with the strong systemic inflammation. He responded nicely and quickly to drip and pain relief. It could be that he simply ate something inappropriate (food poisoning / gastritis), he also has severe osteoarthritis of the elbow joints and hip which, together with the general feeling of illness you get from such severe inflammation, may have contributed to his unwillingness to move . Of course, it is not possible to say for sure, but I am very happy to see how quickly he recovered - something that speaks against a disease of a more serious nature that you always have in the back of your head with older dogs (cancer)!

Give no more Vetoryl until I have consulted your other vets. We will talk next week!

labblab

10-31-2021, 09:43 AM

I’m so relieved to hear that Yohnny remains at home and is still doing well. And thanks so much for your detailed summary of the vet’s report. The one piece that really surprises and disappoints me, though, is the fact that they did not check Yohnny’s cortisol level. Truly, I think that low cortisol remains a possible explanation for his collapse and I don’t understand why they wouldn’t have checked that. I’ve gone back to review what you had written about his recent pre-Vetoryl tests:

His most recent Pre Vetoryl Tests have been 148/138/149 (30-200) but this latest one was different: 51 (Sep 14, 2021)

For our U.S. readers, those first three results all translate to between 5 - 5.4 ug/dL. The September reading had dropped clear to around 1.8 ug/dL. Something had happened to cause Yohnny to metabolize the medication differently even though his dose was unchanged, and his cortisol may have dropped even further at the time of his collapse. It would have been really helpful to know what his level was at the time he was hospitalized. And I’d definitely want to know where his level is at before considering starting back. Whether or not there’s something else going on that is responsible for the change in his response to Vetoryl, we do not know. But as I said earlier, we’ve seen cases where dogs simply end up processing the medication differently over time, requiring dosage changes as a result. If appropriate changes are not made, dogs can end up overdosing with results that look very similar to what happened to Yohnny.

So, for sure I’ll be very interested to hear what your Cushing’s specialist has to say about all this in the coming week. In the meantime, I surely hope he continues to do well!

Marianne

Jayessi

11-02-2021, 05:37 PM

Hi Marianne and thank you for being so involved and adament about Yohnny’s health. Vet that had been taking care of Yohnnys cuahings called today. We are going in for an ACTH test tomorrow morning. So in you opinion they should have done this earlier? Is there anything else I should ask/keep in mind when I see vet tomorrow? Thank you ad always.

labblab

11-02-2021, 06:24 PM

I’m so glad to hear about the ACTH test. The current status of Yohnny’s cortisol production will be the most important factor in making a decision about restarting his Vetoryl, and if so, at what dose. When you took Yohnny in to the hospital at the time of his collapse, they may not have been able to do a full ACTH due to his condition and also the IV meds he was receiving. But in my opinion, they definitely should have at least checked his baseline cortisol level as part of his initial blood draw.

But I think an ACTH now will be very important. Also, I would think your vet would want to draw enough blood to check Yohnny’s basic blood chemistries as well. The balance of sodium and potassium is especially important to monitor, both when a dog is actively taking Vetoryl or also when an overdose has been suspected.

That’s the main thing I can think of in advance of your visit tomorrow. Good luck!

Marianne

Jayessi

11-03-2021, 10:05 AM

Thank you Marianne. This is very helpful. Still waiting for results of ACTH test. In the mean time vet called and his red bloodcell count has gone down. 32 lats Thursday, now 23. Vet asked for a stool sample so that is my mission right now. The knot in my stomach is back. :(

Joan2517

11-03-2021, 11:09 AM

That knot...it's something we all get...watching for signs, waiting for vet visits, waiting for test results. We love our babies so much and only want everything to be okay with them. I hope that only positive results come back for Yohnny.

labblab

11-03-2021, 11:31 AM

Oh me, too! We’ll be waiting anxiously to hear more as soon as you find anything out.

Marianne

Jayessi

11-03-2021, 12:21 PM

Joan2517

11-03-2021, 01:06 PM

Everyone on this site understands...we've all been there. There is nothing that you haven't gone through that members here haven't.

Jayessi

11-03-2021, 03:21 PM

Thank you Joan.

Jayessi

11-08-2021, 11:22 AM

Update: Evening on Nov 4 Yohnny fainted. Went to vet next day (Nov 5) we where worried a hard decision had to be made. Took a lot of blood tests, stool sample, xray and ultrasound (2nd one in 3 days). He still has anemia but numbers are better (but still not within range). ACTH stim test showed adrenal glands working (Cortisol 0 min 130/<120 Cortisol 60 min 342/<350). His liver still has something going on but they could not find any blood leakage on ultrasound, but he did have blood in his poop. They are now treating for gastric catarrh and stomach ulcer (Losec+Andapsin). In general he seems ok we is alert when things are going on in but does have much lower energy and sleeps more. He eats well, goes out to peep and poop, although poops is loose (maybe due to medicine?) Our plan is to try this medicine and see if it will help. Today Nov 8 he is a little perkier. Vet is contacting me this week. Cannot figure out how to attach Lab results and vet notes.

labblab

11-08-2021, 12:45 PM

Thank you so much for the update! And thanks so much for the ACTH report — yes, it looks like I can finally stop worrying about low cortisol! I’m very relieved about that, but sorry to hear about the internal bleeding. Unfortunately you can’t add any attachments to your replies other than in photo form. But you’ve done an excellent job all along about explaining to us what the vets have told you. It sounds like a stomach ulcer might definitely be the source of the bleeding, and hopefully the new medication will really help. We’ll continue to watch for more news this week.

Sending healing pats to your sweet boy!
Marianne

Jayessi

11-28-2021, 04:26 AM

Dear Marianne and group,

Quick update. After 3 weeks of Losec and Andapsin for his stomach Yohnny is doing well! His energy and spunk is back. And once we stopped with the Losec his stool was normal too. We will be going in for a blood test and check-up on anemia etc beginning of dec. Thank you for your support. I think I figured out how to attach a photo of him...after he was sniffing a pile of leaves... ;) https://imgur.com/a/qOnakBZ

labblab

11-28-2021, 12:36 PM

Oh my, this is *great* news — thanks so much for the report!!! And thank goodness for that new medication! I’ll definitely be watching for your photo of your sweet boy :-)))))))

Best wishes, as always!
Marianne

Jayessi

05-09-2022, 04:39 AM

Hi! Yohnny and Amanda here. It's been a while. After the stomach problems in November last year. Yohnny has had to have an eye removed and several teeth removed in a big surgery (not cushing's related) and he is struggling with anemia/stomach issues - this has taken a toll on him physically, but he is not in pain and still has that twinkle in his eye and is a happy dog.

I am looking for some practicle and emotional support. He has had loose stool since Thursday and I am worried. He seems ok in general but needs to go out in middle of the night etc. The question is how worried should I be? His health issues have taken a financial toll on me and I don't want to take him to the vet unless I really have to - also for his sake since he has been so much.

I know it is hard for you all to give direct advice without knowing anything and seeing the situation yourself, but how do you think in these hard situations when it does not seem to be an emergency...but I am worried that if I wait it might become one....

Thanks for any input.