Hi all, foster girl with Cushing's

[medusa]

Hi and sorry for my english:rolleyes: I am from Greece and I found this forum while searching for Cushing's syndrome, never thought there will be a specific forum! Glad I found it!

I have 2 mixed breed dogs of my own and i often foster strays, we really have a problem here.:(
Last 20 days I have a new foster girl, sweet Lucy . She is small, only 8 kgrs, around 10-11 years old, and was abandoned at the streets of Athens about a month ago so I don't know anything about her past.
From the first day I noticed the bad skin condition, the alopecia, the large belly, the excessive drinking and urination and how hungry she was, she was licking the floor for hours ! She had many of the symptoms, we did the blood work and she was officially diagnosed some days ago. I believe she was abandoned cause they found out she was ill and the cost of the exams and meds is quite big here.

I already found a lot of interesting and helpful information in the forum, thank you!
Hope the best for your fur babies

[labblab]

Hello and welcome to you and Lucy! I’m so glad you’ve found us, and your English is excellent — there is no problem at all with that! I’m afraid it will be tomorrow before I can write more to you, but I did not want to wait to welcome you and to let you know that your membership has now been fully approved and anything you post from now on can be seen by all our members. You do not need to reply to an email request for membership confirmation if you should receive one — you’ve now already been fully approved.

You are a wonderful person to take care of all your dogs, and we’ll do everything we can to help you make decisions about Lucy. As I say, I’ll write more tomorrow, and once again — welcome to you!!

Marianne

[medusa]

Thank you mery much :)

I ll do my best to "study" as much as possible, its quite a new and complicated thing for me.
So nice to find people that can understand and have a knowledge, I want to do the best for this poor girl someone left.

[labblab]

Alright, I’ve made it back once again! As I said yesterday, we’re so grateful to you for taking care of the stray dogs who have been abandoned — you are truly their guardian angel. Sadly, we know how overwhelming and expensive Cushing’s treatment can be in all countries. I’m sure Greece is no exception. If you could share Lucy’s numerical test results with us, that will help give us a clearer picture of her current situation. I’m not sure what diagnostic testing is done in Greece, or what medication options may be available. If you can tell us more about that, we’ll then do our best to help you find the best solutions for her care.

So please feel free to ask us any questions you may have. We’ll be so anxious to learn more about sweet Lucy!

Again, welcome to you both.
Marianne

[medusa]

Marianne, thanks again for your nice and encouraging words :)

From previous posts I read, I noticed things are quite the same. Except from the symptoms which she had most of them, she also had some anomalies in her check up blood test, like high ALT. So she did the LDDS test. I do not have the numbers etc of the LDDS test ( it was done by the towns shelter vets and its somehow complicated to have them in hand) . Vetoryl is also used here, as i understand its the only medicine suggested for Cushing's by greek vets.

Vet prescribed to start 30 mg vetoryl every morning, cause he said her cortisol is very high and her symptoms advanced. It seems so big dose for a such small girl (she is around 8 kgs.) and i am scared (in general overprescribing its usual here). An animal welfare organization donated her first box of medicine but i did not started yet, I am trying to get the papers/exams so I can take an opinion from a vet clinic I trust ,asap.

I hope i ll take the second opinion fast, cause her skin condition is worse in comparison with the first day she came here. Her panting is somehow better cause she is all day in a room with air condition and i take her small walks only late at night (Greek summers are very hot). I also think she has lost some weight and the belly looks smaller. She probably had a poor diet before, now i feed her 3 small meals, only cooked low fat meat with vegs and also grain free kibbles. I also started her milk thist , turmeric and probiotics to prepare her body as best as possible for all these meds.

My main concern at this time is the 30 mg dose, seems very high. I noticed dogs with the same weight in the forum usual started with 10 or maybe 15 mg.

Thank you, Matina

[labblab]

Dear Matina,

Thank you so much for all this additional information. I think you are doing all the right things in the way in which you are taking care of Lucy -- the air conditioner, the short walks, the meals, the supplements. Everything you are doing is so good, and such a gift to her after her life in the street.

I understand that it can be difficult to personally get test results from some vets, especially if they are working directly with shelters. We do know that conditions other than Cushing's can give "positive" results on the LDDS test, but from all the symptoms you've described, it does sound as though Cushing's is the likely cause of Lucy's problems. I'm especially sorry to hear that her skin condition is getting worse, because there is a particular kind of skin ailment called "Calcinosis Cutis" that can make life miserable for Cushing's dogs. If you do an internet search on that term, you can find some pictures that you can compare to what you're seeing with Lucy. If it looks the same, then it's true that you'll want to start Vetoryl treatment as soon as you can in order to try to keep it from getting even worse. It it's only the case that she is losing hair and having bald spots, it's not so important to be be speedy in starting treatment. In that case, it's mainly just her appearance. But if she is developing sores that look like the pictures of Calcinosis Cutis, then the problem is more serious.

It's so good of the welfare organization to have donated a first box of medication. However, like you, I wish so very much that the shelter vet had prescribed a lower dose to begin with. I'm afraid many vets make the same mistake of thinking that, if the symptoms are bad and the case seems advanced, the dog should be given a higher dose. But everything we've been told by researchers and even the company that makes Vetoryl is that initial dosing should be based solely on weight and not severity of symptoms. So you're right, a safer starting dose for Lucy would be 10-15 mg. Every dog metabolizes the drug differently, and it may well be the case that she might end up needing to take a larger dose such as the 30 mg. daily. But in order to avoid risky side effects, you want to start with a lower dose, and see how the dog does both in terms of symptom relief and bloodwork results. After you see how the dog handles the medication, then it is safer to increase the dose at that later time if it seems necessary.

In Lucy's case, though, especially if it looks as though she has Calcinosis Cutis, I really don't know what I'd do if she were mine and it looks as though it will take a long time to be able to get a smaller dose. I might risk going ahead and starting the medication, while watching her very closely for any ill effects and stopping the medicine if anything worries you. You can see that I am placing a lot of importance on her skin, though. So if you can describe her skin in more detail, that can help us make some decisions about whether or not to wait to start treatment.

Marianne

[medusa]

I searched about calcinosis cutis, I think she is not so bad, seems an awful thing.

Lucy has some sores in her back legs and tail and her belly seems to have some kind of mild infection, the skin is very thin i can see her veins and not so elastic, i can also see 2 large round spots that seem infected and she has some small bumps . She also has some darkened spots that seem a little dry. Her nose is crusty and dry also and her ears seem a little dirty.

The main skin problem is around her throat, when she came here she had already lost her hair and had some dark patches but now it seems like some kind of dermatitis or bad infection, has sores, its greasy and has developed a weird odor.

I expect to have the exams tomorrow and get her to another vet for a second opinion , especially about the dose. I ll try to talk again to first vet also , maybe he will agree to a smaller dose.

Thank you.

PS. I send the vet the Dechra protocol about Cushing's treatment , where is is clearly suggested to start with the smaller dose of 2 mg/kgr and i am waiting an answer.

[labblab]

You are doing such a great job for Lucy! I know I keep repeating this, but it is *so* true! Good for you that you sent the Dechra info to the first vet, and that you've set up the new exam as well. Thanks also for the thorough description of Lucy's skin problems. I agree with you -- it sounds more like she may be suffering from skin infections rather than the Calcinosis Cutis. Skin infections of all kinds are pretty common in untreated Cushing's dogs because their immune systems are weakened by the disease. Low thyroid levels can also be associated with Cushing's, and that can also make dogs more vulnerable to skin problems. If Cushing's is causing low thyroid, the thyroid levels should improve on their own once the Cushing's is treated. However, sometimes dogs end up needing thyroid supplementation if their levels are low and Cushing's is not the cause. I just mention the thyroid because that may be a blood level that you'd want to have checked by the new vet if it wasn't already done by the shelter vet.

No matter what, we'll be anxious to hear how the new exam goes tomorrow.

[labblab]

Me again! I had one more thought to add. After posting a similar reply to another member, it occurs to me to also suggest to you to request a “rescue” dose of prednisone from one of your vets in the event that you do decide to start her off with that higher 30 mg. dose of Vetoryl. Having prednisone on hand could give you some extra peace of mind, because you would be able to quickly supplement Lucy’s corticosteroid level in the event that the medication were to drive her natural cortisol level too low. Hopefully you will be able to start off with a lower dose of Vetoryl to begin with. But I just wanted to suggest the prednisone as a backup if the lower dose is not available. The necessary dose of prednisone would be very small for a dog of Lucy’s size — I’m very annoyed with myself that I can’t remember the exact formula! But it is just one more thought that I had before your vet visit tomorrow.

[medusa]

Its a good thought, I have always predinasone at home, saved my dog once when he had a bad allergic reaction, so that will not be a problem. I ll ask the vet about the dosage.

Tomorrow Ill probably have the numbers of the LDDS test and her blood work so I can ask a more experienced with Cushing's vet about the 30 mg dose.
I hope I ll get an answer until Monday and can finally start with the treatment.

Lucy is now enjoying her new cooling mat, seems to work for her. ;)

[medusa]

Ηι , I have a good update, I went to the second vet, way more experienced. He agreed that 30 mg is too high , also he commented that her cortisol levels are too high. He suggested that she starts with a 15 mg a day. I am feeling better about this dosage and more willing to start the treatment.
Also thinking of start even lower at 10 mg , the cost of 10 and 5 mg medicine will be too much and we rely on donations for her meds.

I m thinking of starting at Monday, that doctor will be easy available in case something will go wrong.

[labblab]

I’m so glad to hear this news! I think that’s a good idea to wait until Monday to start the medication. And given the expense, I also understand why starting off with 10 mg. may work out the best — both in terms of cost and safety. I’ll be thinking of you and Lucy on Monday, and hoping all goes well!

[medusa]

Hi, we finally did not start the medicine yet, as it seems currently there is a problem with finding the 10 mg meds in Greece. After calling many pharmasists I found just one box available and we will have it tomorrow.

Also i found a pharmacist that splits the 30 mg, makes new capsules and can make them the right amount. Will be that safe? I met 2 people that did that in the past in the same pharmacist and everything went well. I ll start now with the 10 mg meds, but i kept the 30 mg also, so in case i can't find the 10 mg in future i ll continue with the split capsules in the dosage that Lucy will require after the first month.

Thank you

[labblab]

Yes, I think that should be fine to have the pharmacist repackage the 30 mg. capsules for you. We caution against people opening capsules and sprinkling out portions of the powder themselves, because it’s likely that the individual doses that they end up with can vary quite a bit. But I would think a professional pharmacist should be able to repackage all the capsules safely. There may still be a little variation in each individual dose, but far better than if any of us tried to do it ourselves. Good for you for finding these options, and hopefully you’ll already have the new 10 mg. capsules tomorrow.

[medusa]

hi! We finally managed to get the meds yesterday! Today Lucy took her first pill, i decided to start with 10 mg. She seems ok for now.

I arranged her test for 17 august, 13 days from now.

Hope everything will go well, Lucy is a tough girl.:o

[Harley PoMMom]

Just want to make sure you're aware that the Vetoryl has to be given with a meal to be properly absorbed. Also, those ACTH stimulation tests have to be performed 4-6 hours after the Vetoryl was administered with food...Good luck!!

Lori

[medusa]

Thank you Lori.
Yes I already read that in the forum, also the vet told me about the meal and that the test must be done 4-6 hours after the pill. I give her the pill with wet food , I believe it must be better than kibbles.

Lucy seems ok today, hope the meds will help with her appetite and thirst/urination , last days she is even more aggressive around food.

[medusa]

Hi. Lucy is now taking the meds for 6 days, I think the drinking/urination is less already. Yesterday I came back from work and for the first time the water bowls were half full.

I finally got the LDDS numbers also

there are 3 numbers
26.2 μg/dl [ref. 0.7-8.0]
11.8 μg/dl
8.2 μg/dl

(maybe this is not the correct order, i took printscreens:eek:)

[labblab]

So sorry for the delay in replying to you, but I’m so glad that Lucy is already doing better! And thank you for the test results. This result is indeed consistent with Cushing’s, and the form of the disease that is caused by a pituitary tumor. This is the most common form of Cushing’s. I hope that perhaps you’re seeing even more improvement by now. We’ll be anxious to hear :-).

Marianne

[medusa]

Hi, I was away for vacation, so Lucy spend her last 20 days in another foster house. She did her 14th day test, her cortisol levels are still high 11.4 μg/dl [ref. 0.7-8.0], but she seems to have some improvement. They told me her belly seems better and her drinking /urination is less. Tomorrow she will come back here so i can see on my own eyes, if there is a real improvement.

I'm currently looking for another doctor near me to continue her treatment, cause with the shelter vets its difficult to be sure that the test was done in the correct time (I have a strong belief that with so many strays and work, they didn't test her in the 4-6 hours frame), and we can't in general agree with the treatment plan, they don't agree with the smaller 10 mg dose. They also wanted to give her an even bigger dose before the 30 day period.

[labblab]

Thanks again for this new update. Like you, I surely hope you'll be able to find a new vet who will be more knowledgeable about Cushing's treatment and protocols. I'm especially glad that Lucy didn't get the increased dose at the 14 day mark. It's possible that her cortisol may have been running even higher at that time due to stress over being in a new foster house. So it will be good to get her settled back down in your own house, and then to go from there. Once again, thanks for letting us know what is going on!

Marianne

[medusa]

Ηι! lucy is back here with us and she seems well. I visited another vet also, not quite satisfied again, they all just told me , take vetoryl, come back for exams every 2 months, i had to make all the questions and suggestions again.
At least the new vet agreed that the right dose to start was 10mg, he is next door and i can arrange to make the test in the right time frame, and in a very good price. (And i will be able to communicate easy and ask questions, in the shelter clinic that was difficult)

I got the results of her 14th day test ( shelter clinic), they just gave me a number 11.4 μg/dl[ref. 0.7-8.0], No explanation nothing


After almost one month on vetoryl I noticed some changes

The belly seems quite smaller.
She has no new hair lose and the smelly bad spot in her throat is somehow heeled now.
Drinking/urination is better , she still urinates frequently but i need fewer bed pads.
Her apetite is still huge!
She is more energetic and sassy, she is the boss here!
Panting is better, but the weather is not so hot any more.


The new vet also suggested that i skip the one month test , give her vetoryl another 2 weeks and then take the test. Not sure about that, although she seems to have no bad effects from the meds.

[Harley PoMMom]

Is the 11.4 ug/dl result a post number? I'm thinking it is and if so I believe waiting a month for a recheck is fine as long as she's acting normally.

[medusa]

Ηι! Just here to inform you about Lucy. She seems to do well with the 10 mg meds, no bad symptoms .

Panting is much better , her belly is smaller also and the skin is better, not thin anymore.
She still pees many times a day ( around 8-10) but much less than before (before was 25-30 times a day).
She is still hungry all time also, but somehow better, at least she stopped licking the floor for hours.
Her hind legs also seem to be stronger, the last 3 days she can stand on them to reach things ot jump happy around

She is going to have a test in 2 days. They told me they take just one sample, wondering if you ever heard about that. I thought they take 2 samples for the retesting..

[Harley PoMMom]

Thanks for the update and I'm happy to hear that Lucy's symptoms are doing better. Regarding the one sample collection, your vet may be doing the pre-Vetoryl method, I'd definitely ask the vet if this is what they are doing. Here's a link about that: .https://www.k9cushings.com/forum/showthread.php?8925-GENERAL-GUIDELINES-for-Vetoryl-(trilostane)-Dosing-amp-Monitoring-with-ACTH-Stimulation
Good luck and let us know those results, please

[labblab]

Thanks again for another update! I’m glad to hear you’re seeing some improvement, but realize you would like to see even more. As far as the testing, one monitoring protocol with which we’re familiar does involve only one blood draw. This testing protocol involves taking a blood sample right *before* giving the morning dose of trilostane. Here’s a link that describes how the test is done and how the results are analyzed:

https://www.k9cushings.com/forum/attachment.php?attachmentid=8772&d=1659215520

Traditionally, the ACTH stimulation test has been the most commonly used monitoring test, and it does involve taking two blood samples one hour apart. However, during the last couple of years, the pre-Vetoryl monitoring test that I’ve described above has become common, especially in Europe. It’s less expensive because it doesn’t require the injection of a stimulating agent. As long as dogs appear to be generally well, this may now be preferred in many places. However, the ACTH stimulation test remains a valuable testing tool when more information about a dog’s adrenal function is wanted due to a poor medication response or the fear that a dog may be overdosed.

Hopefully, the pre-Vetoryl cortisol level is what your new vet is talking about. A single baseline cortisol level taken randomly throughout the day does not provide the same monitoring value as a level taken right before the daily dose of medication. So I’m hoping this is what he/she has in mind.

Marianne

P.S. I see that Lori and I have the same thought ;-)

[medusa]

I am not sure about the pre vetoryl test, cause he told me to bring her 5-6 hours after the dose, so i maybe did not understand well. I have to clarify that.

By the way the sores around her neck and head area was in fact the beginning of calcinosis cutis, she also has a smaller spot in her back. They seem to remain the same after the meds and have not progressed more. I also noticed that her legs must feel itchy, she licks them all time. I bath her with chlorhexidine shampoo once a week and use some aloe vera gel to help her with the itching.


I am glad she started the meds, she is already better, her mood also is different, she seems younger and more energetic. Sometimes i am thinking she is lucky her previous family abandoned her, she was probably left untreated for much time.

[EspressoAddict]

I'm glad to hear your dog is doing better on the medication. Don't forget to clarify the pre-vetoryl test timing with your vet. Lucy is lucky to have found a loving home with you!

[fernanda.menda]

Hey medusa, I just wanted to tell you that I am following you and that I greatly admire your compassion for Lucy.

[medusa]

Thank you all for your nice words and support.

I decided not to risk it with the next door vet and I rescheduled the test with the big clinic , the one that visited for a second opinion and I trust the vets, they have an experience with Cushing's. They prefer the ACTH and not the pre-vetoryl test.

In general i have the feeling that she maybe needs a bigger dose, the urination and drinking are better but yet not seem very controlled and i have the feeling that the last days she pees more again. Her hunger also is huge.

[Harley PoMMom]

I'm relieved to hear that you have decided to go to the big clinic and will be having the full ACTH stimulation test done, I do believe this is the best choice. Please do let us know those results when you get them...thanks!

[EspressoAddict]

Alright, do let us know how it goes. We're here to support

Best wishes!

[medusa]

Hi all. Hope you are all ok.

We have some, not so good, news.

Before some days i noticed a big lump in lucy's chest (under her leg) firm to the touch, irregularly shaped.
Today we had arranged a visit to the vet clinic. She finally had a prevotoryl test (vet suggested that results can be safe as far as she still has the cushing's symptoms) and also took a sample of the lump to examine. He seemed more worried about the lump than the cushing's progress at this moment.
We ll have the results in few days.

Lucy is still energetic and happy and does not seem to be in any pain. I ll inform you about the results in few days.

[Squirt's Mom]

Yes, please do keep us updated when you can and know you are not alone. You and Lucy are family now and we stick with our family no matter what. We may not have answers or experiences to share in every circumstance but we always have strong shoulders and gentle hugs to offer.

[medusa]

Ηι again and thank you for the support! It's nice and so helpful to talk with people that have been there and understand the situation.

The results came, and we have good news the lump was not malignant! She will take antibiotics and we will check it again in 15 days.

Her cortisol levels were still too high (I have not the paper yet) and fact is that her symptoms especially urination, drinking, polyphagia are not controlled at all so the vet suggested we go to 15 mg dose per day. I am also very satisfied with the new vet, he was very informed about the updates in protocol and everything i read here, and he is very caring and understanding, he even charge me a special much lower price cause she is a stray foster dog.

As i told in past I found a pharmacist that divides the 30 mg capsules into new of 15 mg and i ll go with that cause the cost is less.
Hope we ll see some progress soon!

[medusa]

Ηι, Its the 4th day on new dosage and i already saw an improvement in urination and drinking, much better now. She used to pee 12-15 times a day and now around 8.

Vet described Lucy antibiotics for the lump and skin infections, do you think it will be ok to have antibiotics while on vetoryl? Maybe its better to give her also probiotics or is there something else i should consider?

Thank you in advance.

[Harley PoMMom]

Although I am not a vet, I do believe it is fine to give antibiotics while on Vetoryl. Dogs with Cushing's are more likely to get infections, especially UTI's, so antibiotics are prescribed often. Glad to hear that the symptoms have improved and I hope they will continue to do so.

[medusa]

Hi all, just an update

Lucy is about the same. At the beginning with the new dosage (15 mg) i saw an improvement but as days pass i feel we are back in the same... peeing around 12-14 times a day again, drinking a lot of water , hungry all time.
The skin seems to have no improvement also and as i was bathing her last week i saw some new spots that seem like CC, especially around her genital area and neck area. She is also more easily irritated and seems more anxious, even growling to the cats and other dogs.
I spoke to the vet and we decided to test her again in 15 days. ( 45 days from last test).


Hope you are all ok!
Matina

[Harley PoMMom]

Thanks for the update and I'm sorry her symptoms have gotten worse. It does seem that an increase may be needed and the ACTH stimulation test will let us know. Please do post those results when you get them.

Lori

[medusa]

Ηι all ! Just an update about Lucy.

We are still on 15 μg vetoryl and last days i saw a big improvement in her drinking urination.

The biggest problem this last month is the huge lumps with fluids that they develope suddently ( sometimes on just 1-2 days) in her belly and chest area. This time it was a huge one (size of an orange) and it burst under the skin and become a huge wound so she is again on antibiotics. Vet told me that its something he sees often at Cushing pups. I feel very sorry for her cause it seems bad, but she seems happy and energetic as always!

Hope you are all ok and wish you all a happy new year.

[labblab]

Happy New Year to you and Lucy, too!! I’m so glad to hear that she’s getting some relief from the drinking and urination. But so sorry to hear about those fluid filled lumps. I can’t say that I’m familiar with fluid filled cysts like that, and I’m surely sorry that you and Lucy are having to deal with them. But thank goodness she’s still a happy girl — by far, that’s the most important thing of all.

Once again, best wishes to you both!
Marianne

[Squirt's Mom]

I'm glad things are going good for Lucy other than the sores coming up. At first I thought it was calcinosis cutis, a rare complication with Cushing's but the more I read I realized your description doesn't fit CC so I am stumped too. Hopefully her vet can figure it out and have a solution. Bless her heart...and yours too!

Hope you and yours have a blessed 2024!
Leslie

[medusa]

Ηι . just an update about my sweet Lucy.

The last month she is much better, there are days that she will not need toilet for 5-6 hours, that never happened before. I also noticed that new healthy hair grew back in some parts of her chest!
She had also blood work last week and all seem to be normal, even ALP was down to almost normal levels. :)
We did not test her cortisol levels yet, next month probably.

She seems healthier in general so we decided its time to start her treatment for leishmaniosis also before it progress (if left untreated can soon affect her kidneys, spleen and other organs)

Hope you are all ok, Matina

[Harley PoMMom]

Thanks so much for your update, so happy to hear Lucy is doing better.

Hugs, Lori

[medusa]

Hi, hope you are all well.

Sweet Lucy is still with us, zero interest for adoption. I know there are very few chances for her to be adopted at this age and with 2 serious illnesses. Anyway she will always have our home. :)

She is still on 15 mg once a day, she is relatively good, even has some new healthy hair in her chest belly area. She is now on meds for both Cushing and leismaniosis, the meds for leismaniosis make also the dogs to pee more, so not mush improvement with urination.

Today, we had arrange for her a monitoring test , this time i manage to have it for free in the shelter clinic.
They called me and told me that instead of ACTH test they did the LDDS test. I am wondering if that is normal for monitoring Cushings!

We also arranged for an ultrasound to see the organs, i am feeling a mass or more probably an enlarged organ in her belly. Can be both cushing's or leismaniosis they both affect internal organs as i understand.

She is always funny, happy, energetic and has a huge appetite:)

Hope the best for all fur babies of the forum.
Thank you, Matina

[labblab]

Hello again, Matina, and thanks so much for this update. I’m sorry to hear that Lucy has gotten leishmaniosis. I didn’t know much about this disease, but now I have read more about it and I surely hope the medication will keep her comfortable. I see that the disease can cause enlarged lymph nodes and also an enlarged spleen, so perhaps that is what you’re feeling in her belly.

As far as the LDDS, I’m afraid it is *not* used for monitoring trilostane treatment. In many cases, it is considered to be the best diagnostic test for Cushing’s, so perhaps the shelter vet was thinking it would be a good choice for continuing to test Lucy. Or perhaps they couldn’t obtain the ACTH stimulating gel, and thought the LDDS would be a worthy substitute. But unfortunately it is not.

So I do not think it would be safe to increase Lucy’s dose, regardless of the LDDS results. However, I’m thinking that even if an ACTH had been done, now would not be a good time to increase her dose since the effects of the leismaniosis might be stressing her body and temporarily raising her cortisol level due to that illness and not the Cushing’s. It might be best to wait on the ACTH, anyway.

Under these circumstances, I do think there is one way in which the LDDS may be helpful, though, and that’s to ensure that Lucy’s baseline cortisol is not dropping too low. That will be the first reading on the test, and from safety’s standpoint, the biggest issue is to make sure the adrenal function is not being oversuppressed by the medication. So if I’m not being too confusing, I would not increase Lucy’s trilostane based on the LDDS. But if Lucy’s baseline cortisol is dropping too low, it might be important to lower her dose.

I hope I’m making sense in what I’ve written. If not, please don’t hesitate to ask me to explain more clearly. And please do keep updating us on all the testing.

Big hugs to Lucy!
Marianne

[medusa]

Ηι Μarianne, thanks for the quick response.

I think i understand what you say. I will not get exact facts about her progress but i will at least be able to have an idea if the current dose is working and if she even may needs lower.

She had the leismaniasis from the first day we found her, but its at an early stage, so we decided that cushings was a priority. We started the treatment last 2 months. It's a conservative treatment, just some pills to keep it from progressing. Leismaniasis its very often in mediterenean area, and can be as bad as cushings and cause death if left untreated. Poor Lucy she probably had no proper care at her previous home.

I think she ll defineteley need an ultrasound as next step and a proper test in near future .

I ll come back with the test results when available.

Thank you again.

[labblab]

Yes, from my reading I saw the disease is common in the Mediterranean. I see it is found in some parts of the U.S., too, but just not commonly in areas where I have lived. If Lucy has had it all along, then an ACTH would likely give you helpful monitoring information when you’re able to have it done in the future. But also yes, it sounds like an ultrasound may be a top priority right now.

As always, you’re doing a wonderful job of taking care of Lucy. She’s sooooooooooo lucky to have found her way into your home and heart!

[medusa]

Hi,all. Marianne thanks for your encouraging words.

Just an update for the test.
They definitely did an LDDS instead of ACTH test, i had the results today. They also did full blood work although we did one month ago. Normal sugar levels, ALP is lower than 9 months ago, was 650 then 250 now (6-180 normal)

These were the results ( she had the pill 3-4 hours before the test)
1.3 μg/dl [ref. 0.7-8.0]
3.0 μg/dl
9.7 μg/dl

They told me to just stay on the same dose and that seems to work... I am not sure how they came to that conclusion.
Thinking of continuing the meds as she seems ok and has no bad reaction and retest her in my vet in one month. ( i don't want to stress her more now, her small legs are full of wounds from the needles)


here are the results of her first ldds exam 9 months ago.
26.2 μg/dl [ref. 0.7-8.0]
11.8 μg/dl
8.2 μg/dl

As i understand the meds at least work. Maybe someone can get something more from these results?
Thank you!

[labblab]

Thanks so much for giving us these results. Unfortunately though, as I wrote before, I do not know of any way in which the LDDS test results generally can be used to make monitoring decisions after Vetoryl treatment has been started. Lucy’s baseline cortisol does fall within normal range, so that’s good. However, we probably don’t want it dropping any lower. Even though the normal baseline range for a dog without Cushing’s is listed on your labsheet as low as 0.7 ug/dL, we frequently see the desired results for a Cushpup taking Vetoryl to be at least 1.45 on both the pre and post-ACTH testing. As long as Lucy is generally looking well, you’re probably OK to still maintain this same dose for another month until you can have a genuine ACTH performed. But if she starts acting unwell before then, I’d halt the Vetoryl until you can recheck her cortisol to make sure it has not dropped even lower.

And as far as those original diagnostic LDDS results, I can’t remember whether we already talked about them, but they are indeed consistent with Cushing’s, and also with the form of the disease caused by a pituitary tumor.

Once again, you’re doing a great job taking care of her. She’s a very lucky little girl to have you!

[medusa]

Thank you again Marianne.

I know these exams are useless, and i am so angry cause Lucy was stressed for nothing and i still have to pay for the right exams. The only thing that i know for sure is that I ll never go back to that clinic again.:D

[medusa]

Ηι all, just an update from sweet Lucy.
She had no improvement with cushing's , just the same, but unfortunately her leishmaniasis got worse, she was bleeding from nose last days, a usual sign of advanced leishmaniasis. We did some blood work for that and also for cushings . I am afraid she will need to take miltofesin along with vetoryl,, I am afraid how her tiny body will respond with 2 strong meds that have a lot side effects.

The only happy news is that i officially adopted her and she will be part of our family and i ll not have to worry about her future any more.

Hope you are all ok. Matina

[labblab]

Oh Matina, it makes my heart sing to know that Lucy is now officially yours!!! Bless you for all the love and care that you give her. I’m so sorry, though, to hear that the leishmaniasis seems to be worsening. I’m sending all hopes and healing wishes for her recovery, and we’ll always be here for you if you just want to talk things over.

Please give Lucy many gentle hugs from her family here,
Marianne

[medusa]

Hi all! Marianne thank you again for you nice words. I feel much better and relaxed now that Lucy is part of our family and i know she ll always be safe and have the care she needs.

She finally had an ultrasound and also did some extra some blood work , including electrolytes (no vet told as before) . Electrolytes were all in normal levels which vet suggested is a good sign that the dosage is still ok.
The ultrasound findings were as i was expecting

( I tried to translate from greek as best as i could)
-Hepatomegaly
-Symmetric enlargement of the adrenal glands
-Findings of gallbladder mucocele.
-Chronic pancreatitis.
-Possible degeneration of the splenic parenchyma (haemosiderin deposition).

We had seen signs of pancreatitis last 2-3 months so she is already on special diet (kibbles for pancreatitis and low fat food only)

Good news, her kidneys were fine, so the leishmaniosis is not affecting her organs yet.

Hope you are all ok. Matina