Will do. Thanks, Lori!
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Will do. Thanks, Lori!
Gable's second ACTH results on the Vetoryl. This time I brought him home in between and he was much less stressed.
Sample 1: 0.9 (LOW) ref range: 1.5 - 9.1
Sample 2: 2.3 (LOW) ref range: 8.0 - 17.0
Vet wanted to lower it to 30mg, but he's still panting and drinking a little bit more than the first couple of weeks. What do you think? He's not lethargic, not throwing up and no diarrhea. He said if he seems fine then he doesn't need to see him for 3 months.
He also said that he read the new testing paperwork I gave him and that's what made him look at the range for the resting cortisol which is 1 - 5, so he wasn't too worried about the 0.9.
Is it too low? Should I lower the dose? This is so different from Lena's results....it's freaking me out!
You know, Joan, I’m kinda thinking out loud here, but given the contradictory results — lowered cortisol but increase in symptoms — before lowering his dose I’d be interested to see what his cortisol level is when tested using the new pre-pill protocol. With that, he’d have his resting cortisol tested right before taking his morning dose as opposed to that 4-6 hour window afterwards. As long as his pre-pill level is not lower than 1.5, I’d be inclined to not lower the dose since he remains symptomatic. In that event, one option might be to split the dose (like giving 30 mg. in the morning and 10 mg. in the evening). Dosing twice daily might provide more consistent symptom relief throughout the day.
If, however, his pre-pill level is < 1.5 while symptoms remain, then the picture is more confusing and a call in to Dechra by your vet might be warranted.
As I say, I’m kind of musing out loud, and probably the last thing you want to do is to haul poor Gabe back to the vet. But I’m thinking this new pre-pill protocol may provide useful feedback, especially in instances such as this where ACTH results do not seem to pair up very well with observed behavior. We’ve had another new member here recently whose dog appeared to be borderline low based on ACTH results but who was showing good improvement clinically. They ran a pre-pill test on the dog, and I believe the cortisol was > 1.5 so the dose was left unchanged.
I’m guessing it might be kind of nerve-wracking to let Gabe be a guinea pig with this new protocol, but I just wanted to throw the suggestion out there. Here’s a link to the monitoring chart associated with this protocol:
http://www.k9cushings.com/forum/atta...4&d=1522201966
But you don't think it's too low, do you Marianne? I can't get back to the vet now until the weekend because of work. Should I keep him at the current dose until then?
I always feel uncomfortable making recommendations that are contrary to those of a dog’s vet. But if Gabe was my own dog with a post-ACTH of 2.3 and I didn’t see symptoms consistent with low cortisol, I’d probably talk with my vet about sticking with this same dose for a while longer. If that makes you feel antsy, though, you can certainly go ahead and lower to 30 mg. and see what happens, both behaviorally and also in terms of cortisol level.
I guess my decision would at least partly depend upon whether or not I did intend to go forward with pre-pill testing in the near future. If so, I’d be more likely to leave Gabe at the 40 mg. until that testing was done. If not, I might feel more nervous about leaving him at the higher dose for an extended period of time.
I know I’m being kind of wishy-washy here, but these are some of the considerations I’d take into account if Gabe was mine.
I told him on the phone yesterday that I wanted to keep him at the 40 mg. He's still eating good, he doesn't show any signs of lethargy and was even playing with Cooper outside last night, so I think we're good.
My company is having a conference here in Glen Cove and I'm working from the Glen Cove Mansion tomorrow and Thursday so I'll be able to come home and check on him during the day.
Thanks, Marianne...
Then I think you’re fine leaving him on the 40 mg. for now. That’s what I’d be doing if he was mine ;-).
Knowing that makes me feel better...thanks, Marianne. I just want things to go better this time.
Hey Joan!
FWIW, I agree with Marianne. Some dogs do better when their cortisol is in the higher therapeutic range and others in the lower end so this may be the case with Gabe. Were his electrolytes checked too?
I don't think so Lori. I didn't tell them to, so I doubt it. He still seems fine, eating good, didn't get up last night to drink at all. I must say that his fur looks beautiful. It's getting softer and is starting to look red, even my grandson noticed that. I'll keep watching him and decide over the weekend what to do.