At this point (diagnostic) it doesn't matter as far as the ACTH is concerned. HOWEVER if the vet is wanting to run other labs at the same time then fasting may be best but surely they would have said something if they wanted him fasted. Right? ;)
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At this point (diagnostic) it doesn't matter as far as the ACTH is concerned. HOWEVER if the vet is wanting to run other labs at the same time then fasting may be best but surely they would have said something if they wanted him fasted. Right? ;)
Joan, I’d withhold his food. That way you’ll know for certain that the lab can’t have any complaint about a fatty sample.
My knee jerk response is to say, “Good luck” on the test — but at this point, I’m not sure what you’ll be hoping for. Not that you’re wanting him to have Cushing’s, but maybe there’d be some peace in finally getting a diagnosis and being able to start in with effective treatment??
We’ll sure be anxious to hear the results!
Yes Marianne,
I just want to find out what's wrong. No, I don't want it to be Cushing's, but at least we'll know (I hope). Lee never panted like this. She'd do it when she was hot or nervous, but he does it the minute he gets up and moves. When he's sleeping, he's breathing so fast it sounds painful.
And if it is, well I'm a lot smarter than I was 2 1/2 years ago, thanks to all of you. So, we'll see. I will post the results as soon as I have them...
Okay, well Gable's ACTH results are in:
Cortisol Sample 1: 5.1 HIGH / ref range: 1.0 - 5.0
Cortisol Sample 2: 23.8 HIGH / ref range: 8.0 - 17.0
Vet is thinking Pituitary vs. Adrenal. Completely forgot that Lena was Adrenal and kept saying how much worse that would be (never said that then). I told him we would start Vetoryl at 60mg, Gable is 76.4 pounds. Not doing anything until the weekend. I'll be home from this Friday through the whole next week until June 4. This way I can watch over him.
What are your thoughts?
Well, here we go! Deep breaths all around — we’ve got you and Gable totally covered, Joan. As we said earlier, I truly hope there’ll be some emotional as well as physical relief in finally arriving at a diagnosis. My Barkis panted almost nonstop prior to disgnosis, too. That was one of the hardest things for us to sit by and witness. Once he started the trilostane, that eased off pretty quickly, so I hope that will be the same for Gable, too. Back in those days, we were starting out with a whopping big dose, though. So by dosing more gradually, it may take awhile for Gable to start looking better. But we know that’s the safer way to go, and I think beginning at 60 mg. sounds perfect.
I also agree about the likelihood of the Cushing’s being pituitary in origin. Even though Gable didn’t edge over the “positive” line on the LDDS, his pattern of suppression was consistent with a pituitary vs. adrenal tumor. So I think you’re all set to go, and we’ll all be right here rooting for you. You’re a pro now, Joan. Gable is in very capable and such loving hands!
Marianne
I've been trying to breath all day. I just want to go home and cry...I'll probably start on the train. I'm relieved that we finally have the diagnosis so we can start treatment, but am so afraid of it all over again, Marianne. The expense, the watching, the freaking out at every little thing and the testing. I hope it goes better this time around and I hope we didn't wait to long, but I know he's gotten worse in the last year, so maybe it's not too long. He wasn't like this when Lena was alive, so it's only been 2 years and 3 months.
I guess we'll see...and I am so relieved to have you all with me from the beginning this time.
I sure do understand, Joan. I think it’d be strange if you *didn’t* feel this way. It’s got to dredge up a whole lot of memories that you’d much rather lay to rest. But there are a whole lot of things that are different this time around. Gable is much younger and so he is not facing the age-related vulnerabilities that confronted Lena. Also, the likelihood of it being pituitary means that the symptoms may be more responsive to the medication. Plus, now you know a whole lot more yourself.
None of that changes the worry and the dread, though. It seems so unfair that any of us should have to deal with all this more than once!
So you have every right to cry and scream and rant! You won’t chase us away, I promise. And we’re all gonna help you focus on making Gable feel better. I promise that, too!
I know, Marianne. He's my number two after Lee....my big, beautiful boy. He's so, so good. The fact that he doesn't pee in the house during the day is absolutely amazing, especially when Cooper does. How he holds that in all day astounds me.
Suspecting it and having it confirmed is still upsetting, but I guess it's better than not knowing and continuing to search. I'm sure everyone thinks I've been imagining it and just looking for this because I want to change what happened with Lena.
So, here we go again...
You're gonna be alright, Joan. (((((HUGS))))) We will be with you and Gabe all the way. Remember, this is not Lena and her story will not repeat. That is her story alone. Gabe will tell his own story and I pray it is one similar to my Squirt's - get that dose correct and all smooth sailing from then on! I know how hard it is not to let the past creep in but try to remember this is a brand new story!
Thank you, Leslie...I am so lucky to have found all of you....I do have more ammunition this time around because of my friends here. I think my vet was a little surprised when I told him what dose we were going to put him on. Wait til he hears I want him to try the new testing that Dr. Ramsey is endorsing...I'll take a picture ;)
Hi Joan,
Glad that you've finally got a diagnosis for Gable and sorry it's Cushing's, but you are definitely armed with much more knowledge and experience now and I know you'll do well in treating your precious boy.
I'm just a bit hesitant with the 60 mg starting dose, even though that's a reasonable dose for Gable's weight of 76.4 lbs the study regarding that larger dogs may require smaller amounts of Trilostane per day keeps resonating in my mind, we've also seen that here on the forum. If this were me, I would start out at 40 mg instead...this is just my opinion. Either way I know you will do great!
Hugs, Lori
Thanks, Lori. I'd be happy to start at 40mg if that sounds okay to everyone. I just didn't want to go up to 90, which is what the vet probably would have wanted, unless they are still behind on the updated dosing of 1mg per lb. I wish I had waited to see what they would have suggested, just to see if they have learned anything in the last two years. I don't think they come in 40mg, though, do they? I'm sure my vet will be very happy to charge me for two different dosage packages.
I was going to stop and pick the pills up tonight on my way home. I would like to begin on Friday since I'll be home until the 4th and want to keep an eye on him. Do you think I should have prednisone on hand? If so, how much? This time around I want to be ready for anything and everything.
Vetoryl doesn't come in 40 mg capsules, but what I was thinking was getting either 20 mg capsules or purchasing some 30 mg and 10 mg capsules, because unfortunately there is usually some tweaking involved.
For dogs suffering from Addison's disease, according to Dr. Peterson's blog, he recommends a prednisone dose no larger than .2 mg/kg which for Gable that would be 6.9 mg. https://endocrinevet.blogspot.com/20...-for-dogs.html
Thanks, Lori,
I'll see what my vet has. I looked up on Dr. Forster and Smith today, but I didn't see any 20mg, just 60, 30 and 10. I'd have to pay extra to get them here by Friday, and it looks like just a $5 difference in prices, so I might as well just start with my vet. I want to be home when he starts on the meds.
Hi again, Joan. If it were me, prior to this discussion, I too would have started at 60 mg. as I said earlier. However, one drawback to the 60 mg. capsules is that they can’t be split if that does turn out to be a dose that’s too aggressive for Gable. So making an initial purchase of 30 mg. capsules, to be used in some combination, is probably wise. If you do that, you could indeed start out at the even lower dose that Lori is suggesting by adding in a 10 mg. capsule. And if that turns out to be too low, you can keep adding additional capsules to get to the total you want. This will create added expense for the first month or so, but it does give you much greater flexibility in dosing, and your costs should stabilize along with a consistent dose by the second or third month.
If you do start out at a dose of 40 mg., I am going to break with standard protocol and say that I think it would be OK to go ahead and increase the dose as soon as the 10-14 day mark in the event that you don’t see observable symptom relief or significant downward movenent in his cortisol. Given that you’d be starting at quite a relatively low dose, I don’t think you’d have to wait a full month before tweaking upward if you’re not seeing results. But on the flip side, starting at this lower dose will also allow Gable’s system to adjust more gradually to a decrease in cortisol. And that can certainly be a good thing. So I think the combo of capsule sizes and starting out even lower can make good sense.
Marianne
Okay. I will pick them up tonight on my way home and begin with the 40 mg dose tomorrow morning.
I am so anxious about this. I'm even second guessing that he does have Cushings'...can you believe that! Then I start to think maybe I shouldn't treat him...that is until I hear him drinking, drinking, drinking, peeing, peeing, peeing, panting, panting, panting. I'm obsessing again.
Poor Gabe, he's going to have to put up with me following him around and watching him like a hawk.
You're right, Vetoryl doesn't come in 20 mg capsules :eek: I don't know what I was thinking, sorry about that! Marianne's suggestion of purchasing a combination of 30 mg and 10 mg capsules is definitely something I would do.Quote:
Originally Posted by Joan2517
It so hard not to obsess with our furbabies especially when treatment is involved but I know you'll do great and we are here for you both!
Hugs, Lori
Well, gave him his first dose this morning, one 30 and one 10. Dr. Plunkett went along with what I wanted to do even though he doubted 40mg would do anything. I said that was okay, we'd up it in two weeks if that was the case. He didn't give me any pred, though. Said with 40, I wouldn't need it. I'm fine with that for now.
Gable had his usual bowl of kibble, maybe two if the others didn't finish, a forkful of the soft food I give to the little girls with his soloxine. Then I wrapped both capsules in a piece of cheese and he didn't even know there was anything in there.
And so it begins!
One more thing, and this really bothers me. When I picked up his meds yesterday, the receptionist just handed them over. No instructions, nothing. She had no way of knowing whether the vet had given me instructions or not. I was going to say something to her, but she's new and doesn't know that I've been through this before. I know the same thing happened with Lena. No one told me how to administer. I'm not even sure anymore if she was getting them with a full meal until I joined this forum and that was a month or more after diagnosis. For all I know her first 2 tests might have been wrong.
I'm going to say something to them about it. I'm sure it happens in a lot of vet offices. That could be why a lot of our members wind up giving without the full meal...not everyone reads the inserts in the boxes. I know I don't. I'm going to read it today and see if those instructions are on it.
Just checking in to make sure all is well this morning! And yup, it’s so frustrating when vets (and human doctors!) don’t properly explain medication protocols. That can make all the difference between success and failure, and it ought to be the first thing they think about when they hand out Rx’s!
So far, so good. He's still panting like crazy, but nothing unusual. It was pretty hot yesterday, and the forecast is the same for today. I've got the air on and put down his cooling mat, which he's on right now.
I did read the insert and it does say to give with food, doesn't say full meal though.
Right here with ya, Joan! Remember to breathe!!! :)
Hugs, Lori
Oh my goodness. Miss some time on the forum and all kinds of things are happening!
Well, okay, you got the diagnosis, you have a plan for today and tomorrow and going forward. You know oh so much more about cushings than you did with Lena.
Girl, you GOT this! Gabes in the best ever care with a knowledgeable mummy and daddy and you guys are going to be just fine. You got your support group lined up (every one raise your hand) 1, 2, 3, 4, 5..... yep, all here and accounted for! Meds on hand, testing protocols established... good to go! :)
Joan , I was so sorry to hear the news about your sweet big boy Gable . You can do this Joan. You have so much more knowledge now. And a awesome support group. Gable is in excellent hands.
I feel a little more confident this time around, Dawn. I'm still afraid, but know what I'm dealing with. It's weird, but I feel a little guilty, like I'm betraying Lena somehow because I know more. If only I knew more then, for her. I wonder if it would have changed the outcome...I just hope that things go better this time.
We'll see, Sharlene. I'm not as panic stricken as I was with Lee. I'm not putting all my trust in my vet. I know more and I won't be made to feel like my voice doesn't matter...
He's laying on the floor, right next to me now and seems more comfortable. Maybe I'm just imagining it. I don't know...the watch is on!
That sounds very good ;-)! Here’s hoping it continues!Quote:
He's laying on the floor, right next to me now and seems more comfortable.
Fingers crossed! I'm watching, listening, on high alert!
Gable is going for his first ACTH test this morning after being on the Vetoryl for 15 days. I am anxious to see what the results are. I hope I'm not imaging things, but I do see some improvement in his drinking. I am definitely not filling the water bowls up as much. He seems more comfortable, too. I was starting to get nervous because he hasn't been eating as much in the morning. He used to eat almost two bowls of kibble, but slowed down to one, and I was afraid the pills wouldn't be as effective, but since I see some improvement in the amount of water he's drinking, I figure it's fine. And this morning he did eat almost two bowls. I don't give him the pills until he's eaten and I give them with cheese, which he loves.
So, we shall see...
Oh Joan, everything sounds good so far! We’ll be anxiously awaiting those results, too, but for right now it sounds good.
Ditto!! You're doing a great job!!!!Quote:
Originally Posted by labblab
Way to go! Sounds like appetite and thirst are down for sure!
I picked Gabe up after the test and he came home and drank both bowls of water (4 quarts), couldn't settle down and wound up barfing in the backyard. He's still panting and we've been home for an hour and a half. I called and they said he had a small bowl of water in the cage, which would not be enough for him, and I'm not even sure they are telling me the truth. The last time he came home and drank a lot too.
Maybe next time, I'll bring him home in between. The girl said they don't like that because they want them to rest in between. He was so excited to go out in the car, even though it was to the vet, and now I think he will just remember it as a bad experience.
Do you think that this time it's because he's on the Vetoryl and what they gave him for the test upset him like this? I feel terrible, he's so uncomfortable right now.
Some pups react negatively to the stim agent causing some discomfort for a while after the test. Maybe he threw the water up because he drank too much too soon? Bud does that all the time and it's only because he guzzles.
Lots of folk take their baby away from the vet's between draws. The very idea that a dog would be more relaxed or restful in a strange cage at a vet clinic is funny! :D Did you laugh when she said that? :D If Gabe is stressed at the vet then taking him away for a ride, a walk, even back home if it's close enough can help not only the dog but help get more accurate results since the pup isn't stressed to the max. ;)
Thanks, Leslie...it could've been too much water, too fast. He's laying down and seems okay. It's amazing how quickly the panic set in, though. I had visions of running to the Emergency clinic all over again.
Like Leslie said, some dogs are sensitive to the stimulating agent and may have a reaction such as Gabe's (Sharlene's Molly is one pup I can think of). When Harley had his ACTH test I would have them bring him out to me after they injected the stim agent. We stayed at the vet's office until it was time for the second blood draw, they had a bench outside so we would go there and sit. I would also take water and his bowl with me to his vet visits. How is Gabe doing now?
He's much better. I used to do that with Lena. She'd nap or look out the window and I would read.
Here are his test results. The vet said perfect, but why does it say low?
Sample 1: 1.3 Ref range 1.0 - 5.0
Sample 2: 7.1 (LOW) Ref range 8.0 - 17.0
The labs don't use the ranges given for the treatment drugs - they use only the range for a normal dog, a dog NOT on treatment. So while 7.1 would be low for an untreated cush pup OR a dog who does not have Cushing's (or Addison's) it is actually HIGH for a cush pup on treatment (not "perfect" ;) ). For a dog taking Vetoryl you want that post # under 5.1ug/dl. HOWEVER, that is after the first 30 days. Remember - it is not recommended to increase the dose during those first 30 days because the cortisol may well continue to drop on that same starting dose. So for now, that is good! Continue to watch him over the next few weeks to make sure there are no signs the cortisol has gone too low but other than that you are off to a great start seems to me! :cool:
Wow, your vet is right — those are really good results after the first couple of weeks! :-)))))))
The reason it says “Low” is because the range that is given on the labsheet is the normal range for the ACTH when it is being given as an initial diagnostic test for Cushing’s. Apparently your lab is not additionally listing the reference range when it is being used as a monitoring test for trilostane treatment. That can definitely be confusing, since the monitoring range is much different.
For monitoring purposes, a post-ACTH up to around 9 is acceptable if symptom resolution is satisfactory. If symptoms remain, then you would try to lower the post-ACTH value to a range between around 1.5 - 5.0. However, no dosing increases are recommended until after the thirty day mark since Gable’s cortisol may still drift down further on this same dose. So for right now, I’d leave things just as they are, especially since you think you’re seeing some symptom improvement already. It looks as though Lori may have been right on the mark as far as encouraging you to start at this lower dose. Good job all the way around!!!
Thanks to all of you!! And yes, Lori hit it just right! Thanks, Lori! I know that if I had left it up to them, they would've started him way too high. In fact the vet who called with the results (he's not the one I use that much anymore) sounded a little surprised when I told him that Gable was only on 40mg. I have a feeling he will be talking to the one I'm using about why the starting dose is that low.
Yahoo!!