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Cyn719
11-02-2011, 06:39 PM
Thoughts are with you - will check in to see how the appt went - good luck!! xo

Squirt's Mom
11-02-2011, 07:09 PM
Hi Sonja,

Getting a bit worried here - group worry wart, ya know. ;) Please let us know what you learned from your visit when you can.

Hugs,
Leslie and the gang

mypuppy
11-02-2011, 07:27 PM
Dear Sonja,

I just wanted to send my thoughts and well wishes for your little boy and you. We all know how difficult this is all around, but there you are fighting just as hard as Apollo and with so much love..

Tight hugs and much love to you both..

Xo Jeanette and Princess

apollo6
11-03-2011, 01:14 AM
Dear Rene, Susan, Addy, Juli and Hannah
Making room for you all in the car.
Specialist took biopsy of 3 sites, gave me Muricin ointment to put on the stitches. Ironic, Dechra makes the ointment.
Wondering if all this relates to spine. Went over with Rene. Largest spot is on top of L4,5,6 where has had spinal problems in past. When he sits he stretches his hind legs out, and his front legs are bent back? Could the Staph infection have something to do with his back. Internal issues showing up on his skin. Specialist first said due to sex hormones elevated but told her this just happened around June 2010. Says Apollo's body is trying to fend off infection by building up thick skin. Is this a septic spine infection ?
Will have to wait 5-7 days for results-maybe by next Friday. Baffled why all these doctors can not give me a solution as to where infection is coming from.
HUgs Sonja and Apollo

Cyn719
11-03-2011, 01:45 PM
Sonja

I understand how you feel when you cant get any answers for your little boy - I hope with the biospy results they can figure this out - Apollo is a tropper for sure and you have been doing everything you can on your end!! Sending Love Hugs and Prayers to you and Apollo xo

Bailey's Mom
11-03-2011, 03:43 PM
Hi Sonja-

I am so sorry this is taking so long to work through and to get answers. I know how frustrating that can be.

Please do keep us posted, as you can.

HUGS!!!!
-Susan

Rene
11-03-2011, 09:54 PM
Dearest Sonja,

We are all here to bounce off any ideas anyone might have. I am praying for answers this time. I hate to see you running all over plucking the money tree!

You are the best mom ever.

Big Group ((((Huggggggg))))

jmac
11-03-2011, 11:06 PM
Sonja-
I wish you had more answers about what is causing poor little Apollo so much trouble. I'm hoping you will finally get some answers. We are always here for you. I'll keep you both in my thoughts.
Julie & Hannah

addy
11-05-2011, 07:40 PM
Dear Sonja,

I was hoping too for you to get answers, waiting for them is so hard. Maybe once the biopsies come back the unknown will be lifted.

Whenever I used to get mad at the medical community by brother in law would remind me that medicine is not an exact science. It usually only made me madder:rolleyes::rolleyes: when he would say that but then later, I would kind of understand his point:o:o:o

Hugs dear friend.

One good thing today:Zoe had a happy day

I hope your Apollo and Karma had a happy day as well.

I'll share a Sonja Special Sunday with you tomorrow:D:D:D

love you bunches,
addy

apollo6
11-07-2011, 01:11 AM
All of you are the best. Cindy & Penny, Susan, Rene, Julie and Hannah, Addy.
If I can find that money tree , I'll give you some branches to plant your own.:D
I want answers for that little guy of mine.
Like Rene says, he can hardly walk, but at the dog park he wobbles over to the other dogs like nothing is wrong with him, wags his tail, and is full of joy.:o
HUgs Sonja and Apollo

MBK
11-07-2011, 04:16 PM
Sonja -

I have not been here much - have had home computer issues. But, I do think of you and your little guy often.

Apollo has such an AMAZING spirit! What an inspiration he is to ALL of us humans! I so hope you get some answers soon.

You are lucky to have each other.

Bailey's Mom
11-08-2011, 05:03 PM
..... he can hardly walk, but at the dog park he wobbles over to the other dogs like nothing is wrong with him, wags his tail, and is full of joy.:o

Sounds pretty good to me!:D Especially the "full of joy" part.:)
Susan

Cyn719
11-08-2011, 11:35 PM
Sonja - I know hurry up and wait -- I hate the waiting game!!! But Apollo being happy to see the other dogs at the park must make you:) for sure - he is a happy little guy even with his issues!! love hugs and prayes -- hope you get the results soon xo

apollo6
11-13-2011, 12:52 AM
Dear Friends.
Jeanette and Princess, Susan, Cindy and Penny, Julie &Hannah, Rene and angel Snoopy, Addy and Zoe , Marybeth And Aliva
I have not posted because I have been very discouraged.
I will in brief give the results.
Moderate hyperplasia and hyperkeratosis
marked follicular hyperkeratosis
follicular infundibular proliferation
demodectic mite folliculitis
focal furunculosis and deep mite and keratin pyogranulomatous dermatitis and panniculitis
Comments: changes are consistent with primary keratinization abnormalities with concurrent demodectic mite folliculitis and deep pyoderman, extending down to the level of the panniculus. I would be concerned that this dog is suffering not only from adrenal hyperplasia, but potentially cushing disease(which we already know) or at least marked hyperprogesteronernia(cause of skin infections and maybe leg issues) to create the onset of demodicosis.( in other words a suppressed immune system which can not fight the infection)
Appropriate antimicrobials and miticidal therapy is recommended.
Medication : Ivertmectin , but side effects: seizures, neurological, drunken walk(Apollo already has neurological problems with legs)
So I am looking into a combination of internal support with immune building supplements and considering Ketoconazole instead of Trilostane, with melatonin and lignans. Also topical benzol peroxide shampoos. etc.
Regular doctor is concerned for Apollo going on medication, wants to try 3-4 weeks building up Apollo's immune system and if not work then last resort medication. With Cushings you have to be super careful as we all know.
This is a hard decision for me what to do next. I have been so wrapped up with Apollo's issues that I apologize for not checking your posts on your little angels .

jmac
11-13-2011, 10:30 AM
Hi Sonja-

I wish I had some advice to give, but all of that is out of my realm of knowledge. I am sorry to hear that the medication to help also comes with so many risks. You are definitely in a tough position. I think it is good to be concerned and that your regular vet also does not want you to rush into anything.

Don't worry about not checking on us; you are supposed to be concentrating on Apollo and yourself right now. We are here to support you, and I hope some others will have some advice for you. I'll keep you and Apollo in my thoughts and will look for updates on how things are going and what you decide to do.

Take care and know that we're here for you!

Julie & Hannah

addy
11-13-2011, 10:52 AM
((((((((hugs)))))))))

sweetie, I can't help because I don't know even know half of the terms. I do know mites can be a problem with Cush dogs where as a normal dog would not be bothered. Our friend in colorado with the sweet poodle, why I am drawing a blank with the name I don't know except I must be having a senior moment:eek:, but she had a mite infestation as I remember. As soon as I can recall( started with an m) you could go back and read her thread.

(((((more hugs))))))))

love,
addy

Cyn719
11-13-2011, 02:09 PM
Thinking of you - so sorry Apollo is going through this --- sending love hugs and prayers ---- xoxoxoxo

Rene
11-13-2011, 03:38 PM
Hi Sonja,

You are getting answers now sweetie! Now the search for the solution.

When Snoop had a red yeast infection I changed her diet, gave beneficial supplememts & 1/2 tsp. organic apple cyder vinegar. Washed with Eqyss Micro-Tek shampoo and followed up with the Eqyss Micro-Tec Spray every few days because it was moisturizing and healing. I used the equine versions I had in the barn (safe to use on dogs and humans) but they make pet versions now. The Micro-Tec is non-toxic, antifungal/antibacterial and suppose to help with yeast, mange and mites. This is the same company that makes Ovation Cell Therapy for humans and Eqyss Rebuilder for horses here in San Diego. I have alternated the the human and horse products on myself with no problems.

Can anyone share their experiences with Demodecit Mite/Red Mange or using Ketoconazole as a treatment for the Demodex or Cushings itself?

Praying for a solution to break the chain of this vicious cycle for you guys,
Rene & Angel Snoopie

Interesting Articles on Cushings Treatments:
http://www.marvistavet.com/html/body_pituitary_treatment.html
http://www.vet.utk.edu/diagnostic/endocrinology/pdf/TreatmentInfoAtypicalCushings201107.pdf
http://www.vet.utk.edu/diagnostic/endocrinology/treatment.php
http://avmajournals.avma.org/doi/abs/10.2460/javma.233.12.1896?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed

apollo6
11-13-2011, 03:48 PM
thank you all.
Have a lot to research and digest.
Hugs and licks
Sonja and Apollo

lulusmom
11-13-2011, 07:34 PM
Sonja,

I've had many rescues with demodex mange, mostly puppies with immature immune systems but also a few adults. My sweet foster baby, Mabel, was diagnosed with cushing's after severe bouts of ringworm and demodex. Do I understand correctly that you are not going to follow the dermatologist's recommendation of Ivermectin because you are afraid of the side effects? Did the specialist explain that the seizures, neurological and drunken walk are common toxic effects in herding breeds who have the MDR1 gene mutation? These dogs are not able to process the drug and it becomes toxic in their system. I don't believe these side effects are all that common in non herding breeds but like all drugs, there is always the chance of side effects.

I've used Ivermectin a bunch and have never had any problem with it. Apollo has severe infestation and that needs to be addressed asap with a tried and true treatment. It is not always easy to get the upper hand on and it may take several months of treatment to gain control. Mabel was on Ivermectin and Clavamox for at least four months and was not taken off the meds until she had three clean skin scrapes. She also was under the care of a dermatologist. Did your specialist explain all of this to you?

Aside from your concern that the intermediates are causing problems for Apollo, why do you want to switch him to Ketoconazole? Keto is an antifungal drug that is sometimes prescribed for the yeast infections that can develop with severe demodex but it does not address the mites. Keto is rarely used in the U.S. to treat cushing's because of it's adverse impact on the liver. It is used a lot more in European countries to treat cushing's, as Lysodren is banned in most of these countries. It can drop cortisol quickly which is why, prior to the availability of Trilostane, it was used in preparation for adrenal surgeries.

You mention that your regular vet is opposed to Ivermectin and is instead recommending boosting the immune system? How does he propose to accomplish this? Immune building supplements will not resolve demodex mange so I am very concerned that Apollo's condition will continue to deteriorate.

Cushing's and hypothyroidism are at the top of the list of suspects when an adult dog is diagnosed with demodex. Is Apollo still getting his daily doses of Vetoryl and Soloxine and is your vet sure one or both of these things aren't causing the problem?

Rene
11-13-2011, 08:15 PM
Sonja,

I found this link about demodectic mites which talks more about the breed specific ivermectin side effects Glynda was talking about...gotta love her!

http://www.marvistavet.com/html/body_demodectic_mange.html

There is a further link for breed varieties and testing.

http://www.vetmed.wsu.edu/depts-vcpl/

I have also used Ivermectin paste internal dewormer on my horses for decades without a problem but of course that is a different animal!

Love Ya Guys

apollo6
11-14-2011, 02:00 AM
Dear Lulu's Mom
Thank you for your input. Apollo is still on Trilostane and Solixine for thyroid.
The only reason I am thinking of the Kertcone(forgot spelling) is because it is a less harsh alternative to Lysodern and I think Trilostane may be elevating Apollo's sex hormones.
I will go over all this with vet's on Monday.
Hugs Sonja and Apollo
I am very overwhelmed by all of this.
Thanks Rene for the input will check.
so do I bit the bullet and try the Ivermetcin? I am so confused dosage would be .05 then 5 days later .10mg.

Bailey's Mom
11-14-2011, 05:35 AM
Hi Sonja.....
I as well have no experience in any of the multitude of issues you are facing. I remember the feeling of the head spinning. It's not a good place to be.
I'll be checking in to see how things are going.
Hugs!!!
Susan

lulusmom
11-14-2011, 08:48 AM
Hi Sonja,

In my opinion, the vet you need to contact today is the dermatologist specialist to get Apollo on treatment for demodex. Follow the specialists instructions for whatever oral and topical medications she prescribes.


Regular doctor is concerned for Apollo going on medication, wants to try 3-4 weeks building up Apollo's immune system and if not work then last resort medication. With Cushings you have to be super careful as we all know.

Does your vet truly believe that he can remedy Demodex with immune boosting vitamins and supplements or is that something you hope you can accomplish instead of giving Apollo Ivermectin? What did your vet mean when he said you have to be super careful with cushing's. Was that in the context of prescribing Ivermectin to a cushdog?

The dermatologist, who finally and correctly diagnosed Apollo's skin problems, is the most qualified professional to direct treatment. As a matter of fact, dermatologists are usually right behind internal medicine specialists in their knowledge of cushing's so talk to her about what is going on with Apollo. Ask her where she would go from here if Apollo was her dog. With all of Apollo's problems, if I were in your shoes, I would either let the dermatologist take over treatment or I would be asking for a referral to the best internal medicine specialist in town . I truly believe your boy has multiple issues that far exceed the capability of even the most skilled general practitioner.

Squirt's Mom
11-14-2011, 10:08 AM
Hi Sonja,

I am happy to know that someone finally has as answer for Apollo's skin issue - now the ball is in your court. Do you take appropriate action asap to help him get this cleared up, or do you dance around your fears, and your GP's, while he suffers? Sorry to be so blunt, but that is where Apollo stands - suffering and waiting for help. Let me be a bit blunter - until this mange is cleared up, chasing Cushing's is going to be a moot point. I have no doubt in my mind that a portion of his elevation in cortisol is due to the skin inflammation and until this stress on his system is relieved you, nor Apollo's GP or Holistic doc, can tell where he stands with his Cushing's. His Cushing's will never be under control as long as this skin condition rages. The delay in treating the mange is going to do nothing but further degrade his immune system because it cannot fight this by itself and all that cortisol is going to continue doing it's damage. Trying to "build up his immune system" now is rather like throwing a glass of water at a house fire, IMHO.

So, to answer the question you asked - yes, you bite the bullet and follow the dermatologist order's starting today. If Apollo's other docs have different ideas about how to approach this, do what the expert in this area, the dermatologist, says.

You have searched long and hard for this answer while Apollo has gallantly suffered. You have the answer; you have a solution; Apollo is waiting. For me, there would be no question about what to do now. ;)

Please understand I say everything above with nothing but love for you and Apollo, and from a desire to see the two of you finding more and more "good things" to celebrate for many days to come.

Hugs,
Leslie and the gang

mypuppy
11-14-2011, 11:08 AM
Dearest Sonja,
please don't feel like you owe us an apology for not having the strength to keep up with the rest of us. We all understand that feeling all to well. I am saddened that your little guy is still suffering with so many issues. I would be a basket case for sure.

I don't have any knowledge with all these problems, but it seems Glynda and Leslie have given you some great advice as to how best proceed with your boy--and one thing I have learned from both of them through their tough love is that it is the only way to get some positive results. So close your eyes and go for it!

We will be watching for any updates if and when you start his new treatment, and wish you both much deserved success and love.

please take care of you. God loves you and your boy, and so do all of us here on the forum.

Tight hugs. Xo Jeanette

Cyn719
11-14-2011, 11:38 AM
Sonja - I dont know anything about skin issues but I know i would want to get it cleared up asap - Leslie and Glynda gave you good advice with Apollo being the main concern so I hope you are able to make a decision soon - love hugs prayers and strength xo

addy
11-14-2011, 02:11 PM
((((((((((((((((((((((hugs))))))))))))))))

((((((((((((((((((bigger hugs)))))))))))))))))

If you need to talk, I'm here.

Sisters in battle, mighty warrior that you are, you have the courage and the strength, you always have.

love,
addy

StarDeb55
11-14-2011, 08:41 PM
Sonja, I haven't posted to you in a very long time, but have certainly been following Apollo's story. You have gotten some very good advice from Glynda & Leslie. I'm going to confirm what Glynda has told you. First of all, I will say up front that I have never had to deal with a serious demodex mange infestation in any of my pups. What I will tell you is my dermatology vet, who I absolutely adore, & I have had several discussions over the years about Cushing's as he also had to take care of my Barkley. As Glynda has said, after an IMS, a derm vet has the advanced training necessary to treat Cushing's. My derm vet takes care of Cushing's pups constantly & is pretty successful with treatment. In these discussions with him, we have talked about the associated skin issues with Cushing's, & a demodex mange infestation did come up. Demodex is very debilitating for the pup, & must be treated with the proper medication which you already know is Ivermectin. Until you can get a handle on the demodex, the cushing's has to go on the back burner. There is really no other medication that will get the demodex under control, & treatment is going to take several months, not just a couple of weeks.

By all means, I would try the immune system support supplements that the vet wants to try, in the hopes of keeping Apollo strong. I must emphasize that there is no homeopathic, herbal, or anything else that will get the demodex under control. Let me paint you a picture for a human patient, which happens to be me. I have asthma, & have had numerous episodes of asthmatic bronchitis over the years. When I develop bronchitis, my doctors give me the proper antibiotics to get rid of the infection in my lungs, & the proper medication to help keep my airways open & clear. In the mean time, they do want me taking things like vitamin C, & echinacea to try to give my immune system a boost, but they would never dream of treating a bacterial infection in the lung with simple vitamin & supplements.

Sonja, none of us want to "browbeat" you, we are simply very worried about Apollo, & want the best care available for him. The derm vet has offered you an effective treatment that should get Apollo on the road to recovery with his skin issues. Once the skin issues are good, then you can help him resume his battle against Cushing's.

Debbie

Rene
11-14-2011, 11:29 PM
Sweet Sonja,

I hope the love and sound advise continues to pour in for you and your beloved boy. I know you are overwhelmed. I hope the vet helped clairfy some issues today. When you are ready let us know how it went.

When it gets too much for me I try to separate the issues.

1. You asked, "so do I bit the bullet and try the Ivermetcin? I am so confused dosage would be .05 then 5 days later .10mg. "

Sounds like your very knowledgable vetted support system here has given very sound advise on the Ivermectin front. So, it seems this issue should be resolved if you choose to move foward with this advise.

2. I know you are frustrated with the Trilo as Apollo continues to waste and can now barely walk. I hope your apointment today gave you some answers or at least some more questions for the group to help you move foward with a decision.

We love you and are here for you.

Rene & Angel Snoopie

Bailey's Mom
11-15-2011, 12:10 AM
Hi Sonja-

I am sorry this is such a rough patch for you. Listen to your heart and your gut....and the advice received here and from your vet.....and you will know what to do....for now. My thoughts are with you and Apollo. Please know you can post here absolutely anything you are feeling....no one will judge you for it.

-Susan

Cyn719
11-15-2011, 12:13 AM
Sonja - ditto to what Susan said xo

apollo6
11-15-2011, 02:22 AM
Dear Susan, Leslie, Glynda, Debbie, Addy, Rene, Susan and Cindy
Thank you all for your input.
I am waiting to check with one of vets. But I am going to 10.22 p.m. give Apollo the first dose of Ivermectin.
I am scared. But I know you are here for me.
Like you said I need to help my little boy.
Well here it goes.
God be with Apollo.
Love you all.
Even when you brow whip me.
Someone has to straighten me out. We Leo's are mule headed at times..:(

Cyn719
11-15-2011, 02:46 AM
Sonja - right here with you - I know it must be so scarey - believe me I understand - look I am scared to death -- they want to start Penny on Lyso depending on her tests and I am freaking from now -- Its your baby of course you are scared - its only normal - have faith in the dermatologist - she is the expert and she feels that this is the way to heal Apollo - but its still normal to be scared for sure!! Will be by your side the whole time -- feel my HUGS ----- love strength and lots of prayers xoxo

Skye
11-15-2011, 03:03 AM
I am not fully up to date on this thread.....but felt you might want hugs from me and my two girls anyways! sooooo arms and paws all out stretched to encompass you and your baby for one big massive hug and puppy kisses ((((((((HUGSKISSKISSKISS))))))))))))

jmac
11-15-2011, 09:46 AM
Sonja-

I think you did the right thing, but I'm sure it must have been really difficult. I am thinking of you and Apollo and hoping things go well. Keep us posted. We're here to support you!

Julie & Hannah

Squirt's Mom
11-15-2011, 10:36 AM
Hi Sonja,

Good for you! :) Ivermectin is like any other drug - used properly and with care it is no more dangerous than aspirin. The plan to start low and built Apollo up to the desired dose is wise, and how I have been directed to use it in the past. This does a couple of things that are beneficial - it allows his body to adjust to the med instead of being bombed with it and, most importantly to me, this allows us to watch our babies through each little increase as they build up to the required dose. You always keep a close eye on your sweet boy so I know this won't be an issue for you and you will notice anything that seems "off".

Apollo truly has the heart and spirit of a warrior. In spite of his illnesses, he has retained his love of life, proudly marching forth each new day to tackle whatever comes his way with dignity and joy. He couldn't do this without you, Sonja. And now you have given him another weapon - Ivermectin - which will help him fight this battle. With you by his side, his standard bearer, he can face this fight with courage.

We are here for you both any time.
Hugs,
Leslie and the gang

apollo6
11-15-2011, 01:11 PM
Dear Sky, Cindy and Penny,Julia and Hannah, Leslie and gang.
Thank you all for your support.
Day 2 on .05 mg, then day 5 go to .10 then day 10 to .15mg.
I did not realize, Heartgard is Ivermectin, which I gave Apollo for years.
He can barely sit up now. I have cried so much that waterproof mascara doesn't' even help.:o
There is a sadness about him that I feel. Is he losing the battle?He still wags his tail when I say do you want a treat. His walk is very labored. I am very worried

Is it the progestrone causes the leg issues? Do I stop the Trilostane, switch to Kercotone(forgot the spelling) alternative to Lysodern.


Dear Cindy what ever you do Penny knows you are there for her.

We try to keep on fighting.
Hugs Sonja and Apollo

addy
11-15-2011, 02:16 PM
Dearest Friend,

I can't answer your questions but I can tell you how dear you and Apollo are to me and I am so very sorry you are going throught this. I am holding your hand right now and saying prayers this will all be okay.

love you dearest first friend.
addy

Cyn719
11-15-2011, 02:30 PM
Sonja - I am still learning so much from everyone here - maybe a little trilo holiday is needed right now??? The others can really help with that question-- I am here for you - I know is so hard to see them sick -- hang in there - you are a great mom and you are doing everything you can!!! Hugssssssss love strength support and lots of prayers --- xoxo

Rene
11-15-2011, 06:58 PM
Hi Sweetie,

Love to you. You said, "He can barely sit up now." Just wanted to clairfy. This is not from the Ivermectin therapy. Correct? We assume all is going well on that front. Your question was directed toward the second part of his battle...his wasting and walking issues? What was the vets opinion if so?

Hugh healing hugs,
Rene & Angel Snoopie

apollo6
11-15-2011, 07:54 PM
:eek:Dear Cindy and Rene
the walking issues I think has nothing to do with the Ivermectin.
Dear Cindy
I am thinking about stopping the Trilostane for maybe a few weeks to see if the legs improve maybe elevating the cortisone may help him fight this.
Rene the leg issues are relating to before but getting worse. Like you said he is turning into a statue.
Still waiting to hear from holistic vet, want reg and holistic to work together on Apollo.
Getting stitches out tomorrow. Will ask about heartguard(still have-another name for Ivertmectin) and special shampoo for the skin.
I am freaking out. Today Apollo didn't pop this morning, right away my false alarms go off. Took him out 3 times before he finally did a big dump. I jumped around cheering him. I am a crazy lady.:D
Still no answer on the legs. If hyperprogestrine from Trilostane?
More battles, more fires to put out.
Also Apollo has more gas than normal?
Hugs Sonja and Apollo

StarDeb55
11-15-2011, 08:39 PM
Sonja, I see that you posted on Penny's thread about using something called MicroTek shampoo on Apollo. Has this been cleared by the derm vet? I would think anything you might apply or use on Apollo's skin/coat would need to cleared by the derm vet. Just my 2 cents worth.

Debboe

Cyn719
11-15-2011, 09:02 PM
Sonja -

my IMS says she feels if you really see a problem with the dog stopping the trilo and having a holiday will not hurt - she says alot of dogs usually feel somewhat better when there cortisol goes up - so I hope there is some improvement in the legs if you stop it ---- hugsssssssssssssssssss

labblab
11-15-2011, 09:33 PM
Sonja -

my IMS says she feels if you really see a problem with the dog stopping the trilo and having a holiday will not hurt - she says alot of dogs usually feel somewhat better when there cortisol goes up - so I hope there is some improvement in the legs if you stop it ---- hugsssssssssssssssssss
Cindy, the advice that your IMS has given you definitely makes sense in certain situations. But there are other situations when I'm betting your IMS would give a different recommendation. And Apollo's case may be one of them. It is uncommon for adult dogs to suffer from an infestation of this type of mite unless their immune systems are not functioning as strongly as they should, and abnormally high cortisol definitely undercuts the immune system even further. If trilostane treatment is stopped abruptly and Apollo's cortisol level is allowed to increase without control, I fear that it will be even harder -- maybe impossible -- to ever eliminate the mites. Plus, I do believe that Sonja already tried discontinuing the trilostane for a period of time earlier this year, and it did not end up helping Apollo's legs at that time.

Sonja, for these reasons, I really wouldn't stop Apollo's trilostane or introduce any other new products or supplements without first discussing it with the derm vet. There is a complicated balance involved in treating all of Apollo's problems. I can only imagine how hard it is for you to watch him struggle. But I also know that you don't want to accidentally make things even worse by experimenting with his medications on your own.

Marianne

labblab
11-15-2011, 10:47 PM
Sonja, I also want to draw your attention to this article that suggests that ketoconazole probably would not be a good choice for Apollo right now. Ketoconazole is most commonly used to treat fungal infections (the fact that it lowers cortisol is a less common use). When used in combination with ivermectin for the treatment of skin infections, dogs in this study were much more likely to experience unwanted side effects than when treated with ketoconazole alone. The drug combination was associated with an effect that would be particularly undesirable for Apollo: "ataxia," which is a condition that results in loss of balance and coordination. :(

http://www.ncbi.nlm.nih.gov/m/pubmed/18547382/

So if you are looking for an alternative to trilostane for the control of Apollo's cortisol, I do think Lysodren would be the more likely option right now.

Marianne

Cyn719
11-15-2011, 11:02 PM
Marianne -

I was thinking that stopping the trilo may help Apollos legs -- but I didnt know it could make the mites worse:o:o:o I thought Debbie was saying not to use the shampoo without asking the Derm - I didnt know Debbie said do not stop the trilo:o:o

Sorry

labblab
11-16-2011, 08:03 AM
Marianne -

I was thinking that stopping the trilo may help Apollos legs -- but I didnt know it could make the mites worse:o:o:o I thought Debbie was saying not to use the shampoo without asking the Derm - I didnt know Debbie said do not stop the trilo:o:o

Sorry
Cindy, I'm really sorry that my reply was confusing. You are correct that Debbie did not say anything about stopping the trilo -- all she spoke about was checking with the derm vet about the shampoo. I was lumping her response about the shampoo with my own response about the trilo to come up with a "joint response" saying that changes of any sort should first be run past the derm vet. I will go back now and edit my reply so that hopefully it won't be so confusing any more.

And I also hope that I didn't make you feel badly about what you had written. I think you are right that there are many times when a vet may recommend that a medication be temporarily stopped or changed, especially in the face of ill effects for which you are searching to find a cause. And I am no vet, that's for sure. So I'm just throwing my thoughts out there for Sonja to discuss further with her vet, herself. I know you were doing the same thing -- making a suggestion to Sonja in hopes it will make things better for Apollo. That's the beauty and power of a message board like this -- that people can make suggestions and discuss them with one another. So I really apologize if I made you feel as though you should not have spoken up. You are a wonderful support to everybody here, and what you have to say is always important!

Marianne

addy
11-16-2011, 09:26 AM
Hi Sonja,

I have to agree with Marianne. I don't think you should add or subtract any type of medication right now without clearing it with the dermatologist. Apollo's conditions are too complicated.

Did you like the dermatologist? Do you think you can work with the dermatologist? Is the dermatologist accessible?

We are here for you.

Love,
Addy

Squirt's Mom
11-16-2011, 10:01 AM
Hi Sonja,

How is Apollo doing so far on the Ivermectin? You had mentioned his tummy gurgling - digestive issues are common with this med, as it is with soooo many, so I bet that is why his tummy is noisy.

Honey, I have to agree with Debbie and Marianne about adding or changing anything right now. Your sweet boy has more than enough to deal with as it is. If you add another chemical (shampoo) without being directed to and/or change his meds you can count on one thing, and one thing only - and that is that Apollo's body will have to make more adjustments. Then if he gets sicker, how would you know where to look for the cause?

Look at it this way - Apollo is sitting in a little boat out on rough waters. His little boat is crammed full of cargo, so full it is sitting very low in the water, waves lapping over the sides. His little boat is already unbalanced due to the amount of cargo he is trying to carry across the water. By adding a shampoo, herb, supplement or changing his meds, you are adding to his cargo and moving the crates around in his little boat - which could cause his little boat to capsize. So, as the old saying goes, don't rock the boat! :p

IMHO, Trilostane has been questionable for Apollo for a long time but I do not thing Keto is the answer - and CERTAINLY not now. ;) The priority now is these mites - they have to be brought back into balance or nothing else you try will help him.

So, for right now, sit down in Apollo's little boat, take up an oar, and start paddling him across these waters with the cargo he has on board. Then, LATER, when some of his cargo (problems) have been lessened, you can think about adding another crate (treatment, herb, supplement, etc) to his little boat.

Hang in there honey. I know how frustrating this is and how desperately you want to see your precious little boy get better...right now, this very minute. But patience is going to be your best friend, and his. You are doing what any frantic mom would do when their baby is sick - looking into every corner possible for the cure. Just don't rush into making changes, don't act without the DERM docs approval - not the GP or Holistic docs, the DERM doc. For the next little while, he/she is Apollo's navigator on his little boat and it is your job to follow his/her directions - only. His GP and Holistic vets job for the moment is to stand on the shore, watching you and the navigator (Derm doc) maneuver Apollo's little boat across choppy waters.

Hugs,
Leslie and the gang

Bailey's Mom
11-16-2011, 01:38 PM
Hi Sonja-

How are things today? I agree with what Leslie is telling you.....kind of like a balancing act on a high wire.

I know how rough it is to watch Apollo suffer. You are doing everything you possibly can and he can feel that. It's a very hard time for you and I as well am here to support you.

Try to get some rest (nap with Apollo?)
HUGS!!
Susan

apollo6
11-16-2011, 02:10 PM
Dear Friends:Cindy and Penny, Leslie, Susan, Marianne, Addy, Skye.
I am getting Apollo's stitches out today and will ask about special shampoo, and about the Ket(forgot name).
I read that the combination of Ivermectin and Kecortance has adverse reactions. Thank you
I have talked to one of the vets and taken you advise. Right for now I need to focus on resolving the mite issues, keep Apollo on the Trilostane for now and then look at the alternatives. Like you said , not rock the boat anymore for now. Apollo is dealing with the Ivermectin. Leg issues have worsened.
Will keep you posted. Sorry have not posted on your threads.
HUgs Sonja and Apollo

Cyn719
11-16-2011, 02:58 PM
Marianne - No need to apologize - I learn something new everyday from you and the other members - you have helped me so much with Penny over the past year - you are very knowledgeable and I welcome all the information I can get - as in this situation - Penny did well with her legs off the trilo but now I know how going off can effect something else like in Apollos case - and Penny now isnt doing well with her legs:( Please keep sharing all your comments - opinions and knowledge - I certainly can use it with this disease xo

mypuppy
11-16-2011, 03:22 PM
I don't have much to add here, but I have to say last two weeks Princess was having issues with her hind legs as well, coincidentally while her cortisols were lowered, she seems better now after we stopped the trilo????????????????

Who knows?

Sonja, thinking of you and Apollo fondly and sending healing prayers for his recovery. I am still standing strong on my faith and in small miracles....

God loves you, and so do I

Xo Jeanettw and Princess

jmac
11-16-2011, 10:21 PM
Hi Sonja-

Just wanted to check in today and let you know I am thinking of you and Apollo. I'm hoping you get some helpful information from your vet and that you and Apollo both had a good day.

Julie & Hannah

apollo6
11-16-2011, 11:18 PM
Cindy, Jeanette and Julia
notes from Dermatologists what I am doing with Apollo.
It is not a coincidence about Trilostane and the leg issues.
November 16, 2011
Apollo had stitches out. Look good.
But because of more wobbling and being a little more lethargic, Dr. Board at the Animal Dermatology Clinic, has advised me to stop Ivermectin, and Trilostane for tomorrow.
I started Apollo on .05 mg of Ivermection November 14,15, and 16th, because I felt on his own could not fight mites.
I have Apollo on what Dr. Feinberg and Dr. Weingardt have advised : Meso Silver(Colliard), Colostrums, Rx liquid Immune, RXboitc, Cell advance, alternate with Select Antioxidant, L-Adenosyl 225(has zinc, Sam-E and milk thistle)
Dr Board is concerned cortisol may be too low.
Doing ACHT STIM will get results tomorrow.
Feel like I am going in circles on Apollo.
Being told Trilostane can be causing hormones to go up ? Now maybe if cortisol too low may have Addison( can’t believe this is possible)
Considering Ketoconazole because could lower hormones maybe. But cannot use with Ivermectin.
Dr. Board prefers Lysodren, which I really don’t want to do.
At a loss.

Will get results from Acht STim tomorrow.
As you can see, I am so overwhelmed. Different opinions, now more tests.
HUgs Sonja and Apollo

Rene
11-16-2011, 11:33 PM
Hi Sonja and Little Apollo,

I agree with Leslie's great analogy! Angel Snoopie and I will be blowing stiff breezes from the shore to help carry you across.

Hope you get good news and more answers tomorrow.

Hugh healing hugs!

lulusmom
11-17-2011, 01:35 AM
Hi Sonja,

If you haven't already done so, you should probably make sure that Dr. Board is aware of the all of the supplements Apollo is on, including the L-Adenosyl. Who knows, there could be a problem with the combination of prescription meds and the supplements. Is Apollo eating and drinking okay? Any vomiting, diarrhea?

Squirt's Mom
11-17-2011, 10:17 AM
Hi Sonja,

We've known from the beginning that the Trilo had the potential to raise his other hormones even higher than they were so this isn't a surprise to me. What is a surprise is that your vets would consider Keto to treat. UTK has shown over and over that the Lysodren works on ALL the hormones with the occasional/possible exception of estradiol. This is treated with lignans and melatonin when it is produced outside the adrenals. IMHO trying Keto on him, especially now, is using him as a guinea pig....and he has had enough of "let's try this; let's try that".

I'm with Glynda on all these supplements - are ALL his doctors aware of everything he is taking and are they ALL in agreement with their use? Does anyone know what all the ingredients are in these products, how they were produced/harvested, the purity and consistency between batches, if the "donors" were healthy, if they were euthanized and if so, how, with what drug(s)?

What caused Dr. Board to decide to stop the Trilo and Ivermectin? What did he see or hear that brought him to this decision? Did you see signs that Apollo wasn't able to handle them? If so, what did you see?

To be perfectly honest, I am so confused I don't know what else to say. I am continually surprised that he is not under the care of an IMS rather than his GP and Holistic vets. I am constantly amazed at the number and variety of things that have been tried on him. I am not always clear what the doctors are saying and what are your thoughts. From what I can see, it seems there may be too many cooks in the kitchen, each using their own recipe for the same dish....and perhaps a waitress who stirs the pot from time to time. ;)

I can tell you what I think I would do if Apollo were mine - I would thank the GP and Holistic vet for their time and efforts and ask for a referral to an IMS; I would stop all the supplements he is on; I would continue with the derm doc along with an IMS; I would follow exactly the directions these two docs gave me; I would consult a nutritionist/nutritional consultant and get him on a home-cooked (NOT raw) diet...and I would get to work on these right now, this very minute. And, most importantly, continue to give him all your love as you do every minute of every day.

No one is blaming you for anything, honey, and I hope you don't feel we are. We are all so concerned and so confused/frustrated right along with you, and are doing all we know how to help you and Apollo. I hope you know that above all else.

Hugs,
Leslie and the gang

StarDeb55
11-17-2011, 11:40 AM
Sonja, I agree with Leslie. I'm terribly confused, now, as to who has said or done what. Did the derm vet ok all of these supplements? It could be likely that any or all of these supplements may be contributing to some of Apollo's problems at the moment. Does your GP or holostic vet actually know if these supplements might have interacted with either the ivermectin, trilostane, or both to cause problems? I would be asking them that question. If they couldn't answer, IMHO, Apollo needs to come off of them right now. You seemed to indicate in the past couple of days that you were going to let the derm vet direct treatment, & that you were not going to add any other meds for Apollo so you don't "rock the boat". You really need a single vet, preferably an IMS or derm vet, directing Apollo's treatment. Having 3 different vets offer input is just really confusing the issue, & IMHO, it's not in Apollo's best interest. You just need one captain in the boat, & right now, you've got 3.

Sonja, truly, we are not trying to brow beat you over how your handling Apollo's care. We are all very worried about Apollo. His case is so extremely complex, & has become even worse with the demodex, I seriously don't think even the most talented & knowledgable GP has the skills to take care your little boy properly.

Debbie

Bailey's Mom
11-17-2011, 04:43 PM
Hi Sonja-

I just wanted to let you know I am here and you have all my best wishes as does Apollo. It's a confusing, frustrating time. We are all here to support you.

-Susan

Rene
11-18-2011, 10:24 PM
Dearest Sonja,

Once again I have to agree with Leslie. The advise you have been given by the girls recently is most sound. In Leslies words, "I can tell you what I think I would do if Apollo were mine". Give the Ivermectin a chance a work. Once you have a handle on that we should see a hugh improvement. Then you can address the medication change. As I told you I went back and read your entire thread. I know you are terrified of Lysodren but because of the hormone and other issues I also agree this may be "the second bullet you may have to bite". When I read through the thread Apollo had no problems with the induction of the Trilo and his first rounds of the ATCH drugs when coming off a bout of pancreatitus! He is a strong boy. Both Trilo and Lyso are strong life saving drugs. They both have their pros and cons.

I think Apollo can handle Lyso, can you? At at this point what do you have to loose?

I know you are under tremendous stress and have to concentrate on other issues right now. Perhaps (as you posted the vet wanted try the Lyso) you can just get it over with and direct your IMS to move foward with the Ivermectin and when the time is right the Lysodren. Take this issue off your plate. We will all be here to support you.

With much love,
Rene & Angel Snoopie

apollo6
11-18-2011, 11:04 PM
Dear Friends
Thank you all for your input.
The results did come back. And too many vets have their hand in the fire and I am getting conflicting info.
see Below:
November 18, 2011
Dr. Board-Animal dermatology
Report : Apollo 2.8 cortisol was 2.5 before( this is a very skimpy report , don't know if this is post or what?)
Treatment_
1. Increase cortisol by treating Trilostane maybe every other day or 2 days on 1 day off to help fight infection.
2. Wait one week to restart Ivermectin at lower dosage
3. Or try Advantage Multi- topical treatment( this would be bad for his already neurological issues.
4. Can take 3-4 months for skin problem to resolve.
Waiting for confirmation with Dr. Feinberg.
Neither doctor has called me back.
I am very numb right now in addition to worrying about all the feed back and suggestions about Apollo. We have a house in Reno, Nv. My husband called and said it is all gone, everything. Our house and all our possessions in the house were destroyed. We had this house for over 23 years. My husband barely got out with himself and our other little dog, Karma. I am down in San Diego and trying to get all the information for the insurance company. My husband at 2a.m. was given less then 1 minute to evacuate our house. All he has is the clothes on his back , wallet, my Karma and his car. We are both numb. I will try to post, put must be there for my husband. Trying to get the vets to call me back.
I did have an IMS before and a IBD test was done(forgot correct spelling) He said he would put Apollo on a steroid type of drug which would make his conditions even worse. Because of that I went back to my caring regular vet and the holistic vet who does acupuncture on Apollo's back issues for over 8 years and knows his history. I did not like the sterile clinical attitude of the IMS asking for another test , biopsy on Apollo for yet another $1,550. That is why I stopped going to the IMS.
hugs Sonja AND Apollo

Rene
11-18-2011, 11:10 PM
What about the IMS you originally wanted to see that was on maternity leave...can you see her now?

Call when ever you need sweetie.

apollo6
11-18-2011, 11:40 PM
Dear Rene
Would need to check. Very numb right now.

November 18, 2011
Dr. Feinberg notes:
1. For one week Trilostane: 2 days on 1 day off
2. Second week restart Ivermectin at lower dosage per Dr. Board will let me know
3. Third week call Dr. Feinberg discuss next option, on Trilostane
4. Only if Apollo does full treatment on Ivermectin and is off consider Kerocanto( for cushing, hormones, fungal infections)
5. Lysdern would not be a good option considering Apollo’s weakened health at this time.


Hugs Sonja and Apollo

LhasaLover
11-19-2011, 05:31 AM
My Lhasa Elfie was diagnosed with cushings when she was 10. My vet gave her a poor prognosis and informed me of two medical treatments she felt appropriate..Lysodren and Trilostane. I researched both and we decided on Trilostane. Keep in mind that Trilostane was not FDA approved for use in the US at that time. I was terrified of both of these drugs as the side effects sounded worse than the cushings itself. I am happy to report that Elfie is now 15. She is the poster pup at our vet's office for Trilostane. We have noted no side effects with the medication. Acth levels are perfect and associated liver enzyme tests have improved. I hope Apollo has the same experience whatever drug you choose you go with. Just know that there is hope after cushings!

Squirt's Mom
11-19-2011, 09:56 AM
Oh, Sonja!

I am so, so sorry to hear that you and your family were affected by the wildfires in NV. :(:( I am so sad for you all. :( I lost much in a fire years ago and I still think of some of those irreplaceable items that were lost. The good thing is that your hubby and other baby were not harmed....that would have been just tooooo much for anyone. I am glad you and your family were spared the worst.

Honey, take care of your family and yourself first and know we are here anytime you need to vent. I know there are prayers by the 1000's rising for you and your family. If we can help, please let us know.

Many hugs...and prayers of gratitude no one was hurt,
Leslie and the gang

Bailey's Mom
11-19-2011, 04:40 PM
Hi Sonja-
I am so very sorry for the fire loss, but thank goodness your husband and Karma got out safely. I've not experienced fire loss, but it must be very frightening, scarey and a real downer. You certainly do have more on your plate right now than there should be.
This is going to sound very simple....but try to do the next (dumb) thing. Try not to take on everything at once. Live from 5 minutes to 5 minutes.

At least this was a second home, so you are not out on the street with absolutely nothing. Do what screams at you the loudest. When that gets done, look for the next "loud screamer." You are doing absolutely all you can. It's time to have a little faith that someone/something bigger than you or me knows what is going on. Somehow this will all straighten out, which is not to say you'll be happy with all the results, but life will go on.

We are here for ranting, raving, crying, screaming and/or saying nothing. You can just stop by to read if you want.

I am so sorry and I hope things start to get better.

-Susan

mypuppy
11-19-2011, 05:49 PM
:(:(:(:(:(:(:(:(:(:(::(:((::(:(:(::(::(:((:(:((:(


SO SORRY FOR ALL YOUR TRIALS LATELY...

Praying for you and your family.

Jeanette

HarrysMom
11-19-2011, 06:05 PM
Sonia,
So sorry to hear about the Reno house. I really hope that insurance will take care of everything.
I am glad that your husband and Karma made out OK.
Have you considered getting another IMS for Apollo? I don't think all specialists have to be clinical. My IMS is the most compassionate person I know. She is lovely and goes out of her way to help (even for non-clients).

apollo6
11-20-2011, 01:40 AM
Leslie, Susan, Jeannette, Yunhee

Thank you all for your support and prayers.
I am trying to be there for my husband and pups. It is overwhelming. WE lost 23 years of our life. I am trying to get all the paperwork started, canceling services, fighting about bills, etc.
Dealing with Apollo's issues is also heavy on my mind. I can not think about changing vets at this time unless it gets out of hand. My vet said most important is the bond between Apollo and I. Apollo is not ready to give up. I need my little guy more than ever.
Our Karma had to have an lump on her eye lasered off, on antibiotics. Wanted to put her on prednisone also said no.
Trying to have faith and have broken down more than once since all this has happened. Numb, overwhelmed at were to start with the insurance company. Doing a lot of praying.
Both my husband and I can not lose our fur babies right now. They are keeping us sane.
Hugs Sonja and Apollo

Squirt's Mom
11-20-2011, 08:29 AM
It's so good to hear from you, Sonja. You and your family have been heavy on my mind since your first post about the fire. There is the ever growing gratitude that your hubby and Karma made it out ok. The news scenes on the news here is horrendous and so, so scary. Memories of our fire have come flooding back.

I remember the insurance people, the firemen and their reports, having to sit down and try to list everything lost - the chaos of those first few days when all I wanted to be left alone so I could curl up and cry. I remember hours of sifting through the debris, tears falling unchecked, looking for photos - or pieces of them, looking for my daughter's baby items I had saved, looking for my great-grand parents glass ware pieces...looking for any little thing that I could still hold on to. But it was all gone, destroyed...and I was devastated. Yet I was also extremely grateful my husband, daughter, nor myself had been home when it happened and that we were all safe.

Our fire was the result of arson and the person who did it has never been found. We were in the process of moving, storing our things in a barn behind the house. Someone intentionally burned the barn to the ground with nearly all of our belongings inside. We had just unloaded the last load of things before the furniture was to be delivered the next day - we lost everything but the furniture and two changes of clothes each. Insurance came through with no problems...but no amount of money could cover the loss of baby pictures, bedding, first doll, first shoes and Easter dress. Yet the one to whom those things were connected was still in my arms that night, safe.

Try to hold on to those things that are most important to you - and they survived. Thank all the gods, they survived. Remember, we are here for you during this time.

Keep doing what you have been directed to do for Apollo and loving him as you always have. Don't worry about finding a new IMS or anything else right now. Take care of your family and above all else, take care of yourself, honey.

Prayers continue....
Hugs,
Leslie and the gang

jmac
11-20-2011, 11:35 AM
Sonja-
I am so very sorry to hear about the fire, but so thankful your husband and dog are okay. I don't think there is much else I can say to you except that you and your family are in my thoughts and prayers. Do what you can for little Apollo. Take care of yourself.

Keeping you in my thoughts...

Julie & Hannah

Harley PoMMom
11-20-2011, 01:46 PM
Oh Sonja,

I, too, am so sorry to hear about the fire and will be keeping you all in my thoughts and prayers.

Sending lots of love and hugs,
Lori

Cyn719
11-20-2011, 02:00 PM
Sonja I am so sorry about the house - thank God your husband and karma got out safely - my thoughts and prayers are with you xo

Jenny & Judi in MN
11-20-2011, 03:27 PM
I'm so sorry about the fire. You need a break. hang in there. Judi

addy
11-20-2011, 05:08 PM
Oh Sonja, I am so, so sorry to hear the news of the fire. How frightening and devestating for you.

Do the best you can, it is all you can ever do. When life throws so many things at us, we find the strength. You have so much strength, more than you realize:)

Love you,
addy

Rebelsmom
11-20-2011, 07:42 PM
Sonja, so sorry to hear about the fire. Glad your husband and pup made it out ok. Thoughts and prayers are with you.

apollo6
11-21-2011, 01:36 AM
Thank you all for your support.
Tomorrow have to call dermatologist on Apollo's mites. Then the process of dealing with our losses. It just comes over me at times, my wedding dress, stain glass parents gave me , and it goes on.
Hugs Sonja and Apollo

apollo6
11-22-2011, 05:12 PM
to top things off Apollo is not drinking any water. I have been adding water to his food to get moisture in. His legs are getting worse. I have left word with doctor. At same time dealing with insurance company, utilities, etc on the house we lost. I am so worried about Apollo.
Hugs Sonja and Apollo

HarrysMom
11-22-2011, 07:22 PM
I am hoping that approaching wet / cold weather in California is causing Apollo's weakness - nothing more serious. My Harry's rearend weakness has suddenly deteriorated since the rain started. My back pain is also flaring up - I think this could be weather related.

Cyn719
11-22-2011, 07:59 PM
Sonja - you have a full plate - sending you a huge hug and lots of strength and support xo

frijole
11-22-2011, 08:38 PM
Sonja - glad you added water to the food. You know it is critical that Apollo get water. How long has it been since he drank? How much is he drinking a day (if any)? I would measure it so you can let the vet know. Is his eating normal? Sending best wishes & strength during what has to be a tough time, Kim

Rene
11-23-2011, 02:31 AM
Hi Sweetie,

Sorry I did'nt get a chance to call and check up on you today. The work husband is the hospital had sugery and will be having another tomorrow. Too late to call when I got home. Will catch up tomorrow maybe stop by when I am working. I will call you in AM.

Give your boy a squeeze for us.
Love Rene & Angel Snoop

pupdog
11-23-2011, 02:42 AM
not eating, not drinking water, hind leg weakness, are early warning signs of renal failure. Since I just went through this, if I were you I would demand the vet do something immediately: stop the medications, put the dog on subQ or IV fluid, do a urinalysis and look for casts in the urine, blood work probably won't be remarkable but could be done too. I hope your pup will be ok.

jmac
11-23-2011, 09:43 AM
Sonja-
I'll say a prayer for you and Apollo. I would talk to your vet as soon as you can to make sure Apollo is okay. Keeping you in my thoughts...

Julie & Hannah

Squirt's Mom
11-23-2011, 09:51 AM
Hi Sonja,

Thinking of you, Apollo, and your family; praying for you all.

Hugs,
Leslie and the gang

addy
11-23-2011, 02:31 PM
love and prayers dear first friend. my thoughts are with you and our little boy.

love, as always,
addy

mypuppy
11-23-2011, 03:10 PM
Love you Sonja and Apollo....

God Bless

Xo Jeanette and Princess

Spiceysmum
11-23-2011, 04:00 PM
Sonja,

Sending best wishes for Apollo. Thinking of you.

Linda x

apollo6
11-23-2011, 08:37 PM
Thank you all
First may you all have a blessed Thanksgiving with your family and cushing fur balls.
Apollo is eating, doing good poops, very fatigued. I am putting petiliad electrolyte in his food, throwing his treats in water so he has to drink, putting all his food in water.
Went to vet notes.
November 23, 2011
Apollo not drinking water since Nov 21
Dr. Feinberg took comprehensive blood panel
Urinalysis
Urine culture
Injected with fluids dehydrated.
Stop Trilostane November 23, 2011

November 23, 2011
Results on Apollo blood work
Bun –same as last test not in kidney failure
Urinalysis-no tract infected
Liver same a little more elevated
Leave off Trilostane through weekend to see if will drink, November 28,2011
Call Dr. Feinberg on November 28 about going back on Trilostane and most discuss Ivermectin when to start.
Apollo is under a lot of stress because of what I am going through with the fire loss, he stopped drinking water on Monday, still not drinking , but like I said getting it to him through food, treats.
Will get full copy of reports Saturday, will try to post on Friday.
Sorry about your back Yunuh.
So much to do, on fire loss, insurance company, utilities, etc.
HUgs Sonja and Apollo

Cyn719
11-23-2011, 09:52 PM
Sonja - also wishing you and your family a blessed Thanksgiving- glad Apollo is eating and pooping and I pray he starts to drink! You have been so stressed with everything that has been going on with the house and Apollo - I hope you can take alittle break from it and try to relax and enjoy the day tomorrow. Love and prayers to you and lots of HUGSSSSSSSSSSS:)

Rene
11-23-2011, 11:10 PM
Love Ya

Angel Snoopie & Me

Bailey's Mom
11-24-2011, 04:41 PM
Hi Sonja-

Sometimes life just isn't fair. I was 38 years old before I learned that. I am so sorry you have so much on your hands now. I think the report back on Apollo sounds encouraging.....from what I know.....which isn't nearly enough! I am sure you are right in that Apollo is picking up on your stress. That is their 7th sense.

I hope you can take a break for awhile today and I hope someone cooks your dinner for you! Take care.

-Susan

Rene
11-24-2011, 09:42 PM
Sonja, What was Apollo's creatinine?

Happy Thanksgiving!

pupdog
11-25-2011, 08:23 AM
It took my dog 7 days to start eating and drinking properly after having a bad reaction to trilostane. When you get the reports please share the numbers for BUN, creatinine, and phos. Did your urinalysis include a sediment test to check for casts? Happy turkey day appolo and sonja.

jmac
11-27-2011, 01:03 AM
Hi Sonja-
Just wanted to let you know I'm thinking of you and wondering how you and Apollo are doing...

Julie & Hannah

Squirt's Mom
11-27-2011, 10:44 AM
Hi Sonja,

Thinking of you, hubby and your babies....hope you had a good Thanksgiving in spite of the recent tragedy and that you each were able to see something in your lives to be grateful for.

Let us hear from you when you can!
Hugs,
Leslie and the gang

apollo6
11-27-2011, 10:57 PM
Dear Cindy, Penny,
Susan, pupdog, Rene, Leslie and the gang, and anyone I forgotten. I will post sometime in the next day or two. I just heard about Yunah and am with heavy heart.
I will post from my notes. There are so many aspects of my life that are stressful, I pray I don't lose my Apollo right now.
November 23, 2011
Apollo not drinking water since Nov 21
Dr. Feinberg took blood panel
Urinalysis
Urine culture
Injected with fluids dehydrated.
Stop Trilostane November 23, 2011
November 23, 2011
Results on Apollo blood work
Bun –same as last test
Urinalysis-no tract infected
Liver same a little more elevated
Leave off Trilostane through weekend to see if will drink, November 28,2011
Call Dr. Feinberg on November 28 about going back on Trilostane and most discuss Ivermection when to start.

November 25,2011
Apollo throw up yellow vile with 2 red dots
1. Dr. Feinberg said give Pep a-c 5ml twice a day, 2 hours after force feed water
2. No food just broth or flavored water-gave distilled water
3. Pedi- electrolyte has sugar? Don’t give
4. Barked at neighbor ate a treat
5. If Apollo gets lethargic go to emergency vet
1. November 26th
1. Said to give Apollo on rice with water
2. Use rice water to get nutrients
3. Still eating treats-cookies
November 27, 2011
1. Apollo had good bowel movement
2. Ate white rice with water-part of only throw in a cookie ate that
3. Ate a little cookie
4. Force feed water with syringe
5. Urinated at 1.23 p.m.
6. Off all medications since November 23 no Trilostane no ivermection since November 14 no supplements
7. Ate rice some turkey and treats with water, wagged tail when I asked if wanted dinner
8. Ate treats this afternoon

I would like to send report as attachment but don't know how to do.
Now Apollo's thyroid is going up too high?
Hugs Sonja and Apollo
I will be dealing with insurance adjuster all of Tuesday.

Rene
11-28-2011, 12:54 AM
Dear Sonja,

I know you are overwhelmed. If you can would you post just the results of Apollo's latest labs for the group. Nothing fancy.

We are all concerned for you and your family. We are your family too and love you. Just let us know what you need.

Loving hugs

((((Rene & Angel Snoopie))))

lulusmom
11-28-2011, 01:15 AM
Hi Sonja,

Did Dr. Board take Apollo off of Ivermectin and for how long? I know he is getting treats but is he eating his regular food?

apollo6
11-29-2011, 01:05 AM
Dear Glynda these are my notes. Apollo is eating white rice soaked in water, gave him a few pieces of turkey last night, this morning rice again with some sliced turkey, later rice with pumpkin. He has kept every thing down. took a little sip of water.
November 22 ,2011
Dr. Boord, Dr. Feinberg
1. 11/21/11 –Trilostane 2 days on 1 day off
2. 2 weeks call Dr. Feinberg
3. Start Ivermection November 28, 2011 .05 4 days then .10 until Dec 20,2011

Apollo was on Trilostane till Nov 22 than this is what happened


November 23, 2011
Apollo not drinking water since Nov 21
Dr. Feinberg took blood panel
Urinalysis
Urine culture
Injected with fluids dehydrated.
Stop Trilostane November 23, 2011
November 23, 2011
Results on Apollo blood work
Bun –same as last test
Urinalysis-no tract infected
Liver same a little more elevated
Leave off Trilostane through weekend to see if will drink, November 28,2011
Call Dr. Feinberg on November 28 about going back on Trilostane and most discuss Ivermection when to start.


November 25,2011
Apollo throw up yellow vile with 2 red dots
1. Dr. Feinberg said give Pep a-c 5ml twice a day, 2 hours after force feed water
2. No food just broth or flavored water-gave distilled water
3. Pedi- electrolyte has sugar? Don’t give
4. Barked at neighbor ate a treat
5. If Apollo gets lethargic go to emergency vet
1. November 26th
1. Said to give Apollo on rice with water
2. Use rice water to get nutrients
3. Still eating treats-cookies
November 27, 2011
1. Apollo had good bowel movement
2. Ate white rice with water-part of only throw in a cookie ate that
3. Ate a little cookie
4. Force feed water with syringe
5. Urinated at 1.23 p.m.
6. Off all medications since November 23 no Trilostane no ivermection since November 14 no supplements
7. Ate rice some turkey and treats with water, wagged tail when I asked if wanted dinner
8. Ate treats this afternoon

November 28, 2011
1. Normal bowl movement am. another at Noon
2. Urinated lifted leg
3. Ate turkey low fat, treats-chicken banana, cookies, some rice, very little water

November 28, 2011
Dr. Feinberg
1. Stool is nice and firm will test fro parasites
2. Draw blood for pancreatitis test
3. Battery of test for G.I. FUNCTION P.O.I.-MAY NEED TO RAISE COBULIM NO SIDE EFFECTS FROM DOING SO
4. BODY X RAY-SHOWS GAS IN INTESTINES, CALICIFICATION UNDER BONES MORE SO ON L4 (breaking down)THAN OTHERS-POSSIBLE CANCER. NO !
5. CHECK CORTISOL
6. REGULAR DOG FOOD/TREATS
7. MAY HAVE PREMIUM DOG FOOD
8. NO RAW FOOD
9. ASK FOR COPY OF URINYLASIS
10. NO TRILOSTANE, IVERMECTIN, SOLOXINE, NO SUPPLEMENTS , NO MESOSILVER
11. X RAY-SHOWS 2 MICROCHIPS , WHITES DOTS CALICUM DEPOSITS IN TISSUE UNDER TISSUES, KIDNEY OKAY, STOMACH HAD FOOD JUST GAVE APOLLO, L 4 has the most calcium deposits under it, (L4,5,6)
12. TESTS-
A. XRAY-3(SIDE, BACK , OTHER SIDE) HAVE RADILOGIST LOOK AT $80.00
B. FECAL –OVA-and parasites
C. PLI-SPEC cPL /Idexx
D. PLI/TLI/COBALAMINE/FOLATE
E. CORTISOL LEVEL RESTING(OFF TRILOSTANE SINCE NOV. 23
SOME TEST RESULTS IN ONE TO TWO DAYS, PLI took take a week or so.
right now Apollo is off Trilostane, no ivermectin, no Solixine.
After I get the test back will see results than decide about internal medicine specialist. I am very worried.
I gave Apollo some pumpkin with rice, forcing rice water ( water that rice was cooked in)down him.
Can anyone tell me how to attach the first round of results on his labs.

So I am overwhelmed, wait for results, go to specialist not on meds now.:confused:
Hug Sonja and Apollo

Cyn719
11-29-2011, 02:53 AM
Sonja -- just catching up on Apollo - keeping you and Apollo in my prayers -- hugssssssss xoxo

Bailey's Mom
11-29-2011, 03:01 AM
Hi Sonja-
I think I'd be overwhelmed too.

I hope test results are encouraging.

-Susan

lulusmom
11-29-2011, 10:21 AM
Hi Sonja,

It sounds as if Dr. Feinberg has taken Apollo off of all conventional medications, two of which are vital in getting the demodex under control. Does Dr. Boord know what is going on and did Dr. Feinberg consult with her before discontinuing the Ivermectin? If not, please, please call her and tell her what is going on.

I am very sad that Apollo's quality of life has continued to deteriorate and I cannot remember the last time you posted anything positive about your boy. I am always waiting for signs of a turnaround somewhere but it just doesn't happen. I've probably cried more for Apollo than most cushdogs here. I read your posts over and over and all I see is a little boy who's quality of life has become miserable and your gp vets have not only not made a difference for him, his condition continues to deteriorate. Please, please, please get Apollo to an internal medicine specialist. It is time.

Glynda

Squirt's Mom
11-29-2011, 11:49 AM
Hi sweetie,

Hope you are seeing the light at the end of the tunnel with the fire mess you have been dealing with lately.

My little 11 year old dachshund was just diagnosed with Cushing diseases. My holistic vet has Apollo on Cushex, and supplements, and said I should get the Ach test, etc. test to make sure he has cushing diseases, which he has. I know I have to decide on a treatment.
The specialists is strongly suggesting Lysordern. I have also heard of Anipryl, and Tri (not sure of spelling will have to look up)

Would like to know what other pet owners have used to help their dogs with cushings. Pretty overwhelmed right now.
Any suggestions would be appreciated.

This is your very first post to us back in May of 2010. For a year and a half you have been fighting what the vets have recommended...and for a year and a half Apollo has slowly deteriorated. You have clung to the Holistic vet (who initially had him on CUSHEX! :eek:) and your GP vet even tho everything they have tried has failed to help him. You had a bad experience with an IMS - so did I; one nearly killed Squirt over that tumor on her spleen - but there are LOTS of IMS' out there and LOTS where you are to choose from.

Fear is the single greatest enemy we humans can ever face. It can paralyze us, causing us to freeze in place at the exact moment action is required. It can cause us to turn and run right back into the fire we just escaped from. It can cause our minds to shut down, completely unable to process information that is critical to our situation. It can render us unable to hear the call that will lead us out of danger. It can cause us to believe nothing other than what is in our own minds, which does nothing but the feed fear - even if what is in our minds is what caused the fearful situation we are now in.

We can never overcome our fears by running, by covering our eyes and ears, by yelling so loud we cannot hear anything else, or by ignoring it. The only way to overcome fear is to face it head on.

To borrow a phrase from Glynda's post - "it is time" to let go of the familiar, to let go of your own desires, to face your fear of Lysodren, to find a doctor that can offer some relief for Apollo, and it is time for you to get out of the way - to do what the doctor wants you to do no matter how frightened it makes you, no matter what your thoughts or ideas may be. Remember that little boat? You are not the Captain nor the Navigator - their jobs are not yours and their decisions are not yours to make. ;) Your job is to row that boat; to keep that little boat as steady in the water as possible by following the directions given. As you row that little boat, doing your job, Apollo lies curled at your feet fully trusting that you are going to do what is needed, what is best for him regardless of how scared you may be.

Sonja, we are all here for you and your sweet boy; all of us desperately wanting to see him get better. Glynda's tears are part of a waterfall of tears that fall for Apollo. Personally, my throat and chest get tight and my face tenses every time I see a new post from you...I am so scared of what I may read. :( It may feel as if you are being personally attacked or judged - but that is not the case at all. We simply want to help...and sometimes helping means a swift, loving kick in the butt. :o And, my dear, you and Apollo are deeply loved by many here; folks you never hear from hold you both in their hearts, thoughts and prayers daily.

Hugs,
Leslie and the gang

apollo6
11-29-2011, 09:43 PM
Dear Friends
Thank you for your worry. I am beside myself. Apollo is my number one concern. I have left word with the dermatologist. Will wait for other test results to than look into internal medicine specialist.
Had to deal with insurance adjuster on the home we lost in
Reno, Nv.
I am so overwhelmed. I am worried about Apollo not being on medication to help him. Will call vet tomorrow.
Thank you
Hugs Sonja and Apollo
I am trying to do the best for my baby.
I will try to post some of results.
Can anyone tell me how to do so as an attachment?
notes for today


November 29, 2011
1. Apollo had white rice, turkey slice a.m. 1 bowl movement
2. Afternoon- egg whites, white rice, chicken slices, greenie
3. Another bowl movement, light colored, see some rice in it.
4. Urinated afternoon
5. Drank a sip of water by himself around 3p.m.

StarDeb55
11-29-2011, 09:55 PM
Sonja, you probably need to stop the greenies. All of my vets have told me that they can be very difficult to digest. They have wheat, so if Apollo has any sort of issues with grain, greenies are not a good idea. Also, when you mention that you thought you saw rice in the stool, that could be an indication that the rice may not be cooked enough for Apollo to easily digest. Plain white rice needs to be cooked to the consistency of a mushy paste, if it still has intact grains, it's not cooked enough.

When it comes to attachments, I'm not sure, but I don't think you can. When I was posting labs for Harley frequently, I would simply type them out in this type of format. Remember on routine labs, we only need to see the abnormal, along with normal range & reporting units. Here are a couple of examples on how to post:

Glucose:
225 mg/dl
Normal range: 70-110 mg/dl

BUN:
50 mg/dl
Normal range: 10-20 mg/dl

Don't read anything into the numbers I used, I simply made them up, so you could see an example of how to post.

apollo6
11-30-2011, 01:15 AM
lost post was writing:
Had a very stressful day.
Apollo doesn't get greene instead Nylane teeth treats
Urinalysis:
SG: 1.026 RANGE 1-1.6
GLU NEG
BILI NEG
KET NEG
BL NEG
PH 7.5 RANGE IS 6
UROB. .2 NORMAL
WBC 3 TOTAL
RBC 0-5 HPS?
CRYS. AMORPHOSUS 2+
BACT: NOB
CASTS: NEG(CAN'T READ)
EPIT: NOB
< 1 GRAM DEBRIS
NO GROWTH


lab. PARTS OF
wbc 7.4 was 6.5 range 4.- 15.5
RBC 8.2 WAS 7.5 RANGE 4.8-9.3
PLATELET COUNT 499(HIGH) WAS 383 RANGE 170-400
BLOOD PARASITES NONE SEEN


NEUTROPHILS 5772 WAS 4615 GOING UP 78% RANGE 2060-10600
LYMPHOCYTES 1110 WAS 1170 RANGE 690-4500
LIVER READING
AST(SGOT) 42 WAS 27 RANGE 15-66
AST(SGPT) 190 (HIGH) WAS 160 RANGE 12-118

ALK PHOSPHATASE 269(HIGH) WAS 129 RANGE 5-131
GGT 16(HIGH) WAS 17 RANGE 1-12

BUN 33(HIGH) WAS 34 RANGE 4-27
BUN/CREATININE RATION 33(HIGH) WAS 57 RANGE 4-27


THYROID
T3 72 WAS 46 RANGE 45-150
T4 3(HIGH) WAS 2.5
fREE T4 45.2 (HIGH) RANGE 8-40
TALKED TO DERMOTOLOGIST:
November 29, 2011
Dr. Boord
Dermatologist
1. Said okay to wait until start Ivermectin, growing hairs out of black area, good sign, Apollo’s body is trying to fight on own. NO TOXIATION FROM MITES?
2. Said an ultrasound would show what is going on internally with Apollo versus X ray may be liver can mimic Cushing’s? BUT aPOLLO DOESN'T HAVE ANY SIGNS OF LIVER DISEASE. MAYBE PANCREATIS BUT NOT VOMITING, STILL EATING, BUT WATER NOT DRINKING UNLESS FORCE DOWN?
3. Would get a second opinion.
eXHAUSTED, OVERWHELMED , GETTING ADVISE FROM ALL OVER.
hUGS sONJA AND aPOLLO
HAS YOU CAN SEE I AM OUT OF IT. THANK YOU FOR THE LOVE AND CARRYING FOR MY BABY BOY.

Cyn719
11-30-2011, 01:31 AM
Sonja - Praying and praying for Apollo - love strength support and hugssss being sent to you and Apollo --- xoxoxoxoxoxoxoxoxoxo

addy
11-30-2011, 09:27 AM
Sending love and hugs, hoping Deb can make sense of the labs

back in the recesses of my brain file cabinet, I remember reading about dogs not wanting to drink water when they are sick to their stomach. Does any one else have thoughts on that?

love you,
addy

Squirt's Mom
11-30-2011, 10:34 AM
Hi Sonja,

A couple of questions that weren't addressed -

Which doctor told you to stop the Ivermectin?
Which doctor told you to stop the Trilo?
Which doctor told you to stop the supplements?
Does Dr. Board know EVERYTHING you have stopped?

Just the name of the doc is fine, and yes or no - no explanations please as they confuse the answer. ;)

Thanks!
Hugs,
Leslie and the gang

jmac
11-30-2011, 11:52 PM
Sonja-
Just wanted to let you know I am thinking of you and Apollo. I will keep you in my prayers and send good thoughts your way. I hope you will find a vet who can help Apollo get the treatments he needs. I also hope so, so, so much to see some good news from you. I am so sorry about everything you have been faced with. I just cannot imagine how difficult it must be. Please know you're in my thoughts often...

Julie & Hannah

Rene
12-01-2011, 10:52 PM
Thinking of you guys. Supportive, healing, loving...((((((hugggs))))).

Cyn719
12-02-2011, 12:40 AM
Sonja thinking of you and Apollo and sending love and prayers xo

apollo6
12-02-2011, 03:08 PM
Leslie, Julie, Rene and Cindy
Thank you for all your thoughts and prayers
Which doctor told you to stop the Ivermectin?
Which doctor told you to stop the Trilo?
Which doctor told you to stop the supplements?
Does Dr. Board know EVERYTHING you have stopped?


My regular vet and the dermatoligist said stop on the ivermectin and the trilostane because of what was going on with Apollo.
The vet said to I can restart supplements by MOnday a few now and rest on MOndaytoo help Apollo now.
Dr. Board the dermatologist know about stopping the Trilostane and Invermectin. Said it was not life threatening at this time, she has seen worse, and says first need to know what is going on with Apollo before restart and can restart at a later date. She was faxed the lab results also.


Additional results:
Cortisol is 5.9 resting-that is to be expected off Trilostane, trying to up cortisol to fight mites.( Please note even the dermatologist said she wanted his cortisol to be higher)
Next test:
for pancreatitis
Spec cPl 697

< or= 200ug/l serum spec cPl concentration is in normal range
201-399ug/l serum spec cpl concentration is increased. May have pancreatitis( already now)


>0r =400ug/l serum spec cpl concentration consistent with pancreatitis:
Not vomiting, bowl movement fair (cow dung)-this time no food,rice in it, urinating, drank a little bit of water Dec 1

have one more test to get faxed
just received:
G.I. LAB old 1/6/11 new Dec 2,2011
COBALAMIN FASTING WAS <150 NOW 230NG/L RANGE 251-908
CONSISTENT with distal small intestinal disease, EPI or small intestinal bacterial overgrowth. check canine TLI TO RULE OUT EPI. Consider cobalamin supplementation. ( next week starting B12 again)

Folate Fasting was 5 ugl. now 17 ug/l range 7.7-24.4
interpretation: normal range

Pancreatic Lipase Immunoreactivity fasting 615 ug/L 0-200
consistent with panceratitis. treatment can be monitored by repeated serum CPLI analysis.
TLI Fasting was 10.8ug/l now 8.9ug/l range range 5.7-45.2
normal range



December 2, 2011
Dr. Feinberg:
1. Low on cobulum- b12 shot every two weeks than once a month not sure when
2. Stay on Trilostane low dosage could do 200ml or 100ml –ml liquid email diamond back5ml per klg, Apollo on 2ml per Klg
3. Restart Trilostane on Dec 5, 10mg, 2 days on 1 day off(would want to go with 5mg would have to check on cost)
4. Restart supplements to help Apollo’s body
5. Bland diet pep-c as needed
6. Still stomach gurgling-stress could have triggered pancreatitis
7. Monday call Dr. Boord about the ivermection
8. Still have concern about the sex hormones causes Apollo leg, skin issues.
Monday after talking to dermatologist, will consider internal specialist.


Please now I have Apollo's best interest at heart.
Hugs Sonja and Apollo
Today I have to deal with lawyer on insurance coverage, closing out our month, payroll, etc., get paperwork for builder doing appraisol on house, notes on Apollo, try to call Dermatologist today maybe.
waiting for other report on Apollo

Rene
12-02-2011, 10:36 PM
Hi Sweetie,

Let me know what I can do to help. Bring you a Starbucks or chocovine is it?

(Hugs)

apollo6
12-02-2011, 10:57 PM
Dear Rene
YOu are a doll. With chocolate of course.:D

I posted pictures of Apollo today and picture of liaison on face with hair growing back
Hugs Sonja and Apollo

Rene
12-04-2011, 01:08 AM
Awwwwwww....there is our boy!!!! Such a spark in his eye.

Everyone. This boy is so present in mind, you can obviously see it in his face...but the little squirt can hardly walk. He has the spirit of a warrior. When I saw them a couple days ago, Apollo had the audacity to "Bark and Guard" Sonja when I approached...and I am a friend! What is he gonna do hump me too...he is a little Casanova! Everyone has to have motivation.

You gotta love this little guy. Check out his album.

Love ya Sonja!

Bailey's Mom
12-04-2011, 06:04 AM
Hi Sonja-

I guess I had not looked at your albums. I had in my mind that Apollo was about the size of that other dog in the picture. How old is Apollo. How long has he had cushings?

You have such a huge plate in front of you. I am sure you must feel like you meet yourself coming and going. I hope you are trying to get your rest. That's one of the best things you can do. You'll be able to think more clearly, less emotionally and you won't be run down for some little ol bug to make you sick and rundown.

Thanks for keeping us posted.

-Susan

apollo6
12-04-2011, 11:59 PM
Dear Rene and Susan.
Rene maybe he did want to hump you, he is a dirty old man and goes for Blondes.:D
Even my husband said I had to rest today, no fire talk, business etc.
Hugs Sonja and Apollo

his legs are getting worse and I feel helpless.

addy
12-05-2011, 10:17 PM
Hi Sonja,

Just stopping by to tell you I love you and Apollo and my prayers continue for you both.

If his pancreas is inflamed, he most likely would not want to drink water or eat. Remember Mary Beth and Ali? Ali was in the hospital with pancreatitis and did not want to drink much water.

Apollo had the B12 shots before, if I remember right and we also thought back then his tests showed SIBO- small bacterial overgrowth. Sibo is usually treated with Tylan but if his pancreas is acting up ?????:confused::confused:

Honestly Sonja, just my opinion but I don't think all of this is from his intermediate hormones at all. With all of this going on, why do they want to start the trilostane again? I don't understand that part. Maybe I am just tired so please dear friend forgive me if I am confused.

I know how hard you are trying.

love,
addy

jmac
12-05-2011, 10:53 PM
Sonja-
Just stopping by to let you know I'm still thinking of you and Apollo. I'm glad you took some time to rest. Hope your cute little guy had a good day...

Julie & Hannah

Skye
12-06-2011, 02:43 AM
stopping in to see how your Apollo and you are doing....you have had so much happening, and you know.....here is what i do not that this is for everyone not that this is right or wrong, but i think what will be there tomorrow....what might not be.........well, long lessons in life have taught me anything living is what might not be waiting tomorrow, paper, phone calls, meetings, etc....those can be there tomorrow. So beautiful, when the heat is on....and you are pulled a zillion ways all at once with demands as high as the clouds....keep grounded...look at what is facing you, what will be there tomorrow...then give the rest to today.
I hope that you and your family fur babies included are doing good....embracing and loving each other. Sometimes when you have a beautiful heart the world will try and break it down....stress....and goodness look at all the wonderful angels fluttering about you and apollo!!!! you are doing everything you possibly can and seeing good doctors to hopefully get answers. Have they determined exactly what is causing the leg issue? arthritis? cushings? side effects from meds?
holding you close and praying for you all, love and hugs from me and my girls....i know i could have never made it through what we endured with out all you angels. I know i am miles away, but if i can help research, make calls, type papers, etc....please let me know and i will gladly help. hang in there my friend.

Rene
12-06-2011, 04:20 AM
Good Morining Sonja & Little Man!

apollo6
12-07-2011, 12:15 AM
Dear Addy, Stormy,Rene and Hannah
Apollo restarted the Trilostane on Monday, started having soft stools, Today he had diarrhea all day. Tomorrow I have him scheduled for an ultrasound to see how liver, spleen, kidney and small intestinal is doing. I measured his temp which was 100.5 still normal.
No Trilostane tomorrow will be talking to vet.
Keep me in your prayers.
To try and be giving dropped a few dollars in Salvation Army and got a gift card for the giving tree at my church. Started crying wondering how I am going to get through all of this.
I cradled Apollo in my arms and said we will get through this together, please don't leave me now.
Very worried about my baby.
Hugs Sonja and Apollo
will post results when get.

Bailey's Mom
12-07-2011, 01:05 AM
Oh Sonja-I am so sorry it is so rough. I have been there and it really sucks.
You will get through this because that's the only "choice". The choice you do have is how much time you spend on the things that are most important to you. There are no guarantees for any of us beyond what is, this minute. Take it one step at a time. We are with you and behind you.
-Susan

apollo6
12-07-2011, 01:10 AM
Dear Susan
Thank you.
I am praying to God for my boy. and all of us.
Hugs Sonja and Apollo

Cyn719
12-07-2011, 01:49 AM
Thanks sonja for the info - do not apologize for not keeping up with everyone --- you have your hands full right now with apollo - just take care of your little guy - sending you lots of love - prayers -strength - support and hugssssssssss xoxoxoxo

addy
12-07-2011, 09:29 AM
Sending loves and hugs sweetie; Zoe is sending love and kisses to Apollo and Koko still wants to put the moves on Karma.

love always,
addy, zoe and koko

Squirt's Mom
12-07-2011, 10:17 AM
I am keeping you all in my thoughts and prayers, Sonja, especially your sweet, sweet boy.

Hugs,
Leslie and the gang

Skye
12-07-2011, 04:16 PM
Oh Sweetheart, sometimes there are not words to speak to heart so full of love and care that passionately loves and cares for others as you. You are a beautiful remarkable pet mom, and your baby knows your one in a million. Your love is Apollos greatest treasure and blessing in life, and your heart openly receives the gift of unconditional love back, embrace every second, and when Apollo is in your arms you think happy warm loving thoughts and share wonderful memories, keep positive thoughts and love flowing all around. If the heart tears and fear/worry consumes, take a moment, go wash your face, let it out, step outside on porch or in garage, then return to your warm loving baby again to shower the richest of positive love. Oh this is so difficult to do.....ask nearly any angel here....wowser, did they ever help me. At one point bless Lesiles heart she had to say okay stop whatever it is your doing......lol
Your love and bond with Apollo is remarkable, Apollo is strengthen by your love just as we are by theirs. Will be standing by to hear what doctors say. Love and hugs sweet angel.

Bailey's Mom
12-07-2011, 08:03 PM
Now CUT THAT OUT, KOKO!!!!

addy
12-07-2011, 08:07 PM
But SUS,

Karma is soooooooo cute and she smells good too:D:D:D:D


love,
Koko

jmac
12-07-2011, 09:42 PM
Sonja-
I am so sorry to hear Apollo is not doing so well. I'm sorry for all that you are going through. You have been so wonderful to Apollo and done everything you possibly could for him. He knows it. And right now you should focus on loving him and enjoying time with him. I hope you'll get some helpful information from your test tomorrow. We are all thinking of you and hoping for the very best. I'm keeping you and Apollo in my prayers.

Julie & Hannah

addy
12-08-2011, 02:14 PM
hi sweetie,


Was hoping Susan and I got you to smile yesterday.

Love you,
addy

Rene
12-08-2011, 11:11 PM
Goodnight sweet Sonja & Apollo.

apollo6
12-10-2011, 02:18 AM
Dear Rene, Addy,Zoe, and you rascal Koko, Stormie, Leslie and the gang, Julie and Hannah, and anyone else I forgot.
Thank you all for your prayers. Apollo is doing better with the pancreatitis, but all the food changes have not been good for him, now trying to stick with one food and lean cooked chicken
December 7, 2011
1. Ultrasound; liver enlarged normal for Cushing
2. Pancreatitis inflamed, chronic pancreatitis scarring
3. Prostrate mineral deposits
4. Kidney okay
5. Adrenal glands increased
6. No bowel tumor, obstruction
7. Diarrhea could be caused by unbalanced, changes in diet and Cushing chronic pancreatitis
8. Hind leg weakness- due to combination of Cushing and Inter vertebral Disk Disease(L4,5,6-past injury), multi calcification of discs, bulging disc cause weakness in legs, neurological causing weakness

• Cushing continue on Trilostane 10mg. 2 days on 1 day off
• Metronidazole 250mg-1/2 tablet 1 time a day for 5 days for diarrhea, gas, intestinal discomfort
• No cottage cheese, no yogurt, no probiotics, enzymes
• 5 days only one food, water with lean cooked turkey and chicken
• Lignans , melatonin
Probiotix
Colostrum for stomach
• Solixane
• Treats have always eaten
• Ask if can add L-Glutamine
Utra sound
History:
Cushing's diseAse (controlled), recently taken off TrilostaNE. Pelvic limb weakness.. No PU/PO/PP.
Findings.:
Abdominal Ultrasound: There is marked bilateral adrenal gland enlargement, each with 1 a maximal diameter
of 1.0 cm. There is no evidence of adrenal gland invasion into adjacent vascular structures. The pancreas is
normal in size but is diffusely increased in parenchymal echogenicity. The liver parenchyma is mildly,
diffusely increased in echogenicity. The gallbladder is within normal limits. The apical aspect of the urinary'
bladder wall is mildly thickened with a slightly irregular mucosal margin. There are two echogenic pinpoint
foci within the prostate cparenchyma which likely represent areas of mineralization( found in older dogs). The prostate is
symmetric and normal in eChogenicity and size. No enlarged lymph nodes or free abdominal fluid are noted.
The remainder of the exam including the gastrointestinal tract, the spleen, the left and right kidneys and the
mesenteric tissue is within normal limits.
Conclusions:
1) bilateral adrenomegaly. This finding is compatible with Phd.
2) Hyperechoic pancreatic parenchyma.Consider chronic pancreatitis or pancreatic fibrosis.
3) Mild, diffuse increased liver parenchymal echogenicity, A steroid hepatopathy is likely, Underlying
primary liver disease (e.g. hepatitis) cannot be completely excluded.
4) Mildly thickened apical urinary bladder wall. Consider cystitis (idiopathic VS. infectious).
5) Two pinpoint areas of prostate: mineralization. This may be an incidental finding. Prostate
neoplasia cannot be ruled out.( ALL THAT FOOLING AROUND-NEED TO HAVE SOME HUMOR)
Recommendations.
Treatment for pancreaTITIS $should be considered. if clinically applicable, Continued therapy for Cushing's
disease if the clinical signs resume. Negative UA and urine culture results suggest idiopathic cystitis.
Ultrasound guided FNA or biopsy of the prostate is necessary for a definitive diagnosis.

Call Dr. Feinberg on Monday to check how Apollo is doing, then decide when to start Ivermectin, legs are not good.
Above is the ultrasound results told normal for cushing dog, and we know Apollo has had bots of pancreatitis.
Need to treat the pancreatitis first.
He started drinking water on his own.
Now I have to deal with a slew of papers from insurance company on fire, next week help Mom with changing her phone service, etc.
I am overwhelmed. Business is failing . My little angels here keep me going.
A creed for Life
Don't take for granted your faith and the things closest to heart. Cling to them as you would your life for without them life is meaningless.
Don't give up when you still have something to give. Nothing is really over until the moment you stop trying.
Don't run through life so fast that you forget not only where you've been but also where you are going. Life is not a race but a journey to God to be savored each step of the way.(Especially with our cushing babies)
Love Sonja and Apollo

Skye
12-10-2011, 05:02 AM
((((((((((((((((((hugs)))))))))))))))))))))))))) lifting you, Apollo, and your family in prayer. Your a beautiful person.

mypuppy
12-10-2011, 09:01 AM
We Love You
Sonja and Apollo:)

XO Jeanette and Princess

Cyn719
12-10-2011, 12:35 PM
Sonja and Apollo

STRENGTH SUPPORT PRAYERS LOVE AND LOTS OF HUGSSSSSS!!! XOXOXOXOXOXOXOXOXOXOXOXOXOXOXOXOXO

Bailey's Mom
12-12-2011, 01:40 AM
Hi Sonja.....just wanted to drop by and let you know I'm thinking of you and Apollo. That is one slew of test results. How did you get all that? Did you take along a recorder?
Best wishes-
Susan

Rebelsmom
12-12-2011, 10:45 AM
Thinking of you and Apollo Sonja. Sending hugs and prayers your way.

Rene
12-12-2011, 02:50 PM
Sonja,

Hope you guys had a super Sunday...free free from "all the stuff". Sending thoughts and big hugs your way.

Rene & Angel Snoop

apollo6
12-17-2011, 03:27 AM
Dear Leslie and gang, Stormee, Addy and Zoe and Koko, Julie, Jeanette, Cindy, Susan,Melissa and Rebel, Rene and angel Snoopy, and Sadie.
Thank you all for your love and support.
I have not been keeping up with the forum, very overwhelmed. Financial the business is bad. My husband keeps saying I got to hang on, we will get through this.
My little Apollo is such a brave little boy. He can hardly walk anymore. But he still tries. I am so wrapped up with dealing with the fire and struggling business, I have to take the time to hold my little boy and tell him I love him so much. Every day I know I just have today with him. And I know God is giving me a gift for each day I still have with him.
His stools are solid again, he is back on the Trilostane, two days on one day off. I want to start the Ivermectin by Monday. He has had about two weeks rest from all medications, supplements.
Love you all.
Sonja and warrior Apollo

addy
12-17-2011, 09:58 AM
Dear Sister in Battle,


WE LOVE YOU

(((((HUGS))))))

(((((MORE HUGS))))))

addy

Squirt's Mom
12-17-2011, 10:23 AM
Hi Sonja,

Good to hear from you but wish your struggles with the fire and business were coming to an end.

Love on that little guy every chance you get. Right now is all we are ever given so we need to make the most of each moment.

Hugs,
Leslie and the gang

jmac
12-17-2011, 11:00 AM
Hi Sonja-
It's good to hear from you. I'm glad Apollo's stool is better, and it sounds like you're trying to get back on track with meds. He's still determined! You're right-you need to make time to love him every day. That's what he needs most.

Take care,
Julie & Hannah

apollo6
12-22-2011, 11:36 PM
Dear Addy, Leslie and Julie.
It has been a real struggle. My little boy has a harder and harder time walking, now has accidents if I forget to take him out to pie. He has such a great spirit and is trying so hard. I am trying to be grateful for each day I still have with him. I pray God lets me keep him a while longer. He is my little rock, keeping me up right now.
I am sorry I have not been on the site lately. I feel like my world is falling apart around me.
May you all have a blessed Holiday and Christmas.
Care deeply, Give freely, Think kindly, Act gently, and be at peace with the world. This is the spirit of Christmas.
Hugs Sonja and Apollo

mypuppy
12-23-2011, 09:35 AM
Oh Sonya,

I so wish I could hug all your troubles away and give the gift of joy to you and your family you are so deserving of right now. You words of advice are powerful and wise. If only the rest of the world would see through your eyes and heart.

May God embrace you, your sweet little boy and your family this Christmas and always.

We love you....xo Jeanette and Princess

Squirt's Mom
12-23-2011, 10:35 AM
Dear Sonja,

I am incredibly sorry Apollo is still suffering on the old protocol and incredibly sorry your fear prevents giving him the hope that things might improve. You cannot imagine the sadness this causes me. :(

It absolutely breaks my heart to know the both of you are in such agony but I have done everything I know, tried everything I could think of to reach you...and failed.

So now I simply pray, and pray fervently, that peace will soon come to you both, that you both have the strength to face the path you have chosen, and that you each find some tiny bit of joy each day you have together. And continue to send hugs and gentle belly rubs.

Hugs,
Leslie and the gang

addy
12-23-2011, 02:48 PM
Dear Sonja,

I hope some Christmas magic finds its way to you.

All my love,
addy

Rebelsmom
12-23-2011, 04:38 PM
Sending you and Apollo lots of hugs and love. Wish I could do more for you as I'm sure we all do. Please know we are all here for you.

Merry Christmas to you and your family.

Bailey's Mom
12-23-2011, 10:17 PM
We Love You Sonja and Apollo-we have you in our hearts. Try to feel the hugs!
-Susan

jmac
12-23-2011, 11:11 PM
Sonja-

Thanks so much for your message. I am so sorry you and Apollo are struggling so much right now. It is never easy, but around the holidays would be so much harder. Make time to love and cuddle Apollo every day. I hope your family will have a peaceful Christmas.

You're in my thoughts and prayers,
Julie & Hannah

Cyn719
12-24-2011, 02:36 AM
Sonja - My heart aches for you - I understand how hard it is - my Penny is having the hardest time walking right now also -- I also embrace each day with her - I pray for Apollo and Penny and hope a little Christmas Magic falls upon them --- love prayers and lots and lots of hugssssssssssss to you and Apollo - Merry Christmas xoxoxoxoxoxo

Rene
12-24-2011, 03:38 AM
We love you Sonja.

I hope your husband has arrived from Reno and you and Apollo have him to snuggle with at night. May you find comfort in the simple joy of having these things with you to forget for a little while. Loose yourself in the love that surrounds you.

Rene & Angel Snoopie

Cyn719
12-26-2011, 12:54 PM
Thinking of you

xo

apollo6
12-29-2011, 12:40 AM
Dear Friends;Leslie, Addy, Melissa, Susan, Julie & Hannah, Cindy & Penny, and Rene.
Thank you for your love and support.
One good thing. Just for today I have my little boy. He walked a little to the mail box.
He is now on Trilostane, 10mg. 2 days on 1 day off, Ivermectin .15 mg a day. Both the dermatologist and vet agreed to this.
Apollo had some more vomiting, but I am to blame, I tried to add in some things. I have to realize that his system is super sensitive, and most always watch out for the pancreatitis. His walking continues to decline. But he still is a little warrior.
My husband and I spent 3 days just going over pictures of our house to see if we could recognize anything and read letters from the insurance company. We had to do it around Christmas since the store is closed. We are both very exhausted. Only God knows how much longer we will keep our store open. It has been a tough year.
May the coming year be hopeful, joyful, prosperous. Relish each day you have with your Cushing pups.
Apollo has his next Acht stim January 26th, I have also requested a full blood panel. He could use a rest from all the vets.
HUgs Sonja and Apollo

addy
12-29-2011, 08:57 AM
Dearest Sonja,

I hope you continue to have one good thing a day:)

My heartfelt wish is for a bright light for you and Apollo in the New Year.

All my love,
addy

Rebelsmom
12-29-2011, 10:41 AM
I agree with Addy Sonja and my thoughts and prayers are with you everyday.

addy
01-05-2012, 09:46 AM
Happy New Year dear friend!!!!

How are you and Apollo? Thinking of you both and sending much love.

(((((((hugs)))))))

love,
addy

apollo6
01-05-2012, 11:33 PM
To all my friends
Today was a bad day. While at the holistic vet, he broke down and cried about Apollo, said they broke the mold when God made him, that he is a once in a life time best friend, what a trooper he is despite all that he is going through. He held me and we both cried. My heart is aching. Apollo is getting worse. I am to start the advantage multi for the mites, since he was throwing up with the increases in the Ivermectin. My vet said let his stomach stabilize before I introduce another chemical into his system.
from my notes:
LOOSING VOICE, RASPING, SALIVA GLAND SWOLLEN, FOAMING WHEN CHEWING, legs weaker
January 5,2012
Dr. Weingardt
1. Wait one more day before give anti vomit-Cerenia
2. Wait for Apollo to stop vomiting before start Advantage
3. More tired, sleeping more
4. Okay Apple juice with water for mites
5. Legs worse
6. B12 shot once a week
7. Make sure Apollo is feeling better before using chemicals on his body
8. Losing voice box may be due to nerve paralysis
9. Apollo will let me know when he has had enough of all this
10. Wait one week before start Advantage multi(pesticide)
The Coshing is progressing.
When I got home, I screamed I am not giving up. God you got to help me. Apollo looked at me and wagged his tail, he ate his meal and his treats. Faith, hope and love that is all I have to give to my baby. I will do the best I can. Each day now is a gift to have him still.
I am overwhelmed with dealing with the fire, the insurance adjuster are emailing everyday for information, etc. the business is on it's last leg, and the only thing I care about is my little Apollo.
HUgs Sonja and Apollo

Skye
01-06-2012, 01:50 AM
sobbing........holding you close.....
you are so strong....and good for not giving up...apollo is not ready. Not today. and today is all that you need to focus on.
At your weakest moment is where you find how much strength you have.
maybe apollo knows exactly what meant when he heard you say those words.....I am not giving up.
Yes.....he will let you know....and you will have peace
everything else IS going to work out and get answers, nothing is more important than your baby.....embrace this day. and bless that vet for caring so passionately.
Apollo is NOT giving up...he isnt ready to give up.....YOU dont give up either. Angels are fluttering all around you.

Bailey's Mom
01-06-2012, 07:00 AM
Dear Sonja and Apollo,
I wish I could kiss it and make it all better. I wish a band-aid could cover the hurt. I wish there weren't so many things all going on at the same time.
What is the business? I don't think I know.
Sonja you are doing a magnificent job under tremendous pressure. Apollo knows how you feel.
May peace be with you and please enjoy every moment you can, together.
-Susan

addy
01-06-2012, 07:53 AM
I love you
addy

Cyn719
01-06-2012, 12:42 PM
Sonja

how could I not be in tears reading this - you have had so much thrown your way and it doesnt let up--
but one thing is for sure you love Apollo with all your heart and more- and he loves you right back-
I am giving you the biggest hug ever and I am praying for you and Apollo -

Sending tons and tons of love support strenght faith prayers and hugsssss

xoxoxoxoxoxoxo

Rebelsmom
01-06-2012, 01:23 PM
Sonja, we are all here for you. Sending lots of love and prayers your way and for Apollo to feel better.

apollo6
01-06-2012, 11:49 PM
Dear Addy and the steaming hot Zoe, Melisa, Melissa, Rebel & Sadie
,Susan, Cindy,Penny, Stormee(Skye) Thank you all for your love and support.
Just for today Apollo is here. I did leave word with the internal specialist. Today Apollo wagged his tail, ate his breakfast, lunch and dinner. Mom came over and hugged him for awhile. I am taking it one day at a time right now.
Love you all.
Praying for you your families and cushing angels.
Sonja and Apollo

mypuppy
01-07-2012, 08:18 AM
Dearest Sonja,

Your sweet little boy and you are in my prayers. We feel so very helpless across the miles, but even if near, the only one guiding you is up above, submit yourself to him and he will show you the way through this.

I am sending you and your precious Apollo some of the tighest hugs ever...Hope you feel them..

Love and faith...xo Jeanette and my Princess

jmac
01-07-2012, 11:14 AM
Sonja-

I just wanted to stop by to let you know you and Apollo are still in my thoughts...sending good wishes your way.

Julie & Hannah

Squirt's Mom
01-07-2012, 11:36 AM
Hi Sonja,

Hope things are settling a bit in your world these days...heaven knows you have had plenty to deal with recently!

I was wondering....do you have any recent pics of your sweet Apollo? It has been a while and I would love to see some new pics of him. Doesn't he have a stroller he rides in sometimes?

Hugs,
Leslie and the gang

apollo6
01-13-2012, 02:16 AM
Dear Jeanette and my Princess , Julia and Hannah and Leslie
Some good news on Apollo

Apollo had a more solid bowel movement
Dr. Feinberg
1. Inside are better- overall
2. ACHT NORMAL-continue Trilostane as is
3. PANCRETITIS TEST still high but better
4. Urinalysis- no infections
5. Blood panel better
6. Thyroid decreased but still within normal range
7. Age may be factor with Cushing’s for intestinal issues
8. Symptomatic – Carafee helping with stomach
9. May need to change diet to hyper allergenic or intestinal diet
10. If vomiting not resolve itself then go to internal specialist
11. Waiting for copies of tests to review
12. Ask Dr. Feinberg if should still see January 26 (yes) to do acht stim and intermediate hormones
13. If no vomiting , etc. start Advantage Multi-January 16th.
I just know with this disease many other health problems pop up.
Apollo still has a rasping bark, he tries to walk a little each day. I am hoping to get him started on the Advantage Multi =next week for the mites( I am not happy about doing this but he can not handle the Ivermetin-this is when his vomiting started) also with cushing, pancreatitis and intestinal issues are very common. Apollo started his journey with cushing in 2009. Today is January 12, 2012, Apollo is 13.33 years old. He is a little warrier.
The fire and Apollo's health issues have overwhelmed me and our struggling business. Like my husband said it would be nice to have a few good days a week.
Love you all
Sonja and warrier Apollo
just posted 2012 pictures of Apollo

BestBuddy
01-13-2012, 04:59 AM
Hi Sonja,

Just had to say I loved seeing the current photos of Apollo. He looks very bright and attentive and I loved the one where he is sleeping with dad.

Jenny

addy
01-13-2012, 09:34 AM
Baby steps are good. Keep the faith sweetie.

Sorry this is so short, snow to shovel and I have a migraine.

Always thinking of you and Apollo. I love the photos.

love always,
addy

apollo6
01-16-2012, 08:51 PM
Hope all is well with all of you.
Dear Addy I do not envy you about snow shoveling.
I have become such a wipe about the cold. Born in Toronto, Ontario Canada and now if it get below 60 degrees in San Diego , I am freezing. sham sham on me.
Apollo has good days and bad.
Will check if Dermatologist to start the Advantage Plus for the mites.
He has good days and bad days.
Love you all
Hugs Sonja and Apollo

Cyn719
01-16-2012, 10:03 PM
Sonja

Soooooooooooo happy Apollo is feeling alittle better - alittle is good:) Love the pics - so cute sleeping with dad and looks so perky in the other picture!! I know its hard with our cush pups - you never know what tomorrow will bring - but hope alittle better turns into alot better:D So sending you strenght support prayes and lots and lots of love and hugsssssss xoxo

apollo6
01-27-2012, 11:42 PM
Update on Apollo
Prayers do help.
Apollo is starting to feel a little better. Still dealing with the stomach gurgling, irregular bowl movements.
On the brighter side, he still can let out a bark(even if he is losing his voice) still wags his tail , and even though he is losing strength in his legs, with once a week water therapy, stretching and massaging his legs he tries to get around. He is now 13.3 years old. All I can do is be grateful for each day I have him and try to be in the moment with him.
Like so many this has been a very difficult journey for both of us. You never know what is going to pop up.
Pretty overwhelmed dealing with the loss of our home, insurance company, paper work, deciding how long we can keep the business open. It has been a struggle.
I try to focus on the little things and be grateful for what I do have and not what we have lost.
HUgs Sonja and Apollo

Cyn719
01-27-2012, 11:43 PM
Thinking of you and Apollo always:)

Lots of love and hugs to you and Apollo
Xoxoxoxo

jmac
01-28-2012, 09:52 AM
Hi Sonja-

It's good to hear from you! I'm glad to hear Apollo is doing a little better, and most importantly that his spirit is still good, with that little tail still wagging. I think you have the right attitude: be grateful for every day you have with him and take one day at a time. You have a lot going on, so that's all you can do.

Take care,
Julie & Hannah

addy
01-28-2012, 10:11 AM
Dearest Sonja,

I think the only way it works is to live in the now with them though it is so hard to do for us humans. I am glad Apollo has good days, we live for those and cherish them.

Our industry does seem bleak right now, we both seem to have the same industry cycles and January is always such a slow horror. I know the worry you have with that and how hard it is to go through it on top of everything else.

Hold our sweetheart tight and give him lots of hugs and kisses from me. Zoe is barking woof to Apollo too and Koko is woofing for Karma. He can't get over his crush.:)

Everyone needs hope. I send love and hugs and a ray of hope to you my dearest first friend. I hope you know how much we love you care. I know you are doing the best you can and that is alot.

sister in battle
love you,
addy

Squirt's Mom
01-28-2012, 11:05 AM
Hi Sonja,

Good to hear from you again and especially good to hear that our sweet boy is improving a little bit! :cool::D:cool: I hope you continue to see him having these good days more and more often.

Hugs and belly rubs,
Leslie and the gang

apollo6
02-11-2012, 03:15 PM
Will try to post later. Third time post deleted.
Apollo is doing a little bit better.
He still has stomach/intestinal issues,stomach grumbling,soft bowel,sometimes diarrhea,all legs are weak,difficulty standing.
Since the difficulty taking the Ivermectin, stomach issues.
Apollo on topical AdvantagePlus every two weeks for the mites.
Next week go to dermatologist for skin scraping .
Following week full blood panel,ACHT stim,intermediate hormones.
Apollo's health is declining,but,, he is fighting,stll eats,won't let me forget his treats,his voice is getter weaker, when he can not get out of his bed he yells for me to get him out. I have a adapted ,Apollo has adapted. I try to thank God for every day I have with him.
Apollo started his journey on 2008'emergency hospital ,on numerous drugs,etc.,belly turned black,hives all over body (feel predisone and years of being on allegory tablets with steroids in it)
But on the good side,Apollo is still here,age 13.5 years old. Just for today.
My vet is treating a dachshund that is 16 with Cushing. Each case is different.


As many have said, it won't be the Cushing,but some other complication that will get them.
Hugs Sonja and warrior Apollo

Altira
02-12-2012, 08:44 AM
Praying for our sweet Apollo... for sure! Let the testing fairies be kind...

addy
02-12-2012, 10:09 AM
Will be waiting with you for all the test results, Sonja.

Try to enjoy your Sunday.

love and hugs,
addy, zoe and koko too

jmac
02-12-2012, 11:57 AM
Hi Sonja-
It was good to hear from you. I wonder about you and Apollo often. I am glad to hear he is doing a bit better. He sure is a little fighter!

Looking forward to another update soon!

Julie & Hannah

apollo6
02-15-2012, 04:28 PM
you all for your support.

I am taking each day as it comes,being grateful for each day with him. The holistic vet said that despite all of Apollo's health issues that he is still in there,fighting. I am sorry for not keeping up with you all. So many newcomers. Wish there was a miracle for this awful disease. Apollo's leg issues are not that common with Cushing . I am worried it may the intermediate hormones that are causing it,which means what is the right medication for him,since we are also dealing with the intestinal issues. He still has a good appetite,let's me not forget his treats.
Hugs Sonja and Apollo

Squirt's Mom
02-15-2012, 04:43 PM
Hi Sonja,

I deleted the post that looked as if it got submitted before you were quite ready. :p It's happened to me many a time! ;)

Good to hear that our sweet boy is still fighting and finding some joy in his days. I hope life has settled down for all of you now.

Hugs,
Leslie and the gang

Rebelsmom
02-15-2012, 05:48 PM
Sonja, just checking in on you and Apollo. Glad to hear he is having some good days. Thanks for checking in on us. Leg issues seem to be popping up more often and I did speak with my Anatomy Instructor regarding it. With Cushings, at least in humans, it pulls fat and muscle away from limbs and closer to the trunk. It is supposed to resolve itself once it is regulated or treated. I don't know if there is anything that can be done or if this can be looked into further.

Cyn719
02-15-2012, 06:58 PM
Hi Sonja.

Just checking in on little Apollo. Regardless of his problems he still sounds like a happy little guy! I know exactly how you feel, it's so hard for Penny and Apollo to get around but they still eat and want their treats!! Don't ever forget their treats!:D they wil
Let you know about it for sure!

Hugs to you and Apollo........he's always in my prayers xoxo

Altira
02-16-2012, 07:23 AM
Sonja, just keep talking to us that's all that matters. Your not alone.

apollo6
02-22-2012, 12:41 PM
Dear Janis, Julie and Addy
Update.
Dr. Board took skin scrapping, found one mite; this was less than last time.
Batches are getting larger, joining together.
Said slight bacterial infection, gave Apollo Convenia antibiotic shot to help. (Has had two already last year) Apollo still on Advantage Mulit topical ointment every other week.
Dr. Board said could have surgery to remove the large skin batches on back, wanted to start Mitaban(can get very weak from taking) I said I do not feel comfortable with applying small ointment on large batch because of the toxicity, sensitivity Apollo had with the Ivermectin, still has stomach issues, stomach gurgling, bowel movements are soft , sometimes a little better, but not normal since his experience with Ivermectin(throwing up almost every day)
Suggested to up Advantage to every week, wait until results on blood tests, also testing the sex hormones. Continually stressing the sex hormones if elevated could be causing the poor response to the Advantage.( I feel less mites is a positive)
Continually stressing me starting Apollo on Lysodern. Left upset
In two weeks gets blood panel and a new ACHT STIM.
This disease has taken a toll on Apollo, his back leg muscles are wasting and also his face. but he still is a handsome little old man.
Hugs Sonja and Apollo

Squirt's Mom
02-22-2012, 01:18 PM
Thanks for the update, Sonja. Once again, I agree with trying the Lyso. Maybe the UTK panel will help make things more clear for us all. ;)

Hugs,
Leslie and the gang

Cyn719
02-22-2012, 01:24 PM
Sonja

Sending you lots and lots of support strenght prayers love and hugs!! I know its so much to go through - but its our babies:) I get the muscle wasting - Penny has lost so much in her legs - hips - body and face also - she aged so much - but yes Apollo is still a handsome boy and Penny still a pretty girl - that will never change:)

xoxoxoxoxoxoxoxoxoxoxoxoxoxoxoxoxoxo

addy
02-24-2012, 02:20 PM
Hi Sonja,

When I originally spoke with Dr. Allen and sent him copies of Zoe's adrenal panel from UTK he told me 80% of dogs with similar adrenal panels will be fine on Trilostane. I wonder now with her problems, if she is the other 20% and perhaps Apollo is the other 20% as well.

Sending love and hugs to you and Apollo and Karma.

love,
addy

jmac
02-25-2012, 12:13 AM
Hi Sonja-
Thanks for your message! I'm always waiting for an update from you and your little man... :)

Take care-
Julie

Altira
02-26-2012, 07:58 AM
I don't know what to say. I never had to face these dreadful things. I can't imagine. I'm so so sorry.

Altira
02-27-2012, 07:01 AM
1-2-3-4-5! Been 5 days! (crossed arms tapping foot) Hows our Apollo?

Skye
02-28-2012, 03:16 AM
stopping by...........how are you and your dear Apollo?

apollo6
03-12-2012, 10:43 PM
Thank you all for your posts.
I am waiting for the results on the UNV Ten, adrenal/intermediate hormones.
Now his liver enzymes are going up, Vet wonders if it could be the Advantage multi plus using to kill the mites. Every since he was put on the ivermectin and other pesticides for the mites he has had problems.
ALT(SGPT)was 169 now 308(high) range 12-118
Alk Phosphatase was 243 now 572(high) range 5-131
GGT was 17 now 41(High) range 1-12
Bun as 38 now 40(high) range 4-27
Glucose was 153(high) now 96 range 70-138
Potassium was 5. now 5.9(high) range 27-38
Na/K Ration was 30 now 25(low) RANGE 27-38
platelet count was 487 now 483(high) range 170-400
Monocytes 891 now 902(high) range 0-840
no parasites found in fecal sample
Pancreas -spec cpl
330 was 457 still high but getting better.
Apollo still has good appetite, not throwing up, bowel is light yellow , indicating liver disease /problem. Still very present.
Legs continue to get worse.
Like Addy, will see what Adrenal panel comes back. Skin issues seem to change and other 's prop up. It is a vicious cycle.
The vet said I could do a test to diagnose the muscle/nerve issue (cost approx $1,500) but would not have a solution to resolve.
Could have the skin batch removed, but would Apollo survive.
So the vet says, we will do the best to provide Apollo a quality a life.
Every day is a gift with him. I don't know how long God will let me have him. He is now 13.5 years old. But he is still here.
Hugs Sonja and Apollo
p.s. sorry have not kept up with your posts. The fire/insurance /struggling in the business, Apollo's issues have overwhelmed me a lot.

Cyn719
03-12-2012, 11:39 PM
Thanks for the update.....no need to apologize.....you have a lot on your plate.....still in my prayers everyday

Kisses and hugs and a big tummy rub to you Apollo:D

Xoxoxo

Rene
03-13-2012, 11:35 PM
We love you Sonja!

apollo6
03-16-2012, 01:46 PM
Still waiting for Apollo's adrenal panel. Don't know why it is taking over a week for the results. Well it has been almost more than a year starting this journey. But, Apollo had the symptons for more than three years. The skin infections, the intestinal issues,the organs-kidney,liver,diarreha,urinating accidents,the change in his bark,
,the muscle wasting,have taken a toll on my little boy.
Just for today,he is okay. He struggles to walk,still dealing with the mitts,the stomach issues. He is such a little warrior.
Every day, is a gift with Apollo.
Just dealing with a lot. My prayers are with you and you Cushing babys.
Will post test results when get.
Hugs Sonja and Apollo

StarDeb55
03-16-2012, 01:48 PM
Sonja, it normally takes 10-14 days to get UTK panel results. This is because the testing is only done once a week, which I believe is Monday. If Apollo's samples were received later in the week, his test would not be done until the following week.

Debbie

addy
03-16-2012, 02:12 PM
Hi Sonja,

I am so glad you checked in. Keep the faith and count every day as a blessing.

Love you and little Apollo very much.

addy

Cyn719
03-16-2012, 02:50 PM
thinking of you and Apollo - I understand the muscle wasting all to well - your little guy in always in my prayers... :) You are a wonderful mom for sure!!!:)

tight hugs - lots of support, strength and prayers
xoxoxoxoxo

apollo6
03-18-2012, 08:22 PM
thanks for the support.
Still waiting for results and next week a skin scraping for the mitts.
Hugs Sonja and Apollo

Altira
03-19-2012, 05:27 AM
Nothing worse then waiting and not knowing. As if things weren't bad enough already. I think this disease is so crewl to dog and owner. When I first learned of it I cried and cried. I'd never servive it all. I got lucky my Kira was cured. But as I spend time here I see that it is as dreadful as I thought. My heart goes out to you for your courage and strength. And for the kindness you once offered me. Bless you. God be with you and Apollo..

addy
03-20-2012, 07:01 PM
Hoping you have your panel by now :)
Thinking of you with love
love,
addy

mypuppy
03-20-2012, 08:23 PM
Constantly in our thoughts here too dear Sonja and sweet Apollo.

Sending many tight hugs and well wishes..

We love you both,

xo Jeanette and Princess

Squirt's Mom
03-27-2012, 02:36 PM
Hi Sonja,

Apollo has been on my mind so I wanted to check in and see how things were going. Did you ever get the UTK results in? Would love to see them!

Hugs,
Leslie and the gang

apollo6
03-30-2012, 12:14 AM
Thank you all for your love and support.
results:
Base RANGE POST RANGE

cortisol 54.1(WAS 21.7) 2.-56.5 95.4(61.3) 70.6-151.2
Androstenedione 4.09(WAS 5.09) .05-.36 8.58(7.36) .24-2.90
Estradiol 67.0 (68.7) 23.1-65.1 52.3(72.6) 23.3 -69.4
Progesterone 1.76 (1.44) .03-.17 3.83(3.44) .22-1.445
17 OH PROGESTERONE 3.72(3.67) .08-.22 8.6(7.95) .25-2.63
ALDOSTERONE 18.6(17.3) 11-139.9 112.7(65.1) 72.9-398.5
So you can see some readings went up and other's went down. We know the TRilostane effects the 17OH PROG and the Aldosterone.

Vets feel Apollo cortisol is still within range , keep at 10mg. -2 days on 1 day off. Still can't understand that for over a year he has been on the same dosage.
The liver enzymes are elevated, but they were almost double before. Told the sex hormones could cause this but does not mean he has liver disease(doesn't have any signs of it). Told to restart the Milk Thistle for his liver.
Dermatologist keeps pushing the LYsodren because of his sex hormone elevations.
Regular vet and holistic feel because of his stomach/pancreas/ intestinal issues if he crashes on Lysodren it could be his downfall.
HOnest Kitchen Preference(veg/fruits) to give him some nutrional post with the turkey/chicken/rice/pumpkin I am giving him.
ON the lighter side, every-time I give Apollo a bill for cooking for him, he eats its.:eek::D
Still dealing with the mitts, legs are getting worse.
But one good thing, his spirit is high and he still enjoys life. He can be very demanding if I forget his treats after a meal.
Both vets say they are trying to keep Apollo as comfortable as possible. People still smile when they see him in his fire engine red stroller.
Apollo and I have had to make major changes with his disabilities. I often time remember how it used to be, and cry.
I am trying to be grateful for every day he is here. I even had the priest at my church bless him. He is 13.5 years old now. Both vets said he is still here because of me. Still do once a week physical therapy for his legs.
HUgs Sonja and Apollo.
Love you all.

Altira
03-30-2012, 08:04 AM
Awe... Apollo's a lucky guy, he has such a great mom. Still out there collecting smiles and eating the chef's bills... lol Kira and Mira used to pull me on a scooter. Almost ripped the thing right out of my hands once. Broke my heart when we had to stop. Yeah I know how that goes. All you mom's who are fighting Cushings are so amazing...

(((hugs)))

addy
03-30-2012, 09:28 AM
Sonja,

Zoe's derm vet freely admitted he was "old" and mainly uses lysodren. He did tell me he felt Zoe's skin problems had nothing to do with the Trilostane but her cortisol and wanted me to bump her dose 100% from 20 mgs to 40mgs SID.

IMS said she got a good chuckle over that because she knew I would never agree to it.

The endocrinologist camps remain divided on the whole "intermediate hormone" thing. It makes it so hard for all of us. I have read in papers the opinion that twice day dosing of Trilostane is sometimes better for dogs with skin problems.

All of this remains controversial. We follow our hearts, I guess.

love,
addy

apollo6
03-31-2012, 07:38 PM
Apollo just as so many issues ,skin-mitts,weaken immune system,calicos(forgot the spelling),muscle wasting,stomach,intestinal,pancreas issues and the list goes on. My vets goal is to keep Apollo as comfortable and happy as possible. We can't cure it and it has been hard to see the decline. So I try to enjoy the moments.
Apollo laid his head on my arm and just looked at me with love. He can be very stubborn, a dachshund thing. After dinner he makes sure he gets his treat. On the lighter side, I took him to the park in his stroller saw some dogs we know, bent down to pet them and Apollo lets out this winning noise(jealousy):eek:
Thinking of you often.
Hugs Sonja and Apollo

lulusmom
03-31-2012, 09:22 PM
Hi Sonja,

How long after the last dose of Vetoryl was the blood drawn for the UTK panel?

Glynda

jmac
04-01-2012, 10:52 AM
Hi Sonja-

Apollo sure does sound like a stubborn little guy. I love that he whines with jealously when you pet the other dogs! Hannah will try to climb up my legs and do a little whining when she is nervous or worried I will leave her. It's so cute.

It sounds like you are hanging in there and taking one day at a time, enjoying the time with your little guy. I think of you guys often and was glad to hear from you.

Take care,
Julie & Hannah

apollo6
04-01-2012, 02:35 PM
Dear Glynda test done 5 hours after dosage on empty stomach. Also in addition to the Trilostane applying Advantage Multiple on back weekly for the mitts, and the solxine for his thyroid. The stomach issues and prior vomiting started when Apollo was on the Ivermectin,had to take him off it.
Dear Julie thanks for checking in on me. Think about you and Hannah a lot.
Hugs Sonja and Apollo

jmac
04-01-2012, 08:12 PM
Sonja-
No need to apologize for not checking in. I know it is hard when you're busy. I had a hard time getting on here the past week or so because I have had so much going on (at work and in my head) and I feel guilty, but I know we all have lives outside of Cushing's. I appreciate you stopping by to check on my Hannah. I think of you and Apollo often, as well.

Julie & Hannah

labblab
04-03-2012, 08:30 AM
Dear Glynda test done 5 hours after dosage on empty stomach.

Sonja, have all of Apollo's UTK tests been done on an empty stomach? The reason why I ask is because trilostane needs to be given along with a meal in order for the ACTH testing to accurately reflect the medication's true effect. I will come back later and add a quote that explains this more fully. But the bottom line is that Apollo's cortisol likely would have been lower had his trilostane been given with a meal prior to the testing. If he has always been fasted, then you can indeed compare his testing results in order to see a trend. But you can also assume that all those results would have been lower had his tummy not been empty.

Also, since you are giving his trilostane on a schedule of 2 days on, 1 day off -- was the UTK test given after the day off, or after the 2 days on? I would think the timing would also influence the test results, since trilostane has a relatively short active life in the body.

I'll come back and add that quote about the importance of giving the trilostane with food on the morning of the ACTH testing.

Marianne

apollo6
04-13-2012, 12:00 AM
Dear Marianne
Apollo was given the Trilostane 5 hours before the test on an empty stomach with a little treat. Not sure.
Apollo can hardly stand or walk anymore, he had diarrhea again for two days. The skin liaisons on his back and face have not improved. Still giving him Advantage Plus topically every week. (the diarrhea started after I gave him the Advantage?)
Next week blood tests to see if his liver enzymes are going up even more. ( worried about liver, organs,etc.)
He has more Calcinosis cutis on his body -3 in all. He still eats, goes to the bathroom(he is a proper gentleman:)) demands his treats and drinks water. Has accidents occasionally. I am sad to say he has declined since the beginning of the year. I try to take each day as a blessing with him. His body is failing but his mind is very alert. I just don't know how long, only God knows. He moans occasionally, stomach gurgling all the time.
Rene(Snoopy's Mom) had me take Apollo to the park today. He wagged his tail when he saw the other dogs. On the lighter side, he was determined to drink Rene's Chai Tea, would not drink the water offered but would drink the Chai Tea-the little bugger. :D So despite all of Apollo's health issues , he still is a very stubborn little guy.
Hugs Sonja and Apollo
Blood test next Thursday. Apollo and I are very exhausted and overwhelmed with dealing with this disease.
Will let you know results.

addy
04-13-2012, 10:02 AM
Sonja, a day at the park with Renee sound wonderful for you and Apollo.

Each extra day is a blessing.

Thinking of you both. Tell Renee "HI":D:D:D:D:D

love,
addy

lulusmom
04-14-2012, 01:15 PM
Hi Sonja,

Sorry for being away from your thread for so long after asking my last question. My concerns with Apollo's level of experienced care remain. I have typed my comments in blue text below.

Base RANGE POST RANGE

cortisol 54.1(WAS 21.7) 2.-56.5 95.4(61.3) 70.6-151.2
Androstenedione 4.09(WAS 5.09) .05-.36 8.58(7.36) .24-2.90
Estradiol 67.0 (68.7) 23.1-65.1 52.3(72.6) 23.3 -69.4
Progesterone 1.76 (1.44) .03-.17 3.83(3.44) .22-1.445
17 OH PROGESTERONE 3.72(3.67) .08-.22 8.6(7.95) .25-2.63
ALDOSTERONE 18.6(17.3) 11-139.9 112.7(65.1) 72.9-398.5
So you can see some readings went up and other's went down. We know the TRilostane effects the 17OH PROG and the Aldosterone.

Apollo's cortisol remains out of control and until it is controlled, Trilostane's effect on the intermediates is likely irrelevant.


Vets feel Apollo cortisol is still within range , keep at 10mg. -2 days on 1 day off. Still can't understand that for over a year he has been on the same dosage.

Apollo's cortisol is absolutely not within range and I'm yet again dumbfounded by your vets unacceptable attitude and treatment plan. Like you, I also don't understand why your vet has kept Apollo on the same ineffective dosing for over a year. It is not surprising that Apollo's symptoms have never resolved, the demodex has been so difficult to control and his muscle weakness has never improved.

At 9.54 ug/dl, Apollo's cortisol is above the range that is acceptable for a dog exhibiting Cushing's symptoms. Even though his cortisol probably would have been lower had he not been fasted before the ACTH, it's hard to believe that his cortisol is being controlled adequately, given all his serious symptoms.

The liver enzymes are elevated, but they were almost double before. Told the sex hormones could cause this but does not mean he has liver disease(doesn't have any signs of it). Told to restart the Milk Thistle for his liver.

How high are the liver enzymes? Some dogs see vast improvement in ALKP but never return to normal; however, I wouldn't say that Apollo is one of them because his cushing's remains uncontrolled. As long as cortisol remains too high, so will the ALKP.

Dermatologist keeps pushing the LYsodren because of his sex hormone elevations.

Is the dermatologist aware of the unorthodox Trilostane dosing your vet has Apollo on and is she also aware that Apollo's post stim cortisol results on the UTK panel is too high? If cortisol is high, you can expect intermediates to be high as well. Yes, Trilostane has an effect on the intermediates but dogs with typical cushing's don't usually have a problem with those elevations as long as the cortisol is within range.

Regular vet and holistic feel because of his stomach/pancreas/ intestinal issues if he crashes on Lysodren it could be his downfall.

I believe Apollo's true downfall is two vets who don't appear to understand how to effectively treat cushing's. His stomach problems could very well resolve if you get him on an effective dosing regimen. Once daily dosing for two days and one day off is inappropriate, and most certainly not effective, for a dog with unresolved symptoms. Calcinosis cutis and demodex are two conditions that you normally see in a dog who has yet to be diagnosed, not in a dog who has been under treatment for over a year and half. Improvement in these two conditions, as it relates to dogs with cushing's, is contingent upon effective control of the disease responsible for them. In Apollo's case, it's cushing's.

In my opinion, your gp vet and holistic vet need to understand that Trilostane has a short half life, usually no more than 12 hours. According to the UTK panel, his once daily day dose is ineffective so on day three, with no dose at all, you have to expect that cortisol will go markedly higher. It's no wonder that poor Apollo's symptoms have not resolved.

Still dealing with the mitts, legs are getting worse.

It's possible that Apollo's leg problems are not related to cushing's but I'm not so sure. Unfortunately, there's no way to know until he's on an effective treatment plan and cortisol is being effectively controlled throughout every 24 hours period. With all that is going on with your boy, it is imperative that your vets strive to achieve round the clock control.


Both vets say they are trying to keep Apollo as comfortable as possible.

I believe that Apollo can be a lot more comfortable if both vets read the Dechra product insert so they can learn how to properly treat a dog with cushing's. They need to know how to assess a stim test and gain an understanding of how Vetoryl works and how long it works.

Still giving him Advantage Plus topically every week. (the diarrhea started after I gave him the Advantage?)

I don't believe Advantage Plus should be given weekly and the fact that you are giving it to Apollo every week scares me to death. Clinical studies done to prove efficacy and safety of this product involved dogs with demodex and treatments were applied at 0, +28, +56 and +84. Did your vet contact the manufacturer or a specialist to ask if weekly dosing is safe?

Next week blood tests to see if his liver enzymes are going up even more. ( worried about liver, organs,etc.)
He has more Calcinosis cutis on his body -3 in all. He still eats, goes to the bathroom(he is a proper gentleman) demands his treats and drinks water. Has accidents occasionally. I am sad to say he has declined since the beginning of the year.

I too am sad because I believe a good part of his problems are cushing's related. Unless Apollo has another underlying issue that is compromising his immune system, he should have never developed demodex and had his cortisol been properly controlled, he should have never developed calcinosis cutis.

If your vets are recommending that you continue to treat Apollo, rather than keep him comfortable, then they need to follow protocol and do it right. I've recommended this in the past and I'm going to recommend it again. Please get Apollo to an internal medicine specialist. His problems have not only not gotten better under your current vets' care, they have gotten worse.

Blood test next Thursday

Can you tell me why you are having bloodwork done? Is it to check liver enzymes? I think you can safely assume that with Apollo's cortisol being too high, his unresolved demodex and calcinosis cutis, you can expect to some abnormalities on the bloodwork, most of which can be directly attributable to Apollo's uncontrolled cushing's.

Apollo and I are very exhausted and overwhelmed with dealing with this disease.

At this late date in treatment, unless Apollo has some undiagnosed problem that your vets haven't told you about, Apollo should not have to be dealing with the discomfort and pain of calcinosis cutis and demodex. These are very serious conditions that are the direct result of cortisol's adverse effects on metabolism and immune system. If your vets don't feel this is cushing's related then perhaps they can explain why Apollo is still having such horrible problems.

Altira
04-14-2012, 05:34 PM
Sonja,

Wow what a mess. If Apollo is still not better I'd sure take Glyanda seriously. When Kira took Trillostine for that brief period I did see changes in her. But skin problems were never a problem for her. Just the food and water thing and those were affected. I gave it to her everyday and I worried because it was a liquid and some always ended up on the floor! The vet said not to worry about it. So I got the impression that the dosing was not that serious. I mean if she got a little too much it wasn't that big a deal. But we only took it for about a month. If I were you I'd either find a new vet or just change the dose myself slightly. And keep some prednisone handy. Boy what a mess. You need to do something don't you think? If its not working. I'm so sorry. (((((hugs)))))

apollo6
04-14-2012, 07:52 PM
Dear Glynda and Janis
Will run by vets and decide on internal specialist.
The dermatologist is the one to say use weekly on the Advantage and every since he was put on the pesticide/flea medication he has had diarrhea , stomach issues, and I have been very concerned about the weekly dosage.
And you are right if his cushing would be under control why would he have all these skin issues. And the leg issue could be the intermediate and calcification on his back. He has herniated disc 4,5, 6 from prior injury.
And I am baffled by the vets keeping him on such a low irregular dosage. But this was the dermatologist once again who recommended this irregular dosage. purpose to have a higher cortisol to fight the mitts? Didn't make any sense to me.
Same dermatologist wanted me to put Apollo on Mitan(not sure of spelling).
The strange thing is Apollo never had hair down his front neck and belly and after taking Trilostane now has fur on front of neck and some on his belly?
Blood test to see if liver enzymes are still high then decide on Trilostane dosage.
Regular vet does not like Apollo being on the Advantage medication.
Thank you for your input

Altira
04-14-2012, 10:01 PM
Your suspicions are probably correct. If cushings is the problem then you should see an improvement. At least thats the way i inderstood it. When Kira was taking Trillostine she was under a IM-Cushings specialists care. I remember everyone here being concerned that the dose was too high but it proved not to be. Or maybe it wasn't used long enough to prove to be. Wishing you the best of luck!!!!

apollo6
04-19-2012, 02:39 PM
Friday another blood test to see if liver enzymes are going up to determine if intermediate hormones or the weekly Advantage is causing this issue. Had diarrhea Tuesday and Wednesday . Today a little better .
Well Apollo sees the internal medicine specialist next Friday. Apollo has quite a support team, Mom and Rene are coming with me for support. Will have the blood test by then to also review. Will try to listen then speak . Very anxious .
Will keep you posted.
Hugs Sonja and Apollo
ps.Thanks for checking in on me.

lulusmom
04-19-2012, 02:46 PM
Yay, Sonja! I'm so happy that Apollo will be seeing an internal medicine specialist. I'm glad that your mom and Rene will be accompanying you on Friday but just remember that you'll have a whole bunch of us members with you in spirit. That waiting room is going to be packed. :D

Hugs,
Glynda

Altira
04-20-2012, 01:56 AM
Friday another blood test to see if liver enzymes are going up to determine if intermediate hormones or the weekly Advantage is causing this issue. Had diarrhea Tuesday and Wednesday . Today a little better .
Well Apollo sees the internal medicine specialist next Friday. Apollo has quite a support team, Mom and Rene are coming with me for support. Will have the blood test by then to also review. Will try to listen then speak . Very anxious .
Will keep you posted.
Hugs Sonja and Apollo
ps.Thanks for checking in on me.

That reminds me of when we were investigating adrenal surgery for Kira. I had a list of 40 questions to ask Dr. Sebestyen. I took my sister with me. SHE READ MY QUESTIONS to him... I was too nervous. I made my husband go too.

Yeah a support team is a good thing to have for sure! ;)

addy
04-20-2012, 07:44 AM
I am so glad Renee and Mom are going along as well as all of us here cramming into the car and waiting room.

Hugs and love and support dear sister in battle. You go girl!!!!!!

Love,
addy

Squirt's Mom
04-20-2012, 09:03 AM
We're all with you and Apollo today, Sonja! I'm so glad that Rene and your mom are able to go with you today. That Rene is a good girl; ya'll are lucky to live so close to each other. Tell her I said, "Howdy!"

Let us know what you learn and any changes for Apollo that result from this visit, if any.

Hugs,
Leslie and the gang

Altira
04-20-2012, 07:24 PM
Me too! :o Wag wag... I wanta know too!

apollo6
04-22-2012, 02:54 PM
Thank you all for your support:Addy,Janis,Glynda,Marianne.
Will have to rent a bus to get you all in.:eek::D

My vet called with Apollo's blood results. His readings have gotten better? I will get the actual numbers faxed Monday. Something about an Alt reading of 136 and other readings that have decreased.
I wonder if keeping Apollo off the Advantage Multi for 9 days may be the reason for the better reading?
Just hate him being on so many things:Trilostane 10mg,Soloxine .1mg, Advantage Multi every week, Calamix 125 mg twice daily
Apollo,s salvia gland has gotten more swollen and is bleeding since it gets in the way when he eats, so my vet has Apollo on Calavmix(not sure of spelling) to see if can get swelling done. Hopefully will not need biopsy. It seems like things continue to pop up. But we adapt, we cope, we handle has best as we can. All I know is it still baffles me that Apollo is on such a low dosage and is still maintaining. Over 1.8 years ago when the first IMS put Apollo up to 12.5 mg.Trilostane his cortisol dropped and he did not feel well.
The appointment is April 27. Will have all of you with me.
Hugs Sonja and Apollo

jmac
04-22-2012, 03:27 PM
Hi Sonja-
Glad to hear the level has dropped. That's one good thing. I hope the Clavamox helps with his salivary gland.

Have you tried Apollo on any liver supplement, like Denamarin? Hannah's levels are completely normal after taking it for a few months. They haven't been normal in over a year. Maybe that would help???

Thinking of you and hoping for more positive news after the next test!

Julie & Hannah

Altira
04-23-2012, 04:42 AM
The below statement is what happened to my Kira. Her current problems first showed up a week after starting Trilostane.....

“Alternatively, some dogs become very uncomfortable if arthritis, allergies, or other inflammatory conditions are unmasked once the excess cortisol is removed, paradoxically reducing the animal's quality of life.“

You didn't say... Was there a stim test done too? Maybe it could go either way. She could have problems either way. Too much or too little trilostane. But what do I know.. I do know that it was the 8hr stim test that told us when she had Cushings and when she did not. It was a very reliable test for us.

apollo6
04-28-2012, 05:34 PM
Dear Friends
Will post later. Pretty exhausted from visit, IMS said would give me copy of notes.
Just an article I copied from the web.USING TRILOSTANE TO TREAT CUSHING’S DISEASE IN DOGS
For dogs with hyperadrenocorticism caused by a pituitary tumor, there are now
two medication options for treatment. Each has drawbacks and risks, and
neither drug is 100% effective. Both drugs are costly and both require blood
testing to monitor for problems and to adjust the dose of medication to fit what is
needed by the dog.
Vetoryl (trilostane) benefits:
*Longer life expectancy
*Slightly greater efficacy – 90% of dogs will respond vs. 80% for Lysodren
(mitotane).
*Treats secondary hyperparathyroidism – calcium and phosphorus imbalances
that may occur in dogs with Cushing’s disease.
*Can be used for adrenal tumors as well as pituitary tumors.
*Can be used in cats and ferrets.
*Also treats atypical Cushing’s disease, in which other adrenal hormones besides
cortisol are affected. (This typically occurs in Scotties and ferrets.)
*Less risk of hypoadrenocorticism than Lysodren.
*Milder side effects than mitotane.
Vetoryl (trilostane) drawbacks:
*Greater chance of sudden death shortly after starting on the medication. If they
do well on it they usually live longer than dogs on Lysodren do, but they can also
die suddenly early on.
*The side effects tend to be milder but are also more common. Side effects
include hypoadrenocorticism, acute adrenal gland necrosis (cell death),
hypercalcemia (elevated calcium level) and hyperkalemia (elevated potassium
level). 64% of dogs will have vomiting, diarrhea or lethargy.
*Can be toxic to humans. Wash hands after handling these pills, and wear gloves
when handling these pills if you are pregnant.
*It’s dangerous to try Vetoryl first and then try mitotane. If you want to try one
drug at a time, try the mitotane first.
Lysodren (mitotane) benefits:
*80% effective
*We’ve been using it for years and are more comfortable with managing side
effects if they do occur.
Lysodren (mitotane) drawbacks:
*Can cause toxicity and some dogs cannot tolerate the side effects, such as
vomiting and diarrhea. 25% of dogs treated will develop one or more side
effects, including lethargy, weakness, poor appetite, vomiting or diarrhea.
*Life expectancy is shorter than for dogs on Trilostane
*Relapse is possible
*About 5% of treated dogs develop hypoadrenocorticism and need lifetime
medication for that disease instead – so instead of making too much of the
adrenal hormones they no longer make enough. This in and of itself can be life
threatening.
*May affect insulin dose in diabetic patients.
*As with trilostane, it can be toxic to humans. Wash hands after handling the

I have a lot to think about.
Hugs Sonja and Apollo

Squirt's Mom
04-28-2012, 05:42 PM
Hi Sonja,

Could you post the link to that article you copied and posted? I have several questions, and others might have as well, that I hope the whole article will help explain. Thanks!

I hope Apollo is doing alright. Let us know when you can.

Hugs,
Leslie and the gang

Bailey's Mom
04-29-2012, 03:40 AM
Sonja-
Thank you for that excerpt. It is certainly one of the most straightforward ones I have ever seen.
Thanks!
-Susan

addy
04-29-2012, 09:42 AM
Sonja, what's wrong? Did the IMS want to put Apollo on Lysodren?

Are you ok?

love,
addy

lulusmom
04-29-2012, 11:49 AM
Hi Sonja,

Thanks for posting the information on Lysodren vs Vetoryl and while most of the statements are corrects, some are not. Whether you are contemplating switching Apollo to lysodren or from once to twice daily dosing of Vetoryl, it is a big decision and I'm happy that you are researching so you can make the best decision for Apollo. There is a lot of erroneous information on the net so my advice would be to try to find copies of clinical trials or papers written by well respected endocrine experts.

I was able to find the page you copied on a gp vet's website. The link to this text is www.bestfriendsvet.com/pdffiles/Trilostane%20Tx%202010.pdf

I'm not sure if statements made are based on this vet's experience with his own patients or whether they have access to recent studies that are contrary to the published studies I've read. If I can find the time, I'll contact the author and ask. My comments are below in blue.

Vetoryl (trilostane) benefits:
*Longer life expectancy

There have been studies that have shown that there is no difference in life expectancy. The abstract below involved a five year study with more test subjects than other studies:
http://www.ncbi.nlm.nih.gov/pubmed/16355673


*Slightly greater efficacy – 90% of dogs will respond vs. 80% for Lysodren (mitotane).

I'm not sure where these statistics came from but most studies I've seen show that there is little difference in efficacy rate. In one study
done in 2002, results stated were "Trilostane was found to be nearly as effective as mitotane in resolving the signs of hyperadrenocorticsm."

http://www.fincaverde.de/Pics/study/Neiger-Ramsey.pdf

*Also treats atypical Cushing’s disease, in which other adrenal hormones besides cortisol are affected. (This typically occurs in Scotties and ferrets.)

UTK would beg to differ with this statement. Results of studies show that Trilostane does increase adrenal hormones; however, there is no evidence that these elevations cause clinical problems with a dog. This was my experience with my cushdog, Lulu.

*Greater chance of sudden death shortly after starting on the medication. If they do well on it they usually live longer than dogs on Lysodren do, but they can also die suddenly early on.

True and false based on studies. Original clinical trials done by Dechra prior to approval here in the states showed that some dogs experienced sudden death. I believe the starting dose in these studies were much higher than those recommended today. We've seen more case studies here than most vets will see in a lifetime and I cannot remember a sudden death of any a dog being treated with Trilostane. More recent studies, which I can't find at the moment, show that dogs on long term treatment of Trilostane can develop hypodrenacorticism (low cortisol) any time. Thus, the need for close monitoring. I was able to find an internal medicine vet's website who cited some of his own case studies and provided some very sound advice.

http://www.metro-vet.com/newsletters/article_10summer.php

Again, no studies to my knowledge have been done that show dogs treated with Trilostane have a longer survival rate.

*It’s dangerous to try Vetoryl first and then try mitotane. If you want to try one drug at a time, try the mitotane first.

I'm not sure where this information came from but I think there is more concern from switching from Vetoryl to mitotane due to adrenal necrosis. According to Dr. Edward Feldman:

"Any dog switched from one to the other should receive no medication for at least six weeks. Both mitotane and trilostane have been linked with adrenal necrosis. Mitotane, as a cytotoxic drug, certainly acts by killing cells. Trilostane, however, is the only drug that has been associated with necrosis, adrenal rupture, acute bleeding, related illness and/or death. Therefore, switching from one drug to the other may not be the cause of necrosis or rupture, since this adverse reaction has been demonstrated to occur in dogs that have only received trilostane. Mitotane has not been associated with adrenal rupture."

I'm hoping that other members will have some feedback or can cite more recent studies on the areas I've touched on. In the meantime, I'm anxiously awaiting your report on Apollo's visit with the IMS.

apollo6
04-29-2012, 04:59 PM
Will hopefully get notes by Tuesday. Thank you for all your support.

jmac
04-29-2012, 07:09 PM
Looking forward to hearing how Apollo is doing and what the plan is. Always hoping you guys are doing well...

Julie & Hannah

dajophlptt
04-29-2012, 07:40 PM
[QUOTE=lulusmom;74683]Hi Sonja,
]

*It’s dangerous to try Vetoryl first and then try mitotane. If you want to try one drug at a time, try the mitotane first.

[COLOR="blue"]I'm not sure where this information came from but I think there is more concern from switching from Vetoryl to mitotane :

Did you mean the opposite? Just asking.

Dave

frijole
04-29-2012, 07:51 PM
[QUOTE=lulusmom;74683]Hi Sonja,
]

*It’s dangerous to try Vetoryl first and then try mitotane. If you want to try one drug at a time, try the mitotane first.

[COLOR="blue"]I'm not sure where this information came from but I think there is more concern from switching from Vetoryl to mitotane :

Did you mean the opposite? Just asking.

Dave

Dave, I'm not Sonja but she found this information on a vet's website. We think it is their opinion. If you read up a bit you will see where Glynda indicated there were a few statements that were cause for concern. I would take this as one vet's opinion. Kim

dajophlptt
04-29-2012, 08:15 PM
I am not trying to be difficult but don't both of those statements say the same thing? I am very interested in having to switch because we may be facing it too.

Dave

labblab
04-29-2012, 09:51 PM
I am very curious, too, about the GP vet's published statement that it is somehow more dangerous to switch from trilostane (Vetoryl) to mitotane (Lysodren) rather than vice versa. I have not seen a similar statement or warning made anywhere else. In honesty, I'm not sure exactly what it is that Dr. Feldman is intending with his comments. But I do not interpret his comments as being a specific warning that a trilostane-to-mitotane shift is riskier than the alternative: "Therefore, switching from one drug to the other may not be the cause of necrosis or rupture..."

For whatever it's worth, recently I spoke by telephone with a Dechra technical representative re: wash-out periods associated with shifting from Vetoryl to Lysodren. Nothing was said about it being a riskier shift than switching in the opposite direction (Lyosdren to Vetoryl). So I, too, would be really interested in knowing the basis for the concern expressed by the GP vet.

Marianne

Squirt's Mom
04-30-2012, 10:36 AM
I think I understand what Dave is saying and I wondered the same thing. Since the Trilo (Vetoryl) stays in the body for such a short time, it would be logical that there is less risk switching from Trilo to Lyso than vice versa as the Lyso lasts longer in the body.

However, and this is one of the reasons I prefer Lyso to Trilo, Trilo hasn't been around all that long when looking at the big picture - it is the "new kid on the block", including it's use in EU before it was approved here. As such, the cushing's community is still learning exactly how this drug will work in the long run, the long-term ramifications and various reactions. Which leads to confusion/disagreement in how to use it - what dose to start on and how often to give it; one vet thinks pred is a waste of time, another says give it to the parent to have on hand just in case; one vet says it is perfectly safe, one says he has had lots of issues with it.

So, logic won't always work. It may be that Trilo actually has a long lasting effect we simply aren't aware of yet which would make switching from it to Lyso more risky.

But, again, this seems to be a quote based on one particular vet or vet clinic's experiences with both drugs, not a scientific study supported by peer review and publication in veterinary journals. As such, we don't know how this vet has used either drug that might have a bearing on their conclusions. It is possible they are misusing one or both and therefore their observations are skewed. ;)

As Glynda said, we have seen more cases here than most vets will see during their entire practice and we have not seen quite a few of the things this article claims regarding Trilo or Lyso so without scientific support for their statements, don't take them to heart. I could go out today and poll 20 different clinics and come back here to report 20 different claims - all convinced they were right based on their own experiences.

This is where we have to find a vet we can trust, where we have to educate ourselves, and where we have to put our fears about one drug or the other out of our minds so we can make the best decisions for our babies. Trilo will not work for all pups; Lyso will not work for all pups. So we have to be able to accept the fact we may have to change treatment at some point. If our fears stand in the way, our babies may suffer needlessly. Trust your own knowledge, trust us, trust the experts like Feldman and Peterson, trust your vet, trust the science. Observations are important and a beginning step in further understanding but it is just a beginning, not a foundation for wide-sweeping conclusions that we can all base our decisions on. ;)

Hope this didn't further confuse things!
Hugs,
Leslie and the gang

apollo6
04-30-2012, 03:12 PM
Thank you all for your input. Will try to get IMS notes. This is very confusing so many opinions.
Sonja and Apollo

Altira
04-30-2012, 09:10 PM
((((hugs)))) :(

apollo6
04-30-2012, 10:41 PM
Below you will find the vets notes: it is very long
Your patient, Apollo, a 13 yrs & 6 mo male Dachshund-Miniature belonging to Sonja & Douglas Honeyman,
was presented to me for evaluation of Cushing's disease, skin lesions, neuromuscular disease. The historical
information provided and my physical examination findings were as follows:
Previous History: Had since he was a puppy. At 6 mos old he was vomiting and then got better.
Bouts with pancreatitis through his life.
2008 face swelled up and his belly tumed black hives all over body. Had pus coming out of his body. Was on
a lot of medications. After this is when things got worse.
When he was initially seen he was PUlPD, pot bellied, lethargic, elevated liver values. Stiff circumducting gait
with muscle wasting and weakness seen at that time. RIO Cushing's V$ other myopathy vs spinal disease.
Started trilostane with good control and resolution of Cushing's signs (PU/PD). Static weakness and gait
abnormalities. Neurologist recommended muscle work-up in 2011 but not performed.
Currently being treated with trilostane.
Adrenal sex hormone panel performed 3/15/12 showed post cortisol 95.4 (ideally <50 for good control) plus
elevated 17 OH prog, prog, and androstenedione elevations.
Prior to that ACTH stirn was 1/12/12 showed good control (post 4.2).
Calcinosis cutis, deep pyoderma and demodecosis being treated for the past year approximately.
December U/S was done showed enlarged hyperechoic liver and bilateral adrenal enlargement.
Moans while sleeping.
Current History: Main issues currently include 1) progression of weakness significantly in the fast 6 months.
Includes thoracic and pelvic limbs and muscle wasting is progressive in the last 6 months. He is still able to
walk, but apparently very difficult.
According to the owner, about 3 months ago had an MRI performed at VICSD and calcified disks were seen
at L 3, 4, 5.
Treated by Dr. Boord at ADC (records are not available at the time of consultation). Deep pyoderma,
demodex, and calcinosis. She recommended treatment with Lysodren, but owner is concerned about using
this.
Moaning, stomach gurgling. Appetite is normal to increased. No vomiting, diarrhea is intermittent, two days
last week. Previously thought that GI signs were related to ivermactin. Stopped ivermectin and diarrhea on
and off. Now treating demodex w~h decreased trilostane dose (on two days, off one day) and
Thirst and urination are normal. Urinates in the house and has accidents, but owner feels that this is probably
related to his difficulty moving to go outside.
Apr-30-2012 11:38 AM Veterinary Specialt 8588757525 2/4
re: Apollo Honeyman Veterinary Specialty Hospital Page: 2
PT water therapy for his legs.
Symptoms of HAC are improved on trilostane.
When he was off trilostane for a month, he was initially better, then he got symptoms of Cushing's came back
and then restarted on trilostane.
Hair has regrown quite a bit after starting trilostane.
Current Medications: Soloxine
Clavamox for one week for oral mass.
Carafate for stomach acting up, (gurgling and gas).
trilostane currently getting 10mg once per day 2 days on and 1 day off.
melatonin
lignans
Supplements from Dr. Weingarten
standard process adrenal gland and musculoskeletal
Cell Advance (Vetriscience)
Colostrum
liquid immune Rx
Fennel Cardigren
Choco- something for stool (to soften stool)
Cosequin
Current Diet: Cooked turkey and chicken
Brown and white rice pumpkin
yogurt
occasional cooked egg whites
lean turkey
Honest Kitchen and Bark dry mix with water
Honest kitchen Preference
Physical Exam:
Weight: Approximately 5kg
Pulse: 100 BPM
Respiration: 32
Previous History:
Attitude: BAR. Hydrated.
EENT: OU: Cornea, sclera, anterior chambers clear. MM pink, moist, CRT < 2 sec, no oculonasal or aural
discharge. There is a firm, approximately 1em flesh mass at the left lingual base.
Fundic: Bilateral nuclear sclerosis.
Lymph Nodes: Mildly enlarged submandibular LN enlargement on the left side (5mm).
Circulatory: Normal rhythm, no murmurs, strong and synchronous pulses.
Respiratory: Clear lungs, no crackles or wheezes, eupneic.
Abdomen: Soft and non-painful, no palpable masses, organomegaly or ascites.
Musculoskeletal: Marked generalized muscle wasting. Body Condition Score;;;: 4/9. Ambulatory but abnormal,
dysmetric gait in all four legs
Urogenital: No abnormal findings.
Integument: Large patch of hyperpigmentation and lichenification on left zygomatic area and on lumbar area.
Multiple small raised crusting lesions (right ventral cervical area, right lateral thorax, over larger
hyperpigmented lesion on lumbar region). Patchy truncal alopecia and over tail.
Rectal: No significant findings.
Nervous: Normal mentation. Stiff-legged, dysmetric gait in TL and PL, mild circumduction, tail extends.
Apr-30-2012 11:39 AM Veterinary Specialt 8588757525 3/4
re: Apollo Honeyman Veterinary Specialty Hospital Page: 3
Assessment: 1) Cushing's syndrome, PDH. Diagnosed with PDH in June 2010. Treated with trilostane, with
improvement in clinical signs of Cushing's (PU/PD). Last ACTH stim was 3/15/12, not consistent with good
controJ (post cortisol is 95.4ng/ml, ideally want 20-50ng/ml). ACTH on 1/12/12 does show good control (post
4.2ug/dL). Currently receiving trilostane 10mg PO once per day 2 days on, 1 day off.
2) Markedly progressive neuromuscular disease (suspect possibly Cushing's myopathy), however other
causes have not been ruled out.
3) Elevated sex hormones while on trilostane, rlo likely related to trilostane administration, vs sex hormone
secreting adrenal tumor. Last ultrasound in December 2011 shows bilateral enlargement, arguing against
adrenal tumor.
4) Calcinosis cutis. Chronic focal deep pyoderma and demodecosis, rlo systemic immune suppression (due to
poorly controlled Cushing's vs other).
5) Oral mass, rlo neoplasia, vs inflammatory, vs infectious, vs other. Recommended surgical biopsy, three
view thoracic rads first, as this could be a malignancy.
Plan: CE: Mrs. Honeyman's biggest concerns are 1) gait and muscle wasting, 2) skin lesions 3) stomach
gurgling and 4) moaning.
For CP weakness recommended neuromuscular evaluation. Very well could be consistent with Cushing's
myopathy, which rarely responds to treatment for Cushing's disease. It is unlikely that even with any
alterations in treatment for Cushing's this will not reverse, and will probabJy continue to progress.
We discussed that the clinical significance of elevation in sex hormones is unknown. I would not typical
consider checking the adrenal sex hormone panel in a dog on trilostane as I would expect the intermediate
hormones to be elevated, and do not know how to interpret this information. Most dogs on trilostane also do
not have evidence of adrenal dIsease after treatment (Le. elevation in hormone levels does not cause
problems in the majority of cases that we treat with trilostane). Apollo has clinical evidence of adrenal disease
(calcinosis cutis, chronic pyoderma, demodecosis), so it may be possible that 1) his cortisol level is not well
controlled (as evidenced by the post cortisol levels from 3/15), or 2) the intermediate hormones are causihg a
problem for him. Given that he has evidence of calcinosis cutis, resistant deep pyoderma and demodecosis
could try treatment with Lysodren. The dermatologist treating him is recommending this, and I would agree
with her that rt is a reasonable option for therapy in a dog not responding well to trilostane therapy. I would
recommend treating with standard doses (as opposed to a low dose regime). Mrs. Honeyman is concerned
about his sensitivity to drugs and possible toxic effects of Lysodren. We discussed these (GI side effects,
adrenal collapse, death) but that this medication can be used safely, and was for years. Need to be diligent
about monitoring his clinical signs and ACTH stimulation test. Skin changes may also be chronic and nonreversible
even with Lysodren therapy. I would defer to a dermatologist regarding therapy for the deep
pyoderma and demodex.
I am more concerned about the oral mass. This could definitely be a neoplastic process. Recommend surgical
biopsy. Maybe slight increase in anesthetic risk given his overall condition, however it is not contraindicated.
Three view thoracic rads should be performed prior to surgery.
With regards to the moaning and stomach gurgling, J am unsure of the exact cause for these signs. Chronic
pancreatitis, abdominal, spina! or musculoskeletal pain, or behavioral (for the moaning) could be considered.
In light of lack of other GI specific signs at this time. I would not recommend additional therapy for these
symptoms at this time.
t recommended increasing trilostane to daily, and recheck ACTH stirn after daily therapy for 10-14 days. Also
consider discontinuation of supplements, as these may have unknown GJ, hepatic, and endocrine effects that
Apr-30-2012 11:39 AM Veterinary Specialt 8588757525 4/4
re: Apollo Honeyman Veterinary Specialty Hospital Page: 4
are unmeasurable. This is obviously up to the discretion of the Honeyman family and other doctors
overseeing his care.
If Mrs. Honeyman would like to consider Lysodren therapy, I am also happy to oversee the loading and
maintenance phase of this medication.
We checked Apollo's blood pressure and it was normal at 140mmHg.
Thank you very much for allowing me to be of service to you and your clients. Please feel free to contact me
with any questions or concerns.

Very knowledgeable and kind IMS
Hugs Sonja and Apollo