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Thread: Introducing Sweetie - Sweetie has passed

  1. #11
    Join Date
    Apr 2009
    Location
    York, PA.
    Posts
    11,037

    Default Re: Introducing Sweetie

    It is really unusual for a cushdog to have concentrated urine. The elevated cortisol makes the kidneys work harder which in turn causes the dog to urinate voluminous amounts so in order to keep up with the kidneys the dog has to drink a lot more water, which causes the urine to be diluted and to have a low specific gravity.

    Another anomaly with Sweetie is that her ALP is lower than the ALT. The majority of time in dogs with Cushing's that ALP level is really elevated, we have seen ALP numbers in the 1000's with the ALT only being moderately high so I am a bit puzzled, getting those LDDS test results and posting them will help us get a better picture.

    Hugs, Lori

  2. #12

    Default Re: Introducing Sweetie

    OK, I have lab report but have no idea what the numbers mean. This is a new one for me so I need to find a better explanation than what is on the IDEXX report. I have a feeling some of you will know what they mean.

    Pre Dexamethasone 3.0 (1.0-6.0)
    post 4 hr 3.8
    post 8 hr 4.9

    Comments/insight welcome.

    BTW, re: the earlier lab numbers I posted, the recent labs went to Antech; the older ones from right before I got her were sent to IDEXX (always my preference).

    Julie

  3. #13
    Join Date
    Mar 2016
    Location
    Gulfport, FL
    Posts
    127

    Default Re: Introducing Sweetie

    Hello and Welcome Julie,

    I will take a stab at this but could be totally wrong. I'm sure someone more experienced will come along and correct me if I am. So don't freak out or anything until then. If this is not a false positive (Clinical Signs seem to point to this possibility) then it's inconclusive to the type of Cushings.

    If
    4 Hour >1.5 µg/dL and >50% of baseline
    and
    8 Hour >1.5 µg/dL and >50% of baseline
    then

    "Perform high-dose dexamethasone suppression, endogenous ACTH concentration and / or abdominal ultrasound to discriminate between PDH and ATH."

    If my interpretation is correct then I would get an abdominal ultrasound done at an IMS. It will be the best value and you will get a clear picture of what's going on. I'm not sure that I would trust an internist telling me "Positive Cushings".

    Hope this helps - Darrell and Lolita
    Last edited by dsbailey; 09-12-2016 at 06:33 PM. Reason: Typos

  4. #14

    Default Re: Introducing Sweetie

    She already had the ultrasound. She had it before the LDDS which is why they did that. Her liver is enlarged, her gallbladder is enlarged and both her adrenals are enlarged. No obvious masses seen. In terms of symptoms, she is extremely lethargic; has no exercise tolerance at all. She pants in air conditioned house. She has lost all of her undercoat. She is truly obsessed with food and has gained over 5# since I got her 13 months ago. The hunger is getting worse. She is tanking up on water but not peeing that much more. Don't know why. She is having some accidents in the house and the last urinalysis was almost a month ago so I don't have really current info there. She can hold it a long time (except in the middle of the night...lol). Thyroid is very low for the breed. ALT and ALP slightly elevated. Cholesterol is elevated but I would expect that based on the weight gain. Internist wasn't surprised at positive LDDS at all.

    Julie

  5. #15
    Join Date
    Apr 2009
    Location
    Florida
    Posts
    1,452

    Default Re: Introducing Sweetie

    Hi, Julie! Since the ultrasound showed both adrenal glands enlarged, this points to pitutary-dependent Cushing's (PDH). The LDDS does confirm the presence of Cushing's. How much does Sweetie weigh? Hopefully, somewhere in the range of 20 lbs. since current dosing guidelines are 1 mg. trilostane per 1 lb.

    You might want to ask your vet why she is recommending twice a day dosing. This is usually reserved for dogs who have concurrent diabetes and/or high blood pressure so that those conditions are kept level for a full 24 hours. Twice a day dosing is more difficult to maintain since it requires 12 hours between doses and each dose is administered after a meal. A once a day morning dose of 20 mg. would be easier all around.

    Have you talked with your vet again about trying Sweetie on thyroid medication? At this point you wouldn't want to start it until after the first month of trilostane but definitely something to discuss after that point.

    Has your vet given you information about the protocol to measure Sweetie's cortisol levels after starting trilostane? Here is a link to Dechra's technical brochure where, on page 11, this protocol is described in detail:

    http://www.dechrace.com/pdfs/vetoryl...alBrochure.pdf

    It is important to keep prednisone on hand in the event of a negative reaction to the trilostane. Unless you have a 24 hour vet, this is important to discuss with your vet. An "emergency" dose is .25 mg/kg. Also, be sure to give the trilostane after a full meal and, because the trilostane is fat soluble, it is advised to give it with something fatty, i.e., rolled up inside a piece of cheese or peanut butter.

    We will be right here with you as you start treatment so please ask us any questions you have. You will do fine!
    Judy H. (Always "Maggie and Abbie's Mom" & now "Sadie Sue's Mom")
    Venice, FL

  6. #16

    Default Re: Introducing Sweetie

    Hi, Judy Maggie. I so appreciate the support.

    Sweetie is now 22.5# and is on 10 mg Trilostane in the am, 10 in the pm. I can see how much of a PITA twice a day dosing is going to be since she has to have her Denamarin on an empty stomach and I feed her 3x/day and sometimes a small snack.

    Internist doesn't want to supplement her thyroid right now because she feels like it is secondary to Cushings and will normalize. We will repeat blood work in a month or two. Regular vet had her on Clavamox and Metronizadole initially when liver values showed up kinda wonky (technical term...lol) so I'm curious if there is any change since she finished them.

    No mention of prednisone but I will ask. She had her first dose last night and another this morning. If she didn't have a reaction, should I assume there will be none or could it happen at any time. She did tell me that if she gets diarrhea, vomiting or stops eating, to discontinue and call her.

    I hate feeding her any more fat than necessary because I have gone through so much pancreatitis with another dog but I did give her cheese this morning (she says thank you!). She is so hungry all the time and a 5+# weight gain is a lot for a dog her size. She looks like her hind legs are going to buckle when she stands. Hard to tell how much muscle mass she has loss because it was not that great when I got her. She is a former show dog that had 3 litters and until I got her, she spent her life in a kennel (albeit a very nice one as kennels go).

    In terms of protocol, the only thing I know right now is that I need to bring her back in 3-4 weeks and she will be monitored with ACTH tests. I was surprised she didn't want to test at 10-14 days but I've worked with this internist enough to feel confident that what she is advising is ok. I will ask her tech though, who has become a dear friend over the years.

    Thanks again for everyone's support. No one expects this kind of issue with their dogs. When I took Sweetie, I made it clear that I wanted a healthy dog. What a joke....she has had dental problems and now this.

    Julie

  7. #17
    Join Date
    Apr 2009
    Location
    York, PA.
    Posts
    11,037

    Default Re: Introducing Sweetie

    Adverse effects from the Vetoryl can happen at any time, some dogs do well when treatment starts than months go by and suddenly their cortisol can drop too low or go too high, that's the main reason for those very important ACTH stimulation tests.

    A lot of information can be found in Dechra's product insert so I'm going to provide a link to it: Dechra's U.S. Product Insert

    Also here is a link to a thread in our Helpful Resource forum with info regarding Vetoryl/Trilostane: Trilostane/Vetoryl Information and Resources

    Please feel free to print anything out of there and if you have any questions don't hesitate to ask them.

    That ravenous appetite, man, it is so strong, we have had members give their cushdogs frozen green beans and or carrots to help abate than hunger. Hopefully in a few weeks that should subside.

    Hugs, Lori

  8. #18

    Default Re: Introducing Sweetie

    Thanks much. I have been supplementing her food with canned green beans and carrots without salt added. She doesn't seem to care much for frozen. She didn't like any kind of fruit before she became a bottomless pit. Now she loves cantaloupe and apples. Thanks for the links.

  9. #19
    Join Date
    Jun 2012
    Location
    Canada
    Posts
    16,150

    Default Re: Introducing Sweetie

    Hello and welcome to the forum. Some vets have a preference for the twice a day dosing and do start out with that. Dr. Peterson in NYC a well known specialist in cushings prefers to start there. My personal internist, likes once a day, so I think often that is a preference.
    The 20mg a day is perfect starting point and hopefully will just do the trick. Give it a few days before expecting to see results as every dog is different, as you already know. 10 days hopefully you'll see some subsiding of symptoms like eating/drinking excessively.
    Coat and skin are two things that take the longest to turn around usually just because of the hair cycle timeframe. Some dogs never get the under coat back. Mine never did, but her over coat grew like crazy.
    Sharlene and the late great diva - Molly muffin (always missed and never forgotten)

  10. #20

    Default Re: Introducing Sweetie

    Thanks, Sharlene. I asked our internist about the once vs. twice a day dosing and she insists on twice. She did discontinue the Denamarin so at least I don't have to deal with the full vs. empty stomach. This would not be a big deal but for 6 months out of the year, I work 2 jobs and this mean I will have to dose her at 2:30pm and 1:30am.

    A bad coat is not the end of the world but it is very sad. How a coat could go from thick and gorgeous to this in the course of 6 weeks is beyond me. I will just be glad if the bloating goes away. She seriously looks and feels like her belly is going to pop.

    Julie

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