Hi, we are new to this group and are so appreciative that it's here. My husband and I are the ones who diagnosed Cushings or suspected it, long story short, our Boston was diagnosed last March 2016.
We are not trying to be vets or micro manage but it seems our findings have always been consistent with what is going on with our animals and we try to research, ask questions, gather info so we can help the vet make the best choice. Again, we were the ones to diagnose Cushings long before the vet. We also didn't agree with our 1st vet giving Sammi 35mg once/day Trilostane because she became almost incoherent. The minute we went to 10mg 2x/day she was like a new healthy dog.
She has been on Trilostane (compounding pharmacy) 10 mg. 2x/day and it has made a world of difference. I'm going to post her ACTH tests that were done 3 times since last year, because even though her results are in the "normal" range if you were looking at them solely by themselves, they are DIFFERENT compared to HER previous tests and her clinical symptoms are different the past 3-4 weeks.
She was on Trilostane starting March 24, 2016. The 1st ACTH stim test was done about 6 wks later. Clinical symptoms during this time were great. Taking Trilostane 10mg 2x/day
3/22/16 First test to determine whether she had Cushings or not. First ACTH to see how Trilostane was working (below).
RANGE
5/6/16 pre - 3.2 1.0-5.0 ug/dl
post - 4.8 (LOW) 8.0-17.0 ug/dl
Next ACTH done 10/18/16 and again her clinical symptoms have been great. Taking Trilostane 10mg 2x/day
10/18/16 pre - 4.4 1.0-5.0 ug/dl
post - 4.4 (LOW) 8.0-17.0 ug/dl
Most recent ACTH test, taking Trilostane 10mg 2x/day, clinical symptoms worse and acting different (symptoms below)
3/11/17 pre - 1.0
post - 2.7 (LOW)
Sammi has been different the past three weeks, more lethargic, head sinking down lower than ever before (almost to the floor) and then catching herself, pulling her head back up, and the same process over and over. She also seemed very confused, very weak in her back legs, and just different. Weight loss and spine showing more (was 13 lbs. over a year ago, she is now 11 lbs- slowly lost over the year) Eating and drinking were normal but more urinating immediately after drinking and not on her wee wee pad (she always tries to make it to her wee wee pad but sometimes she just goes a few steps and pees right there)
The main issue that was scaring us was her breathing. I don't think it was panting, it was more like she sticks her tongue out very stiff and breathes in and out with a snorting sound (its NOT reverse sneezing, we know what that is.
We first noticed this breathing problem on the car ride to the vet back in Oct./2016 we didn't put 2 and 2 together until we took the next car ride to the vet. the breathing episode happened again. We figured out that she now has aanxiety in the car so we started giving her Trazadone before the car ride. This breathing episode ONLY happened in the car until two weeks ago.
She did it again (breathing episode) at night and then it stopped after a minute or two. 4 days ago it happened again but several times throughout the day and enough that we took her to the vet and THIS, combined with her other clinical symptoms prompted us to do the 3rd ACTH which was done 4 days ago.
Her results were this... Taking Trilostane 10mg 2x/day (clinical symptoms changed -everything i described above)
3/11/17 pre - 1.0
post - 2.7 (LOW)
on the test results from lab it says "post-trilostane: pre and post cortisol levels between 1.5-9.1 ug/dl indicate optimal control
Well, the 1.0 is NOT in that range and again the pre and post are very different from her past 2 ACTH tests along with something not being right with her the past 3 weeks
we cant help but think that even though the vet said these results were in the "normal" range, they are much different than both of her previous ACTH results, and her clinical symptoms worsened.
We are wondering if that would indicate and increase in Trilostane, a decrease in Trilostane (we think a slight decrease from maybe the 10mg 2x/day to 5-7.5mg 2x/day) or keep her on the same dosage.
If looking at the most recent ACTH stim test by itself, one could assume "normal" as the vet said, but in comparison to HER past ACTH stim tests and her clinical symptoms worsening, I can't help but think there's some thing we need to adjust (vet just called and is now agreeing to lower her Trilostane to 8mg instead of 10mg 2x/day).
3/12/17 We took her back to the vet the day after the ACTH test because of the breathing episode and she was sedated for them to take a chest xray (which looked fine) and she had a steroid injection.
3/13/17 she had BLACK explosive diarrhea in the morning and then again at night - we brought it to the vet -results not back yet.
Today she still has some diarrhea but it is normal in color.
We thought this was the end for her (two days ago) but yesterday and today she is doing 95% better. Alert, doing her usual waiting in the kitchen for food, getting in her bed, going to the wee wee pad. Just looks like a tummy ache and still a tiny bit of diarrhea. She hasn't had a normal bowel movement since Saturday morning. I want to add she has bouts of colitis from time to time.
She has only had her Trilostane once on Saturday morning before her ACTH test and once Monday eve, (vet said hold back Trilostane because of the diarrhea).
Also, is it possible that these breathing episodes could be anxiety and then more she tries to breathe the more frightened she gets. She'll stop to drink in the middle of an episode, she'll also calm down when we pet her chest. Just wondering if a very low dose anti-anxiety daily pill or one as needed will help. When it happened yesterday we gave her a tiny dose of Trazadone (12.5 mg) and it relaxed her and no breathing episode since.
BLOOD TEST BELOW (i'm only posting high or low) and she did eat a small meal before test (JUST REALIZED THIS BLOOD TEST IS FROM 12/27/16!!) I'LL POST THE MOST RECENT FROM 3/12/17.
I've compared all results next to eachother.
12/27/16
ALT (SGPT) 100 -------------------- 12-118 IU/L (3/12/17 level is now 123)
Alk phosphate 132 (high)----------- 5-131 IU/L (3/12/17 level is now 170)
GGT 43 (high) ---------- 1-12 IU/L (3/12/17 level is now 41)
Total Bilirubin 0.1 ------------ 0.1-0.3 mg/dl (3/12/17 level is same)
BUN 48 (high)------------ 6-31 mg/dl (3/12/17 level is now 24)
Creatinine 0.6 --------------- 0.5-1.6 mg/dl (3/12/17 level is now 0.4)
BUN/Creatinine ratio 80 (high) ------------ 4-27 (3/12/17 level is now 60)
Phosphorus 6.5 (high) ------------- 2.5-6.0 mg/dl (3/12/17 level is now 4.8)
Cholesterol 569 (high)------------ 92-324 mg/dl (3/12/17 level is now 286)
Triglyceride 473 (high)------------ 29-291 mg/dl (3/12/17 level is now 150)
Amylase 186 (low) ------------- 290-1125 IU/L (3/12/17 level is now 2820
PresicionPSL 53----------------- 24-140 U/L (3/12/17 level is now 290)(tummy is hurting but no more black watery diarrhea but still small amt that's normal in color but no good bm since Saturday 3/11/16)
Total T4 <0.5 (low)---------------- 0.8-3/5
HGB 21.6 (high) 12.1-20.3 g/dL (3/12/17 level is now 20.1)
HCT 66 (high) 36-60 % (3/12/17 level is now 59)
Platelet count 504-----------170-400 (3/12/17 level is now 541)
************************************************** ***********************
3/12/17 blood work
ALT (SGPT) 123 --------------12-118 IU/L HIGH (was 100 last time on 12/27/16)

Alk Phosphatase 170------------- 5-131 IU/L HIGH (was 132 last time on 12/27/16)
GGT 41-----------------------------1-12 IU/L HIGH (was 43 last time on 12/27/16)
BUN 24-----------------------------6-31 mg/dL (was 48 last time on 12/27/16)

Creatinine 0.4--------------------- 0.5-1.6 mg/dL LOW (was 0.6 last time on 12/27/16)
BUN/Creatinine Ratio 60-------------4-27 HIGH (was 80 last time on 12/27/16)
Phosphorous is 4.8 normal-----------------2.5-6.0 mg/dl (was 6.5 high last time on 12/27/16)
Amylase 282------------------290-1125 IU/L (LOW) (was 186 last time on 12/27/16)

PrecisionPSL 290---------------- 24-140 U/L (HIGH) (was 53 last time on 12/27/16)
PrecisionPSL elevations correlate closely with abnormal PLI concentrations. In dogs with appropriate clinical signs, a PrecisionPSL result >216 is supportive of, but not definitive for, a diagnosis of pancreatitis
Platelet Count 541------------------170-400 10 /μL HIGH (was 504 last time on 12/27/16)
HGB 20.1 ---------------------12.1-20.3 g/dL (was 21.6 last time on 12/27/16)
HCT 59-------------------------36-60% (was 66 last time on 12/27/16)
T4 0.8 -------------------------------0.8-3.5 μg/dL (was <0.5 last time on 12/27/16)
The Total T4 result is less than 1.0 mcg/dl.
A Free-T4 by equilibrium dialysis may be helpful in supporting the diagnosis of hypothyroidism in patients demonstrating clinical signs compatible with hypothyroidism
Specific Gravity
1.039
1.015-1.050


Protein------------3+--------------------Negative HIGH
I was reading about protein spilling into the urine. Sammi eats chicken (white meat) and pumpkin and occasional carrots, brown rice and I'm wondering if this is contributing to protein in the urine.
We want to feed her what helps her the most and I don't know if chicken is the right thing.
If anyone knows anything about any of these levels going up or down in comparison to her previous tests please let us know.
The PrecisionPSL went from 53 on Dec. 27, 2016 to 290 on March 12, 2017 - and it has something to do with pancreatitis.
I would think the vet would have compared her previous blood test done 2 and a 1/2 months ago to the one taken just three days ago. I'm not a vet and I'm not a doctor so does anyone please have any input as to whether this is why Sammi might be having some of her symptoms - tummy pains, lost a little weight, lethargic, occasional trouble breathing, just to name a few that i think are associated with Pancreatitis.
Thank you so much!