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Thread: clinical symptoms combined with ACTH results - Sammi is now in heaven

  1. #151
    Join Date
    Mar 2017
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    122

    Default Re: clinical symptoms combined with ACTH results-please ANY suggestions/feedback welc

    So we finally got Sammi's results back...

    Her last DOCP 10/13/17
    Her last dose of Prednisone was on 11/12/17

    She had the stim test on 11/16/17

    Pre 4.1

    Post 5.4

    So her body is definitely producing cortisol again.

    She also put some much needed weight back on. Last month she was under 8 lbs. and her weight on Thurs 11/16/17 was just over 9 lbs.!!!

    So the vet said nothing about putting her back on a lower dose of Trilostane and she doesn't have to get any more steroid injections or take Prednisone. Is it possible that Sammi's cortisol levels may remain "normal" and she won't have to take Trilostane, or do we just have to wait and see and monitor her along with doing the stim test again?

    She's really doing well with the exception of the panting and rapid breathing at night and more toward the evenings. The vet said he didn't know what the nightly panting and rapid breathing was from but did mention, possibly high blood pressure or pulmonary hypertension and we'd have to see the cardiologist to determine that.

    He said if she doesn't seem to be in distress we can just monitor her for now.

    What are your thoughts on her most recent pre and post test?

  2. #152
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    Apr 2009
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    York, PA.
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    11,037

    Default Re: clinical symptoms combined with ACTH results-please ANY suggestions/feedback welc

    Those numbers do indicate that she is producing cortisol on her own which is great! Whether the Trilostane will need to restarted will be a wait and see approach. On the forum we've seen some dogs that have had their cortisol drop too low while being treated with Trilostane/Vetoryl and then go on a "Vetoryl/Trilostane hiatus" for a period of time.

  3. #153
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    Mar 2017
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    122

    Default Re: clinical symptoms combined with ACTH results-please ANY suggestions/feedback welc

    Here is our Sammi update...

    She had her 2nd ACTH test since the Addisonian crisis and we're just waiting for the results (any second now!)

    She had gotten extremely weak in the back legs and is doing the panting thing much more. She also just doesn't seem right. We are REALLY hoping her results come back and show that her cortisol is way high again otherwise I don't know what could be going on.

    Just now got an email saying Sammi's numbers were normal!!!!!!!!!! That doesn't make sense. I asked what the numbers were so I could compare them to a month ago.

    when we did the last stim test her numbers were

    pre 4.1
    post 5.4

    I'll find out the numbers of yesterdays test.

    MY QUESTION... would anyone suggest starting Vetoryl is Sammi is showing outward signs but her numbers are in that range.

    Her numbers when she had the stim test (prior to taking her off of Vetoryl) were

    pre 0.6

    post 0.9

  4. #154
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    Mar 2017
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    Default Re: clinical symptoms combined with ACTH results-please ANY suggestions/feedback welc

    ok, here are yesterdays results

    pre 6.1 (high)
    post 8.2

    How do read these and how is it that Sammi is showing the signs of Cushings again?

    I know the pre test says HIGH but isn't it the relationship between the two?

    So her cortisol has gone up significantly but I don't want to do something that will hurt her by giving her the Vetoryl. BTW we would only start her on 5mg per day. Waiting for the vet to call but i'm starting to feel like she doesn't know what she's doing (new vet at the VCA).

  5. #155
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    Mar 2017
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    Default Re: clinical symptoms combined with ACTH results-please ANY suggestions/feedback welc

    I just don't understand this.

    Spoke with the vet, she explained that in order for her to recommend the Vetoryl again Sammi's #s would have to be in the teens or greater than 20 on the post test. I don't understand how Sammi is having all of these symptoms and the test is coming with numbers that are not yet at the point where she can start Vetoryl again.

  6. #156
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    Mar 2017
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    Default Re: clinical symptoms combined with ACTH results-please ANY suggestions/feedback welc

    So, while we were waiting for the vet we emailed Dr. Bruyette with all of the tests and he said to start Sammi on the Vetoryl again. That is our (husband and I) instincts and we would only start her on 5mg. how is it that the ACTH results are interpreted so differently?

    But once again I come back to the question that brought me here... Don't you want to compare test results in comparison to YOUR animals test results (and signs and symptoms)?

    Any input is appreciated!

  7. #157
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    Apr 2009
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    Georgia
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    Default Re: clinical symptoms combined with ACTH results-please ANY suggestions/feedback welc

    Welcome back to you and Sammi. I’m sorry you are receiving such conflicting information, because it must make a worrisome situation so much more confusing. But yes, you are correct — you need to take into account the symptoms and test patterns that your own dog is exhibiting when you make treatment decisions. And since Sammi is again displaying symptoms and her cortisol seems to be steadily increasing now, restarting her Vetoryl would indeed seem to be the appropriate recommendation. I don’t know why your new vet is wanting to wait until her cortisol were to elevate so significantly. Here’s the printed guidance of Dechra, and it corresponds with Dr. Bruyette’s instruction. Note that it is the post-ACTH value that is bring referenced below, and is key in making treatment decisions.

    If the ACTH stimulation test is < 1.45 μg/dL (< 40 nmol/L) and/or if electrolyte imbalances characteristic of hypoadrenocorticism (hyperkalemia and hyponatremia) are found, VETORYL Capsules should be temporarily discontinued until recurrence of clinical signs consistent with hyperadrenocorticism and ACTH stimulation test results return to normal (1.45-9.1 μg/dL or 40-250 nmol/L). VETORYL Capsules may then be re-introduced at a lower dose.
    http://www.dechra-us.com/Admin/Publi...ack-insert.pdf

    I do think you need to discuss Sammi’s situation further with your new vet. She needs to be aware if you indeed restart the Vetoryl. Now that you are armed with both Dr. Bruyette’s advice and also the link to Dechra’s official product insert, you can ask her if there is something specific to Sammi’s situation that is making her hesitate to restart treatment at this time.

    Marianne

  8. #158
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    Mar 2017
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    122

    Default Re: clinical symptoms combined with ACTH results-please ANY suggestions/feedback welc

    Thank you so much!!!!

    The new internist vet is just temporary because Sammi's internist is out for the holidays BUT, we've been concerned with some of the issues that have happened at our vet and Sammi's dosage should've been lowered months and months ago and her Adisonian crisis may not have happened. It's this situation that's happening now, but in reverse (ACTH numbers going down and down each time until they were extremely low.

    We decided to look for a completely new office to go to even though the West Los Angeles VCA has helped Sammi in the past with other things. But it does seem like there are so many doctors that say different things and then one discovers something that the others had no idea about so she doesn't get diagnosed until months after the problem she's having (her mange, for example).

    We asked Dr. Bruyette for a referral and if he knows a good vet. Well, I don't think we could've gotten a better response....

    His wife, Dr. Maya Lottati is an internist and practices literally ONE MILE away from where we live!!!!

    So, we will be taking Sammi there!

    It's been so difficult to watch her struggle the past few weeks. Her back leg just slides right from under her, she's panting and because she's a Boston it sounds like she's in so much distress, she's peeing and sliding in it when we can't catch her, can't sleep or get comfortable, and it's just killing us to watch this.

    She also is having that mucus discharge come out again and I've been reading about sex hormones and cortisol and sometimes the hormones can be high and a bunch of other stuff that is so hard to follow if you're not a vet, but I can't help but think this is related to Sammi's cushings.

    Thank God she is still eating!

    She's going to start on 5mg once per day and then she'll be having another ACTH test in 7-10 days per Dr. Bruyette.

    Thank you so much for responding and I'm going to read that insert right now!

  9. #159
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    Apr 2009
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    Georgia
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    Default Re: clinical symptoms combined with ACTH results-please ANY suggestions/feedback welc

    Omigosh, that is such great news about Dr. Bruyette’s wife!!!!!! What a huge relief to think she’ll be taking care of Sammi from now on — cuz I bet you’ll continue to get the benefit of Dr. B’s wisdom, too ;-))))))).

    Please keep us updated, OK?
    Marianne

  10. #160
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    Mar 2017
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    Default Re: clinical symptoms combined with ACTH results-please ANY suggestions/feedback welc

    Yes! That's exactly what I was thinking too!

    So, wouldn't you know... Sammi does not want to eat this morning. She's been eating fine, every day and eating all of her food, so her not wanting to eat this morning is worrying me.

    Just to be sure... there's no way Sammi could be toward Addison's with those numbers, right? Also, her potassium and nova stat electrolyte panel has been perfect the past two times (nov 16 was the last one). I just want to be sure because she's been just wandering around lately, and now, this morning, doesnt want to eat.

    She hasn't gone poo poo in two days now so maybe that's it but now it makes me think something else in addition to the Cushing's may be happening.

    They were able to do another blood panel the day after we left the vet. Case and point, AGAIN... my recommendation was to get more blood at the time of Sammi's second draw for her ACTH test in case we needed to order more tests. We didn't end up seeing the vet until after her second draw (their mistake, not ours because that's how I had set it up - common sense), so I'm really glad I had them take extra vials because now they have it and we don't have to subject her to a two hour car ride and nerves.

    Anyway, the impt thing is that the blood panel is getting done so we can see if anything else is going on.

    My poor girl... the not eating is scaring me and I think she's been nauseas the past two days (licking her lips a lot).

    Hoping to get in with Dr. Lotatti asap but will have to stay with the other vet until then.

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