Pokey, Cushing's to Addisons (update: now on pred & Percorten V injections)

[Pdog]

Hello, I'm new, have only been lurking until now. Our dog was diagnosed with atypical pituitary cushings a few months ago. She has been on Lysodren and was doing ok we thought until this week. I don't have the results but we had an ACTH test done again on Thursday (yesterday) because she had hardly any appetite for days. She was given a injection at the vets yesterday plus fluids, put on an appetite stimulant and prednisone to be started today. Today she has had diarrhea badly many times (7 times today) and her appetite and thirst is still not right. She will only eat a small amount of certain foods, she is turning away from almost everything. I've spoken to the vet several times today and given her prednisone 3 times already (5mg, 3 times today plus the shot yesterday. Last Lysodren dose was Sunday. She is 7 years old and about 45lbs.)...she just had diarrhea again. Shouldn't the prednisone be working by now? I don't know whether to take her to the ER vet or not. I hope someone is on now that can advise me as to whether she should be taking all day to have a turn around.
Thank-you.

[Pdog]

I forgot to add that the ACTH came back that she was quite low although I don't know the number at this time. thank-you

[Harley PoMMom]

Sounds like your girl still isn't feeling well. Is there any blood in her diarrhea? Is she vomiting? Is she keeping any thing down?

[Harley PoMMom]

Did they check her electrolytes too?

[Pdog]

Thank-you for replying so quickly. She has not vomited, just the diarrhea. She has had some food today, we got her to eat a little roast beef and some turkey deli meat. She is refusing everything else. She will drink if we hold a cup up to her.
Thank-you

[Pdog]

no, just the ACTH.

[Harley PoMMom]

If her electrolytes were not checked, then I believe she should be taken into the Emergency Clinic.

[labblab]

Is your girl drinking water? I wouldn't worry so much about the food right at the moment -- I think the greatest immediate concern would be dehydration and the risk that her electrolytes (blood chemistries) are badly out of balance. Aside from the diarrhea, how is she behaving?

Marianne

P.S. I see that Lori and I were typing at the same time...

[Pdog]

We have to entice her to drink..she is not drinking much. She is lethargic and just doesn't look 'right'. Even when I ask her questions that would normally get her excited she will perk her ears a little but just looks sad. Thank-you.
I didn't know about the electrolytes until reading this and Harley's post.

[labblab]

I see you've spoken to your vet several times today. What were his/her latest instructions to you?

Marianne

[Harley PoMMom]

If too much Lysodren is given the layer of the adrenal cortex that produces aldosterone is also eroded away. This is what causes the electrolyte imbalance and necessitates the use of Florinef (or Percorten). These meds artificially replace aldosterone.

If it were me, I would definitely take her to an Emergency Clinic.

[Pdog]

Each time we talked she asked questions to determine whether or not to give her another prednisone, which I did each time. I last talked to her when she left the office for the weekend and we were both hoping the last pill would have her show some improvement. I just don't know how long it should take for the prednisone to work or whether something else is going on (like the electrolyte levels others have said) and she should be taken to the emergency clinic. Looks like she needs to go.
Thank-you

[labblab]

I have to agree with Lori -- I'd rather be safe than sorry. I surely would have wished that your regular vet would have put together an emergency plan for you in the event that your girl didn't respond appropriately to the prednisone! But since she did not and your baby is still having diarrhea and acting so "off," I'm thinking it would be best to have her blood chemistries checked out at the emergency vet's. It just involves a simple blood draw.

Marianne

[Harley PoMMom]

Prednisone usually works within 30 minutes to 1 hour. Since you have given 3 doses already, if she were my pup, I'd take her to be looked at.

[Pdog]

we're getting ready right now, waiting for husband. Thank-you so much for replying so quickly and helping me out. I appreciate it SO much..we love her and are worried. thank-you

[Harley PoMMom]

Please let us know how she is doing, ok? Best of luck to you and your girl.

[Pdog]

It's about 1:30am and we just got home from the emergency clinic. We had to leave her there which was hard to do but seemed to be the best option. Someone here had asked if she had blood in the diarrhea and she hadn't that we could see, then we gave her the chance to go potty right before we got into the car and when she was done she had a lot of red blood allover her long white hair. At that point I was freaking out a bit but thankfully my husband was calm so off to the vet we went. The vet kind of dismissed the electrolyte idea but we wanted them tested after what we read here and sure enough, her electrolytes were imbalanced plus being dehydrated. We left her there to get IV fluids and she will be put on florinef in the morning (when they get some in).
Hopefully she will be feeling better tomorrow..she just looked so pitiful tonight.
Thank-you again to all who replied, it was so helpful and is greatly appreciated.

[Harley PoMMom]

Thanks so much for getting back to us. I am sorry that you couldn't bring her home but she is getting the best care there, I realize how hard it is to leave them there but know you are doing what is best. I am sure she will feel better tomorrow, especially after they get the Florinef in her. Good for you for making them check her electrolytes!

Although I am no vet the blood was probably just some irritation from her lower GI.

Please keep us updated and we will be sending healing thoughts your way.

Love and hugs,
Lori

[labblab]

I agree with every single word that Lori has written, so I'll just say "ditto, double ditto, and triple ditto!!" You made exactly the right decisions and I've got my fingers crossed that your baby will be much improved today and able to return home again -- in much better shape!

Huge hugs,
Marianne

[frijole]

Just reading your story - do keep us posted. The ER room was the right move no doubt.

You said your dog has atypical cushings I believe. Normally the dose is quite low for atypical so it would be strange to see a lysodren "overdose"

Could you please share your dog's weight and the lysodren dosing protocol you were on: frequency and amount?

When was the last blood panel done? (full panel not acth test) Was there anything that stood out as being abnormal? Thanks. Just trying to figure out what might have caused this episode beside the lysodren.

Keep us posted!! Kim

[Casey's Mom]

So glad you got her to the vet - let us know how it all turns out.

Love and hugs,

[Harley PoMMom]

Just wondering how your sweet girl is doing, keeping you both in my thoughts and prayers.

Love and hugs,
Lori

[apollo6]

Welcome.
We will be praying for your little one and you. Hope she or he gets better. Let us know. It sounds like the medication dosage is effecting her or him, diarrhea, lethargic, and no appetite. Other symptons not sure.
Hugs from Sonja and Apollo

[Pdog]

We just brought our girl home a little while ago. Her electrolytes were still out of balance so they kept her all day and evening. She had bloody diarrhea a few times after we left her but the last time was at 5am so that seems to be ok now. They said her sodium chloride is still a little low but the others came up. Her appetite seems good and she is drinking too. She is resting comfortably right now but was a little wired at first..the prednisone seems to be working.
They sent her home with Florinef, medtronidazole, prednisolone (3 per day) and proviable.
We are to take her back on Monday to check her bloodwork again.
She still doesn't look normal but I think that is probably to be expected after all that. Hopefully she'll get a good night's sleep tonight although I imagine she'll need some extra potty times after all those fluids. She was napping a little while ago and got up all of the sudden, stepped in front of my chair , quickly squatted and began urinating. She went and went and went, poor thing. I guess she just couldn't control it.
I did ask the vet to look back at her labs from before, a few months ago and she said that everything was within normal range but her potassium was a little high. I know someone asked that so just wanted to mention it.
Will the new bloodwork on Monday determine whether she has Addison's now or whether these were just temporary symptoms?

Thank-you all again. It's amazing that I was able to register, and write a message late at night and have such quick and helpful replies last night!

[Casey's Mom]

So glad you got her to the vet and she is now home. She may not be addisonian but you have everything now to keep her comfortable until Monday. The others will chime in with more helpful advice, I just wanted to wish you well!!

Love and hugs,

[StarDeb55]

I have been following what has been happening with your baby. I'm very glad to hear that she is feeling better. The only way to determine whether or not she has gone Addison's is to do an ACTH. You really need to know where her cortisol level is at after this crisis, & prior to attempting to restart any medication. The only catch is that an ACTH needs to be done, at least, 24 hours after giving any prednisone. Prednisone will mimic cortisol on the test, & thus will give you a result that is actually higher than it probably is.

Debbie

[Squirt's Mom]

Hi and welcome to you and your baby girl! :)

I am so very, very glad you found us when you did! Your baby is lucky to have such an attentive, determined mom on her side. You done good, Mom! :D

Now to get her through this crisis, have an ACTH done to see where she is, and go from there....one step at a time. It is scary to see our babies crash like that but usually they turn around soon with the pred.

One suggestion I have is Pedialyte - the plain, unflavored kind. Just add a little bit to her drinking water and that will help keep the electrolytes up and keep her hydrated. Squirt weighs around 14lbs and I put around 1cc/cup of water. She just had surgery and I continue to use it to help her for now.

Keep your chin up and keep up the good work!
Hugs,
Leslie and the girls - always

[Harley PoMMom]

I am glad your precious girl is home with her loving mom and dad.

There are two forms of Addison's - one is what is called Atypical Addison's which is when just cortisol production is affected and the other is more typical Addison's where the production of both cortisol and aldosterone are affected.

Sometimes once a dog has got to the point of needing aldosterone replacement (Florinef) the Addisonian state will be a permanent thing and the adrenal cortex will not be able to regenerate.

While electrolyte levels are important indicators, they are not the definitive test to determine Addison's disease. For definitive diagnosis the pup is given an ACTH stimulation test.

Be aware that some glucocorticoids, such as predinsone, can affect the results of the ACTH test, while dexamethasone does not.

Please keep us updated and I will be keeping you all in my thoughts and prayers.

Love and hugs,
Lori

[Pdog]

Thanks again Lori and everyone else that has taken the time to reply.
I'm still concerned. She is refusing most foods. She perks up when you ask if she wants a treat but then she refuses it. She won't eat her dog food. I put some gravy on it and she just licked the gravy. She ate a little bit of some canned dog food. She is still lethargic. She's not an active dog to begin with but this is not normal for her. I called her to jump up on the bed and she made a half-hearted effort and then just laid next to it. I would say she does look a little better than when we first took her in Friday night (and at least the diarrhea has stopped) but not nearly what I feel she should be after all the fluids and meds. She does seem to be drinking ok on her own.
I called the emergency clinic and to be honest, they weren't any help at all. They said I could bring her in, or not bring her in, or wait until my appointment that I have for tomorrow. ?? I wasn't able to speak to the vet. I hope she will eat enough that I can get her meds in later. Hopefully she'll eat something that I can hide them in.
Someone had asked what her Lysodren dosage had been. It was One and one-half 500mg tablets, twice a week. Her weight is down now but she did weigh 48lbs.

Any suggestions? I'm back to the same question I basically started out asking (before I learned about the electrolytes)...is it normal to be taking so long to 'bounce back'?

Thanks again
Tammy

[frijole]

Tammy, I'm the one who asked about the lysodren dosage. I asked because normally atypical dogs are on a reduced dosing and it would be really strange to see a dog with atypical cushings get too much lysodren... unless of course the dose that was prescribed was too high or the dog was misdiagnosed.

A dog with full fledged cushings and your dog's weight would get max of 50 mgs/kg. That would be two pills a week if they were on maintenance. You are giving 1 1/2 twice a week or 3 pills a week. It might be that the dose is too much.

Are you still giving prednisone I assume? First thing is to get your dog stable and drinking water, eating food. Then we'll want to have the cortisol levels checked (acth test) as that will tell us if that is the culprit.

Is she drinking water? That is the most important thing.

[Pdog]

I just had to add this, we are going to run to the store to get some canned dog food and other foods that might entice her to eat and she got excited when I asked if she wanted to go 'bye bye'. And she ate a few bites of dogfood. So maybe I'm just overreacting..I just don't know. I waited too long this week to take her to the vet, and then almost didn't take her to the emergency clinic so I think I'm doubting my own judgment at this point. But she is better than Friday..just not as back to normal as I hoped.

[Sabre's Mum]

Hi Tammy

As said previously ... drinking water is the first thing that you need to be concerned with. If you can try and tempt her to eat this would be great.

What you are seeing with your pup is a dog in an addisonian state. They are typically lethargic and disinterested in food. Our Sabre never went into permanent addisonian but when he was low he was extremely lethargic and although would eat food ... wasn't really interested in it nor would finish it.

Tammy, do you have all the results from when she was diagnosed? I also would concur that the Lysodren dose may have been too much. Generally dogs will get a maintenance dose of between 25 and 50mg/kg per week in total.

Good luck in finding something that your pup will take to eat and please keep us updated.

Take care
Angela and Flynn

[Pdog]

No, I do not have the earlier results but can get them. She responded very quickly to the Lysodren during the loading dose, 2 or 3 days.
I'm feeling really upset right now because if I'm understanding correctly, she has been overdosed. And not just 'every dog is a little different' overdosed, but overdosed quite a bit for her weight and then ontop of it she was said to be atypical and responded so quickly during the loading period. I'm starting to feel anger at the vet and definitely anger at myself for not doing more research on my own. I usually research so much but at the time our cockatiel that we had for 13 years was having seizures. I was so upset about her and trying to learn everything I could to help her because the avian vets were stumped and then she passed away in my hands and it was only a few days later everything happened with Pocono and the Cushings. I was grieving and then worried so much about her...I was so overwhelmed. But now I feel horrible if I allowed her to be overdosed and she may have permanent damage because of it. Our vet was supposed to be in communication with the Vet school about all of this..I just don't know.
OK..deep breath.

Yes, she seems to be drinking ok and I was very glad to see her excited about going for a car ride. I will be giving her the night medications soon. Thanks again.
Tammy

[frijole]

We understand and please know it isn't too late to help her. We will help get you up to speed.

To get a diagnosis of atypical cushings they would have to have sent bloodwork to the Univ of TN. Do you recall whether this happened? It would be helpful to get ahold of the test results. On them you will see specific dosing recommendations given by Dr. Oliver. I would be interested to see what his recommendations were. If this test wasn't done then you can't have a dx for atypical cushings. To my knowledge they are the only lab in the world that does the test.

It would be helpful if you could get and share all tests done so far so we can confirm some things and get up to speed. You will want to have them on file for future reference as well.

As Angela said - every sign you have described is that of a dog that is Addisonian. It could just be temporary - often the adrenals become active again and produce cortisol. If not, that can be treated as well.

So when you went to the ER they would have checked the electrolytes and if low they would have given her an IV. Did this happen? Also they often will give another drug florinef.

Are you still giving prednisone? Any other drugs? I am glad you are going to the vet's tomorrow. I am going to link you to our info on atypical cushings so you can read up on it if you have time. As you will see, if a dog has atypical cushings there is no loading period. This is what has me a bit confused. Anyway - you are on your way to getting the info and help you need. Hang in there!!

Any questions, just let us know. Kim

http://www.k9cushings.com/forum/showthread.php?t=198

[AlisonandMia]

Hi and a belated welcome from me too.

I don't have a lot of time to do a proper reply (I've got to dash out in about 10 mins) but here's a link to another thread where a dog has become fully addisonian (electrolyte imbalance as well as low cortisol) after a Lysodren overdose: http://www.k9cushings.com/forum/showthread.php?t=2089

I think in your situation there is a possibility that there is something else going on (like some sort of infectious enteritis, for example) either instead of or as well as addison's. It looks like the vet is thinking along those lines - thus the metrodanizole (sp?) as well as the other meds. It could hard to know if the electrolyte problems was caused by the prolonged diarrhea or addison's - or both at this stage I would think. But it sounds like she has got the right treatment and is safe for now. The stress of addison's could most certainly make a dog vulnerable to an infection too.

Sorry to hear about your cockatiel - I have cockatiels too and sadly lost one a few months back too:(. They are great little guys, aren't they?

Must finish up here!

Alison

[Sabre's Mum]

Hi Tammy

Take a big deep breath and relax. I am sorry for my brief and to the point post and sorry if it sent you in a spin. You are truly doing your best for your pup. As Alison has said it appears that your vet has covered everything that your pup needs at the moment.

I jumped to conclusions rather fast but, even though your pup was on pred before seeing the vet, was an ACTH stim test done at any point in the last couple of days? Generally you need the pred out of the system for 24 hours to get a reliable result.

Take care
Angela and Flynn

[Pdog]

I will definitely read the link to the other information, thank-you.
I do not have the labs from the Vet School, but I am pretty confident in saying that she must not have an official 'atypical' diagnosis if that is the only way to get that done.
Here is her ACTH results from 8/12 when I first took her to the vet because she wasn't eating well and didn't seem right. The diarrhea started after that and then we took her to the emergency clinic.
PreACTH cortisol <0.2
PostACTH cortisol <0.2

If I'm reading her electrolytes correctly they were:
8/13 8/14
Na 133 140
K 6.7 5.4
Na/K 20 26
Cl 98 102

These were the things that were not in Normal range from her bloodwork on 8/13:
RBC 8.53 h
HCT 59.5 h
HGB 18.3 h
RDW 18.1 h
WBC 26.39 h
NEU 19.94 h
Mono 3.24 h
BUN 31 h
TP 8.3 h
Glob 4.7 h
ALKP 306 h
AMYL 326 low
Glu 154 h
Na 133 low
K 6.7 h
Cl 98 low

They are the only labs that I asked for copies.
She will be on the prednisone for quite awhile so I guess she won't be having another ACTH test done for a few weeks.
I appreciate everyone's input!
Tammy

Edited to add that she had IV Fluids at the ER, electrolytes and unasyn injectables.

[Sabre's Mum]

Hi Tammy

I will let Deb look at your results as she is more an expert in this field but I will comment on what I know.

Your pup's cortisol is definitely low ... generally when we treat with Lysodren we want a post reading of between 1 and 5. I would also say that she is also fighting some sort of infection with her elevated white blood cell count. It does sound as though she is getting everything she needs at the moment.

You are doing a great job ... hang in there.

Take care
Angela and Flynn

[Pdog]

Hi Angela. My pup's name is Pocono. My husband and I were on the way home from a little vacation in the Poconos when we met her. It was a very bad night, snow and ice and right before we got home I thought I noticed something strange in the headlights beam. I asked my husband to turn around and there was this tiny little white ball of fluff on the side of the road. She hesitantly came to me and we went around and knocked on some doors but nobody knew her. (and they weren't happy with us knocking on their door at 11pm either!) So, we took her home. She was in bad shape, so skinny and fleas and worms. Took her to the vet and got her fixed up but never intended to keep her....and here we are 8 years later!
So that's our Pocono/Pokey. We get asked all the time what kind of dog she is, we say 'the kind you find on the side of the road!' She definitely seems to have some Aussie in her though. :-)

[Squirt's Mom]

Hi Tammy,

Honey, don't you start blaming yourself for your baby's problems. No, no, no....that is not allowed. ;)

First of all, I am the Queen of Guilt and am not about to give up my throne! :D;)

Second, many vets don't understand Cushing's and they have spent years in schools, seminars, and practice. It is unrealistic to think we would understand when we first learn about our babies having this condition. It is normal for us to trust the experts, those who have the years of study and experience. We expect them to know how to handle the problems our babies face.

The thing is, Cushing's is one of, if not the, most difficult disease to diagnose in canines as well as humans. So many things can present as Cushing's does yet not be Cushing's at all. So we learn to give the vets a bit of a break...but just a bit. ;) If we are lucky, we have a vet that will listen and is willing to learn. If we are not so lucky, we find a new vet who will work with us, if possible.

YOU have done nothing wrong...nothing! You have done your very best to help your baby, you trusted the people you should have been able to trust, and you were aware enough to know something was wrong, you sought help and found it. In short, you have been a good mom and no one can ask more than that.

Cushing's is a learning adventure and you have had a rough start but you are in good hands here and we will be here to help you and your baby. We will start from today and move forward, putting all those bad thoughts away and concentrate on helping you baby get back on her feet.

Keep your chin up!
Hugs,
Leslie and the girls - always

[addy]

Hi,

So sorry to hear what you are going through. Sometimes when a dog loads that fast, it could be they are extremely sensitive to the drug. I had read some 30% of dogs will have a "problem" and 20% simply can't use lysodren.

Neither case is the owner's fault. We will all be here crossing our fingers and praying this will indeed get fixed and you will be okay.

Let's be optimistic, another hurdle to get over, but you will get over.:)

Hoping and praying for that,

Addy

[Pdog]

We're back from the vet and Pocono had another electrolyte test. She was in normal range except for her Cl, that was still a little in the low range. One more prednisone was added so she will be getting 20mg per day. On Thursday I will not be giving her the night dose of Florinef and will have another electrolyte test done on Friday afternoon. She was given appetite stimulants and is still on an antibiotic and probiotic. She was super nervous at the vet's office and was panting and wound up in general. Today we saw a different vet. She offered her treats and she ate them and she also ate a whole can of dog food. Not how she's acting at home but the vet seemed to understand that. I was able to calmly ask her to do the calculation of how much Lysodren Pocono should have been getting per week and as was suggested here, and as my husband and I calculated last night..she was being overdosed quite a bit. More than twice the amount. The vet seemed upset about that and definitely understood how concerned I was about it. The office manager came in and spoke to us and explained how they will proceed about that, but at this point I'm mostly concerned about how Pokey is now since the damage is already done.
I do feel guilty, can't help it but I know we're doing the best we can now. Hopefully Pokey will finally catch a break and this will all be temporary and not actual Addison's.
Thank-you all again,you've been so helpful.
Tammy

[StarDeb55]

Tammy, I'm the Deb that Angela mentioned earlier. I'm a lab tech with 30+ years experience, so I'm used to looking at these lab reports. Before I get into the lab's that you've posted, I don't see where you've posted the date on the ACTH that was so severely low. If you did, please forgive my memory, but could you remind me, along with whether or not Pokey was already showing any signs of the overload. I would like to make a suggestion, as IMHO, it's very important that you get another stim done ASAP. I know we have told you that pred has to be held for 24 hours to get a valid result. There is another option, Pokey can be given a dexmethasone injection which will act just like the pred but will not interfere with the ACTH. The pred could be held for 24 hours, on the day you withold it, the dex injection could be given. This is all dependent on when that ACTH was done. Now, on to the rest of the labs.

I won't go over any of the electrolyte results as those abnormalities are more than likely due to the Addisonian crisis. The high RBC, Hgb, Hct are probably due to dehydration, but as long as she is drinking, now, along with the water she would get from any canned food, this should resolve on it's own. I believe Angela already mentioned that the WBC count, along with the neutrophil count is very high. This is indicative of a bacterial infection. Did either the ER vet or your regular vet say anything about an infection? I'm thinking with the bloody stools that this may be some type of gastritis. I would ask the vet. A elevated globulin is also an indication of an infection. Globulin is the protein that is made in the body to help us fight infections. The high BUN which is a kidney function test, is probably due to dehydration. As long as her creatinine was normal, this is probably nothing to worry about.

The only abnormal liver function test you posted is the alk phos. An elevated alk phos is extremely common in our babies, & is frequently what will tip off a vet to look at Cushing's. Frequently, there are other liver function test that are abnormal, also, including cholesterol, ALT, or GGT. Were any of these 3 abnormal?

It sounds like Pokey is hanging in there. I'm, also, glad to hear that the vet's office has admitted that the vet that started her on lysodren seriously miscalculated her dosage. If I were in your shoes, I think I would be asking them to cover the charges for the trip to the ER since this is strictly their fault.

If you have any more questions, please feel free to ask, & please keep us posted on how Pokey is doing.

Debbie

[Pdog]

Thank-you for your reply Debbie. I gave Pokey her last dose of Lysodren last Sunday, over a week ago. Monday evening she started reluctantly taking treats. Tuesday she refused certain ones..Wednesday I was supposed to give her the next dose of Lysodren but I didn't because I was concerned and Thursday is when she had ACTH test and was so low. Then Friday the diarrhea started and we took her to the ER that night.
I'm trying to digest your other information but wanted to answer your question about when the ACTH test was done. The ER vet never really mentioned anything specifically about an infection but I think gave the antibiotic because of the bloody diarrhea.
Pokey is doing well with eating tonight. Still a little fussy but much improved. I think she would inhale as much canned dogfood as I was willing to give her tonight!
Thanks again.
Tammy

[Pdog]

Frequently, there are other liver function test that are abnormal, also, including cholesterol, ALT, or GGT. Were any of these 3 abnormal?
Debbie

I'm sorry, I forgot to answer that question.
Cholesterol 152
ALT 57
GGT <0
They all show as normal but now that you've pointed it out the GGT says normal range is 0-7 but her result shows as <0 so I don't understand why that didn't get recorded as low.

[Sabre's Mum]

Deb ... the ACTH was on post #37 ... you will see it near the top

PreACTH cortisol <0.2
PostACTH cortisol <0.2


Angela

[Pdog]

Pokey is still being picky with her eating. Does this sometimes become a new 'normal' or does it mean she is still not well? It's confusing because somethings she will inhale and other things that would normally be a favorite, she doesn't want any parts of. I've seen her eat a few pieces of her regular dogfood here and there since around August 9th. She acts like she is starving, and should be because she lost quite a bit of weight, but is so picky. I know that hydration is most important and she is drinking but I can't help worrying about the food. I don't mind fixing other things for her to eat but I am confused and still concerned because it's not normal for her.

[MyRudy]

It took my dog, Rudy, a good week to start eating normally again. Even then, I had started supplementing his dry food with canned, so he has never really gone back to eating just dry food. This was after an apparent overdosage of Vetoryl for a week.

[frijole]

I have never used trilo but I recall reading others' posts saying that after giving trilo their dogs became more finicky eaters. At this point it is hard to say - it is hard but just take each day and look for a wee bit of progress and it you do that you are doing just great. Great that the water intake is good. I think someone mentioned it already but once when my elderly girl was ill with the flu I bought pedialyte and added it 50/50 to water. There is a flavorless variety. Sending warm and positive thoughts your way. Kim

[Harley PoMMom]

Hi Tammy,

How are Pokey's bowel movements? Is she still having diarrhea and with some blood in it? And don't worry, the more details about her poop, the better! :eek::p:D Sometimes we can get alot info about how a pup is feeling from their poop.

Usually to get a finicky pup to eat is thru their nose! So the smellier or stinkier the food is the better chance one has that the pup will eat. Some members swear by tripe, also pouring tuna water over her food or sprinkling a little parmesan cheese over her food. Baby food is also a very good alternative but one has to make sure that no onion or onion powder is listed in the ingredients because onions are toxic to dogs and cats.

Hope this helps.

Love and hugs,
Lori

[Squirt's Mom]

Lori's suggestions are right on the mark! To reinforce...do read the labels on the baby foods, meats, veggies and all to make sure you are getting as pure a product as possible, ie - what the label says is all that is in the ingredient list.

Another option is over-cooked brown rice and home-made chicken broth. Many pups find this simple combination palatable when most others aren't. Adding a little of the green tripe to whatever you feed, is a good idea to raise that "stink factor" Lori is talking about. ;)

Hugs,
Leslie and the girls - always

[StarDeb55]

Thanks, Tammy, for posting those other liver function tests. Since you didn't post the normal ranges, I assume these are within normal range?

Now, that Pokey is stable, we are going to ask you for a whole lot more information about Pokey's history which will help us to help you get up to speed. What type of symptoms was Pokey suffering from that led you to go to the vets? What were the Cushing's diagnostic test that were done including the results? In light of the overdose that Pokey has suffered from, I'm concerned about the actual diagnosis. Granted none of us are vets, but we have seen too many pups misdiagnosed because of insufficient diagnostic testing, an vet with little experience with Cushing's, or both. Could you tell us what dose Pokey was on during loading? Were you given any specific instructions about how to load such as give the med for a specific number of days then do an ACTH? What was Pokey's weight when you began loading? Were diabetes & thyroid ruled out when the Cushing's diagnosis was originally determined?

Thanks for clarifying the timeline of the ACTH, & when Pokey became ill. Yes, you are correct, it's going to be awhile before Pokey will need to an ACTH. You want to watch for a return of symptoms, she has a good appetite, & feels good before you restart any medication. It will be imperative that you get an ACTH done prior to restarting meds. I hope I didn't repeat what anyone else has already asked you, but I did a fast scan of your thread & didn't see the information.

Debbie

[Pdog]

Thank-you for the suggestions on foods to entice Pokey to eat. I just read about tripe, specifically what 'green' means, and I don't know about Pokey but I doubt that *I* will be eating again for awhile.. (attempt at humor)
Pokey hasn't done as well today. She seemed better yesterday, today she has just been lying around and not drinking as often and didn't even seem excited about the canned dogfood. She ate some but it was very slowly. Last night I had to hold her back to put it in the bowl and she voraciously gulped it down. The only thing different that I can think of is that the new vet changed her prednisone from 15mg a day to 20mg. But she said to divide the dose so Pokey has only had 10mg today so far whereas she had been getting 15mg in the morning.
We initially took Pokey to the vet because she was breathing very rapidly and making loud noises that sounded like they were coming from her nasal area. When she would open her mouth and pant, the noise would stop. We began seeing the vet that overdosed her and she took chest xrays and thought she had bronchitis. The medications didn't do anything and we went back because we didn't think it was bronchitis. We were then referred to the Vet school. We had to take her there a bunch of times for a lot of different tests. No vet has ever heard her noisy breathing to this day. She pants the whole time she is at the vets so no noise and since the Lysodren the noise has stopped and she breathes much slower.
Here are the highlights from her discharge comments on 5/20/10 from the vet school:
_____________________________
Diagnoses/problems:
1. Adrenal Mass
2. Wheezing and snoring
3. Mild Thoraco-lumbar spinal pain
4. Splenomegaly (enlarged spleen)

Her weight was: 50.2 lbs. and this was after treatment of presumed bronchitis with temaril-P, theophylline and benadryl to which she was non-responsive. We had counted her breaths at between 90-100 at this time.

Results of Diagnostic Tests:
1 Thoracic Radiographs: normal thoracic structures, mild splenomegaly
2 CBC: Mature neutrophilia (likely due to stress)
3 Chemistry: Mildly increased ALP (likely due to steroid administration)
4 Heartworm ELISA test: negative
5 Urinanalysis: low urine specific gravity (1.014)
6 Fundic Exan results: normal, very healthy retinal vessels and optic nerve
7 Abdominal Ultrasound: splenomegaly, 1cm nodule on left adrenal gland,mild atrophy of right adrenal gland
8 Splenic Aspirate results: normal splenic cytology
9 Arterial Blood gas: hyperlactatemia
10 Blood pressure results reveal that patient is fairly normal even in the hospital (average 158 systolic using #4 cuff Cardell on right TL)
11 Low Dose Dexamethasone Test results: pending (trying to find that)

Based on Pocono's diagnostic tests she likely has either a pheocromocytoma or hyperadrenocorticism due to a functional adrenal tumor. Stimulation test will help differentiate between the 2 conditions. (it then goes on to describe how she doesn't have the usual symptoms)
____________________________

Unfortunately I don't have the results of the LDDT. If I remember correctly they called me with that information and then referred us back to the other vet for treatment. Up until that point they were preparing us for Pokey to have surgery but then after the test came back they said she had Pituitary Cushings. I wish I had more information about that ,I will try to get a copy of the rest. The vet that we saw yesterday was going to speak with the Vet School vet and try to understand more about Pokey's diagnosis.

Thank-you again in advance for any input.
I am going to get the unflavored Pedialyte and try the tuna-juice over her food and babyfood.
Tammy

The poop, I forgot the poop! She pooped and it looked quite normal, formed, no blood.

[StarDeb55]

treatment of presumed bronchitis with temaril-P, theophylline and benadryl

One specific drug Pokey was on concerns me, the Temaril-P. "P" stands for prednisone. How long was she on it, & was the low dose dex test done while she owas on Temaril? Long term use of steroids or steroid containing medication can cause iatrogenic Cushing's. The only way to resolve this is for the pup to be slowly weaned off the steroids. I'm not seriously concerned about this, but would just like it clarified. If the an adrenal mass was seen on the abdominal US, I don't think you're dealing with iatrogenic at all.

Were all of the liver function tests you posted last night within normal range? Also, what was the lysodren dosage you used while loading, along with the instructions you were given by your vet for loading?

Debbie

[Pdog]

From what I am reading, she was on the Temaril-P when she got the test. I believe she was started on it May 11 and the vet school report is from May 20. It says 'Temaril-P tapered dose'. Current dose of Temaril-P is 1/2 tablet every 12 hours. She will completely finish her steroid on May 22,2010.(so she must have still been on it when the low-dose Dexa test was done). At Pocono's last visit to (the other vet) she had a CBC and Chemistry Panel which revealed a mild thrombocytopenia (143,000), low normal ALT and GGT and bilirubinemia. Consistently tachypneic.

The tests and ranges from 8/13 that you asked about were:
Cholesterol 152 110-320
ALT 57 10-100
GGT <0 0-7

I'm sorry, but I don't have anything in my records about what her loading dose was. I remember that it was a very short time before I took her in for the ACTH test. She reacted very quickly to the Lysodren, 2-3 days.
I wish I had more information for you because I know you're trying to help.

Tammy

[frijole]

Based on Pocono's diagnostic tests she likely has either a pheocromocytoma or hyperadrenocorticism due to a functional adrenal tumor. Stimulation test will help differentiate between the 2 conditions. (it then goes on to describe how she doesn't have the usual symptoms)
____________________________

Unfortunately I don't have the results of the LDDT. If I remember correctly they called me with that information and then referred us back to the other vet for treatment. Up until that point they were preparing us for Pokey to have surgery but then after the test came back they said she had Pituitary Cushings. I wish I had more information about that ,I will try to get a copy of the rest. The vet that we saw yesterday was going to speak with the Vet School vet and try to understand more about Pokey's diagnosis.

.

Tammy - This caught my eye because my dog Annie was my 2nd diagnosed with cushings. (April) and we started lysodren but it didn't work and she quit eating. Her LDDS test came back as pituitary as well. she had multiple (4) acth tests that showed cushings.

When she quit eating we ceased giving lysodren and started working on what her issue with eating was. I've been thru pure HELL for the last 3 months with tons of testing.

I ended up at Kansas St Univ and they ruled out via ultrasound and CT scan a number of issues and said they do not believe she even has cushings.

It doesn't sound like your dog had any cushings symptoms because that heavy breathing/nasal sound is not cushings, panting is.

My gal has a small tumor on her left adrenal gland. They suspect it is a pheochromocytoma however her blood pressure is always normal and so unless that happens it is not classified as a pheo.

Her hunger comes and goes. I write everything she eats and doesn't down and still can't figure it all out. If its a pheo (google it) it can cause intermittent inappetance.

I share this because they want me to retest her for cushings but they truly believe she had 5 false positives and was misdiagnosed.

At this point - what matters is keeping fluids and eventually food in your dog. Trust me I know it is soooo stressful. But take it slow. Feed her small meals more frequently. Tripe did work for my gal. I have one can left I use for emergency non-eating situations. When my Annie didn't eat I could always get her to eat canned chicken and boiled egg white (source of protein) - no yolk.

I don't know if any of this will help but it seems we share some experiences. Thinking of you and sending the very best. Kim

[Pdog]

Hi Kim. I'm sorry that your Annie has been having such a hard time. I truly hope that you will get a conclusive answer soon. It sounds like you are doing everything possible and are a great Mom. Thank-you for sharing that info with me, it seems as though Pokey and Annie have some similarities.

[StarDeb55]

Tammy, I want to emphasize I am not a vet, but the information about the temaril-p caused me a great deal of concern since you indicated that Pokey would have had to been on the drug when the low dose was done. I have spent some time trying to find further information about how this might affect a low dose test, & found the following from the IDEXX vet labs test information on LDDS tests.


Where there has been prolonged (greater than 2 weeks) administration of oral prednisolone at anti-inflammatory or higher doses, testing should be delayed for at least 14 days after the withdrawal of therapy to allow normalisation of the pituitary-adrenal axis.

I have posted in the mod forum to get some of the other forum staff who have done a huge amount of research on all aspects of Cushing's, to get their input on this, & Pokey's situation.

Temaril does contain prednisolone. I am very concerned that Pokey may have been misdiagnosed because of this, & if this is the case, this would explain why she got so ill when given the lysodren. Giving either medication, trilostane or lysodren, to a healthy, non-Cushing's pup is a recipe for disaster.

Debbie

[frijole]

Tammy, Thanks. I agree with Deb. And I probably wasn't clear enough about why I shared Annie's story. I too am wondering if there wasn't a bad diagnosis in your case with skewed test results.

Whether it was from the 'Temaril-P' or from the pheochromocytoma (that can cause cushings like symptoms & I believe test results) I am wondering if your dog ever had cushings.

Since the LDDS tests can have false positives I am wondering why the vet went with a pituitary diagnosis (from the LDDS) vs the ultrasound result which was either adrenal cushings or pheo. Hindsight I guess but I would be doing some serious questioning of someone and ask for some form of compensation for bills regarding current treatment of low cortisol.

[Pdog]

I spoke to a different Vet at the school today and she said that after reviewing Pokey's case that she had no doubt that she has Cushings. She is going to send me the last notes that were written after her ACTH results but she stressed that she has no question whether that was a correct diagnosis. She did, however say that if Pokey continues to not respond completely to the meds that she should come back for another ultrasound to check on her adrenal glands again because then she would question whether or not she also has something else going on in addition to the Cushings. She basically said that although it was not ideal that the vet there did an ACTH test before Pokey had been off the Prednisone for a proper amount of time, that she didn't think it affected the diagnosis. She said that if anything it made her more certain that Pokey had Cushings because even with the prednisone in her system she still tested in a way that proved Pituitary Cushings.
?
It was a long conversation and as usual, things were over my head which is why I asked her to send the findings in writing.

I bought Pokey some unflavored Pedialyte today and coincidentally she drank a large amount of water right after I put it in the bowl. She had a better night tonight and I am wondering if that is just a coincidence? She took a small mouthful of dry dogfood and trotted with it to the carpet to spit it out and then eat it which is a 'normal' Pokey thing to do. She only did it once, and it was only a small amount but still a good sign. She also seems quite alert tonight and happier in general and is loving the canned dogfood and most treats.
I voiced my concern to the vet I spoke with today about taking Pokey off of the Florinef for 24hours before her electrolytes re-test on Friday. She agreed with me and told me to keep giving her all of her meds and she was going to call the local vet to tell them that Pokey needs to stay on the Florinef for at least a month or 2 with no breaks.
Should I not give her the Pedialyte since she is getting the electrolyte test on Friday? Will that confuse things?
You all probably already know about this, but I found treats at Petsmart today that are made to hide pills in and they worked great. I was able to put all of her evening pills inside one and she gulped it down...done! Much easier than trying to wrap them in turkey meat and keep them from falling out. I also asked about caned tripe but they didn't carry it.

Thank-you again everyone.
Tammy

[frijole]

Tammy regarding the pockets to hid treats in I assume you are talking about the Greenie Pill pockets. I had never tried them until my girl got sick.. love em. I will share what I learned...Beef ones get kind of greasy as they sit in the bag. Chicken ones don't. I also bought the cat sized ones when I was giving tiny doses and they worked great. I currently am buying the largest sized ones and just break off the amount I need and roll pill in it. Saves money and they last longer. :) Kim

[Pdog]

Yes, Kim, that's what they are. I love them! Just filled another one this morning and down all the pills went. She is on 5 different meds and some are 2 pills at a time right now so it really does make it easier. I didn't see chicken ones so I guess I'm going to have a bag of grease soon!

Her new local vet just called and she wants me to bring Pokey in for the electrolyte test tomorrow and will be giving her an injection instead of giving the Florinef 2x a day. I asked her about the Pedialyte and she said it really wouldn't effect the test unless Pokey had been eating a salt block or something major like that.

[Pdog]

Pokey had diarrhea and vomited overnight. She has an appointment to get her electrolytes tested again today and she was going to get an injection of Florinef. (I know the injection is not called Florinef but I think you will know what I mean since I don't know the correct name).

Do any of you have any input or suggestions on why she would have diarrhea and vomit when she should be getting better? I wish I knew what to ask the vet today or suggest or something.

I'm giving her pedialyte, she's still on antibiotic and probiotic, florinef, prednisolone, and an appetite stimulant. She still won't eat some foods but is gulping down others. Drinking is good and I've been putting Pedialyte in her water. She has been more alert and better in general although not herself. I did notice that she is breathing deeply. Even while resting her breaths are just so deep.

Is the injection safe? After the big mistake with the Lysodren dosage I'm having trouble trusting dosages. I don't want them to give her a shot that lasts a whole month and have it be a wrong dose or something but the vet says it's a standard dosage.

Any help would be appreciated. Thank-you all again.
Tammy

I didn't know whether to keep posting to my original message below or start a new one so please excuse me if I chose wrong.

*** Admin note: We like to try to keep all the info about each dog all together in one topic/thread. So it's always better to post in your original thread (than to start a new one). We've therefore merged your new one with your original, as you can see.

[acushdogsmom]

Hi,

The injection that your Vet is going to give is probably "Percorten V" (also called "DOCP").

Here's some information about it:

http://www.percorten.novartis.us

http://www.percorten.novartis.us/pdf/PercortenV-product-info.pdf

You can see the dosing info at the second link above, where it says:


Dosage:

In treating canine hypoadrenocorticism, PERCORTEN-V replaces the mineralocorticoid hormones only. Glucocorticoid replacement must be supplied by small daily doses of glucocorticoid hormones (e.g., prednisone or prednisolone) (0.2–0.4 mg/kg/day).

Dosage requirements are variable and must be individualized on the basis of the response of the patient to therapy.

Begin treatment with PERCORTEN-V at a dose of 1.0 mg per pound of body weight every 25 days. In some patients the dose may be reduced. Serum sodium and potassium levels should be monitored to assure the animal is properly compensated. Most patients are well controlled with a dose range of 0.75 to 1.0 mg per pound of body weight, given every 21 to 30 days.

The well-controlled patient will have normal electrolytes at 14 days after administration or may exhibit slight hyponatremia and hyperkalemia. This needs no additional therapy as long as the patient is active and eating normally. Watch closely for depression, lethargy, vomiting or diarrhea which indicate a probable glucocorticoid deficiency.

At the end of the 25-day dosing interval, the patient should be clinically normal and have normal serum electrolytes. Alternatively, they may have slight hyponatremia and slight hyperkalemia. This constellation of signs indicate that the dosage and dosage interval should not be altered.

If the dog is not clinically normal or serum electrolytes are abnormal, then the dosage interval should be decreased 2–3 days. Occasionally, dogs on PERCORTEN-V therapy may develop polyuria and polydipsia (PU/PD). This usually indicates excess glucocorticoid, but may also indicate PERCORTEN-V excess. It is prudent to begin by decreasing the glucocorticoid dose first. If the PU/PD persists, then decrease the dose of PERCORTEN-V without changing the interval between doses


Starting Dose:

DOCP: 1 mg/lb every 25 days
Prednisone: 0.2 – 0.4 mg/kg/day

Guides for Adjustment:

Clinical Problem/Solution

Polyuria/Polydipsia
• decrease prednisone dose first,
• then decrease DOCP dose,
• do not change DOCP interval

Depression, lethargy, vomiting or diarrhea
• increase prednisone dose

Hyperkalemia, Hyponatremia
• decrease DOCP interval 2–3 days

So it does seem to be pretty straightforward. As with any medication, if it has an effect then there's always a possibility of side effects, but according to what I can find online, serious side effects with DOCP/Percorten V are rare. If you see any of the more common side effects, such as PU (Polyuria/excessive peeing) or PD (polydipsia/drinking excessively) it may mean that the dog does need to have the dose adjusted or maybe the pred dose just needs to be reduced. (as per the dosing guidelines above, they'd reduce the pred first)

It wouldn't be unusual for a dog to need some dosing adjustments at the beginning, but it's usually it's the pred dose that is the one that needs to be reduced - to the lowest amount of pred that can prevent the symptoms of too-low cortisol.

I have a friend whose dog had Addison's (not from a Lysodren overdose - this dog just had Addison's Disease) and once they figured out that he was Addisonian and got proper treatment for it, he was fine and he lived a long and happy life.

He got a Percorten V injection once a month (every 24 days I think it was) and was given a small dose of pred every day as well. Once in a while, in very stressful situations, he was given some extra pred to help him handle the stress better. They only needed to adjust the time between the DOCP injections once or twice at the beginning of his treatment.

Hope this helps.

[Harley PoMMom]

Do any of you have any input or suggestions on why she would have diarrhea and vomit when she should be getting better? I wish I knew what to ask the vet today or suggest or something.

Tammy


Hi Tammy,

Just a thought on my part...You may want to ask the vet about Pokey having pancreatitis. Although I did see from an earlier post that her amylase levels are normal; amylase enzymes and lipase enzymes are produced from the pancreas but not only from this organ. My boy Harley has pancreatitis and his amylase and lipase levels have come back normal.

The only way to diagnose pancreatitis in a pup is with a spec PL test. Here is a link with info about this test: http://www.idexx.com/view/xhtml/en_us/smallanimal/reference-laboratories/testmenu/innovative-tests/spec-cpl.jsf?SSOTOKEN=0

Keeping you both in my thoughts and prayers. Please keep us updated.

Love and hugs,
Lori

[Pdog]

That was a lot of helpful information about the Percorten injection, thank-you so much. And it also eases my mind a bit to read about your friend's dog living a long life after being diagnosed with Addison's.
The only thing that came back low on Pokey's electrolytes test today was the Cl again (103 range is 109-122). The vet said she isn't concerned with that one. Her liver ones were high again. (ALT 205 range 10-100, was 57 on 8/13) (ALKP 630 range 23-212, was 306 on 8/13)
The vet is telling us that Addison's is better to have than Cushing's. Easier to treat, cheaper, etc..basically that Pokey is better off. If this is true than why isn't purposely causing Addison's in all Cushing dogs the standard treatment? I know that some vets do this on purpose but there must be negatives to it or I would think that all vets would do it.
Pokey has gained a few pounds which I'm happy about but it has been work to get her to eat.
Her prednisolone is still 20mg per day and she is 47lbs. I am to check in with the vet on Monday and based on how Pokey has been doing she will lower the prednisolone. She had me stop the antibiotics since she was almost done and it may be causing her stomach upset. She added a med for diarrhea and one for nausea. Of course we stopped the Florinef too since she got the injection.

Thank-you for your input about her pancreas Lori, I will read up on the spec PL test and mention it to the vet.

They also told us today that she will need at least one more Percorten injection and then I guess we will be watching for signs of Cushings to return so that we will know if the Addison's is temporary or permanent. They also said it could possibly take a year to know which confuses me. There is just so much to take in and my brain just can't keep up with it all but I'm trying.
Thanks again everyone.
Tammy

[StarDeb55]

Tammy, I know at one time, it was common practice in Europe for vets to intentionally destroy the adrenal glands taking the dog from Cushing's to Addison's as it was felt the Addison's was easier to treat. I believe that this is still common practice. I really can't offer why this isn't done in the US. I know that my former IMS & I discussed it when Harley was diagnosed. I, very vehemently, told her that I absolutely would not consider it as I have a real problem in intentionally damaging an internal organ just to make my life a little easier dealing with taking care of the dog. I believe the term for this is the "Utrecht protocol", so you might want to "google" that to get some more information.

Debbie

Just found a link with some more information

http://www.vin.com/proceedings/Proceedings.plx?CID=WSAVA2006&PID=15787&O=Generic

[Squirt's Mom]

Hi Tammy,

Here are some links on canine Addison's. A couple have support groups that you can join and talk with folks who live with this condition daily.

Links for Addison’s

http://www.addisondogs.com/

http://canineaddisonsinfo.com/

http://www.vetinfo.com/dencyclopedia/deaddisons.html

http://www.marvistavet.co/html/addison_s_disease.html

http://license.icopyright.net/user/viewFreeUse.act?fuid=MjU5MDkyMA%3D%3D

http://www.k9addisons.com/

The fact that there are support groups for Addison's tells me this condition isn't as easy as some would have us believe. If you happen to have a pup who is really laid back and not easily excited, I can see where it might not be such a big deal. But if you have a pup who is apt to get excited over every little thing, then I can see where it would be difficult to manage as stress, even happy stress, is something Addison pups cannot handle. They no longer have the hormones to cope with stress.

I, too, could never intentionally destroy an organ just to make things "easier" for me or the vet....not sure at all it is easier on the pups. ;)

Hope the links help!
Hugs,
Leslie and the girls - always

[Loladog]

Hi Tammy,

I understand all to well what you are going through and I'm sorry.:( We also accidentally put Lola into Addison's with her Lysodren treatment. Her last dose of Lysodren was in 2/10 and she's been on Pred on and off ever since. Each time we try to wean her off of the Pred, she becomes ill (listless and loss of appetite). I have no problem keeping her on Pred for the rest of her life but there's no way of knowing if the Addison's is temporary or permanent. I guess only time will tell.:confused: Anyway, I just wanted to say hang in there. At least you caught everything in time and you are on the right treatment path.:)

[lulusmom]

The vet is telling us that Addison's is better to have than Cushing's. Easier to treat, cheaper, etc..basically that Pokey is better off. If this is true than why isn't purposely causing Addison's in all Cushing dogs the standard treatment? I know that some vets do this on purpose but there must be negatives to it or I would think that all vets would do it.

As Debbie mentioned, the Utrecht Protocol is a common practice in Europe wherein dogs are purposely made addisonian by bombarding the adrenals with high doses of mitotane (lysodren), for much longer periods than the average loading phase. This protocol was never adopted in the states because it's radical, risky and a substantial number of dogs will relapse in the first year and more will relapse after the first year. The adrenal glands have amazing regenerative powers and unless you kill every last cell, the chances are very good that they will regenerate at some point in time. Here's a link to an abstract of a study on this subject conducted by the Utrecht University.

http://www.ncbi.nlm.nih.gov/pubmed/10028568

[sunimist]

The fact that there are support groups for Addison's tells me this condition isn't as easy as some would have us believe. If you happen to have a pup who is really laid back and not easily excited, I can see where it might not be such a big deal. But if you have a pup who is apt to get excited over every little thing, then I can see where it would be difficult to manage as stress, even happy stress, is something Addison pups cannot handle. They no longer have the hormones to cope with stress.
Believe me, it's not as easy as some think. Having had a dog that had both, I would have to really do some soul searching to express which is easier to manage. JMO. Having said that, either or both can be managed successfully, and the dog can have a fairly normal and healthy life, but addison's is not a cake walk. :)

FWIW, the links Leslie gave have a wonderful and knowledgeable addison's support system.

Shelba and Suni

[Pdog]

Aimee, I'm sorry that you're having similar troubles and that they have been ongoing. I'm so stressed out and it has only been a few weeks. I hope things eventually calm down with Lola.
Tammy

[Pdog]

Thank-you all again for your input and the informative information and links. They have been helpful.
Pokey is back in the vet hospital and they are going to keep her 48 hours. She is down to eating almost nothing at home, basically just some deli meats. She's not eating enough and of course deli meat is lacking a lot of nutrients. She has had bad diarrhea again and the blood is back too. I'm so worried about her. They are just going to give her barium to coat things and then feed her the prescription food. No tests, no IV. They said she was eating for them which is frustrating. She gets so upset when she is there, so nervous but she eats. We bring her home, she doesn't. Although she did refuse treats from them today so at least I know I'm not completely crazy and Pokey sure isn't just 'spoiled'.
Since she doesn't have Cushings at this time I guess I'm going to change to an Addison's forum. I'm not sure where we belong.

Thank-you all again, you were very helpful and I've learned quite a bit.
Tammy

[frijole]

Tammy, First off my heart goes out to you... it is so difficult when they don't eat...I will keep you and Pokey in my thoughts and send prayers your way. Meanwhile - don't let a diagnosis keep you away.. you are always welcome here and we hope that you will come back and update us. We have had other members whose dogs went addisonian and we consider you family forever. I am sure that Pokey is in the best place right now but look forward to hearing she is back home where she is obviously loved and cherished soon. Big hugs, Kim

[labblab]

Tammy, I want to "second" what Kim has just said so well. You will ALWAYS belong here, no matter what additional forums you may join. You and Pokey are now members of our family, and we will worry about you if we don't hear back from you. It has now been six years since I've had a Cushpup in my house, but I have made so many dear friends here that I shall always consider it my home :o. And I hope the same will go for you, too. So I will be keeping my fingers crossed that Pokey quickly starts perking up, so that your next update will be to tell us that she's back home again and doing better.

With many hugs,
Marianne

[Loladog]

Tammy,

I'm so sorry to hear that Pokey isn't doing well.:( I can imagine how worried and stressed you must be but hang in there. You're doing a great job caring for Pokey and you'll both be in my thoughts. Hopefully you'll still keep us posted on this forum. I guess Lola is technically more Addison's than Cushing's right now but I feel very at home here. As long as everyone still accepts us which it sounds like they will.:D

Please take care,

[Pdog]

Thank-you for your kind words everyone.
I'm happy to report that Pokey is finally back home! We were able to pick her up tonight, she has been at the vet's all week...Monday-Thursday with no Pokey is too long!
They gave her barium on Monday just to try to coat things and that is really all they did besides feeding her. They sent her home with prescription dry food and also canned. Her prednisone was reduced from 20mg to 10 and hopefully 5 soon. She is on antibiotic because of the colitis and will stay on the probiotic and pepcid plus I have meds for nauseu, diarrhea, an appetite stimulant..I think that's it. And she had the injection so should be ok for about a month with that. I'm to take her back next week to have her electrolytes tested and then again in 2 more weeks.
She had to stay so long because she wasn't having any bowel movements and was still being picky with her food. But today she is eating a mix of the dry & canned and had a few big poops.
I just gave her a little of the canned & dry and she ate it! Yippee! She still refuses treats so she's not 100% yet. We are trying to be very low-key with her and not create a fuss. I just hope the pickiness keeps improving so we can get her back to normal.
Things are looking up I think!
Thanks again
Tammy & Pokey

[Loladog]

Tammy,

That's great to hear that Pokey is now back home with you and feeling better!:D I can imagine how hard it was to be without her for four days.

[Casey's Mom]

Wonderful news that you have Pokey back home and eating!!! :):):)

Love and hugs,

[Wally P's Mom]

Hello All:

I have been off forum for a long time after the loss of Lady and decided to get caught back up on my reading. I wished I decided to get back sooner. I would of chimed in earlier.

My Wally was once Cushings and is now Addisons. One of the diagnostic tests that is used for Addisons besides an initial ACTH Stim Test is a check of the electrolytes (Potassium and Sodium levels). The ratio of K/Na is normally 27-40.

Wally does take DOCP every month and 1mg of pred every day. I do keep an eye out for those same symptoms that I used too when he had Cushings. Again if those same symptoms arise, please take your pup to a vet. Wally has had Addisons for 14 months. He is doing ... (I ain't going to jinx things now). Addisons is forever. Treatable, but not cureable.

To help educate you and others on Addisons Disease, I am attaching a link to a YouTube video that was made by some vet students. A little corny, but describes Addisons Disease very well and treatment involved. I wished I had seen this when Wally was first diagnosed. The terms "waxing and waning" are now words I use with my Vet. Stay in touch as there are others that do read and post whose dogs have become A-Dogs.

http://www.youtube.com/watch#!v=AkswONTG-Z8&feature=channel

I hope this helps you and others.

Marge and Wally

[Roxee's Dad]

Hi Marge,

Thanks for the link, I loved the video and the way it brings the level of awareness to a higher level. Addison's is not a condition one can mess around with, it is very serious and takes a conscientious owner to treat successfully.

Thanks again for that link, I will keep it handy and hope it helps others.

[Wally P's Mom]

John:

The video was the most informative way that I understood Addisons Disease. I was informed about this video from one of the Addison's groups that I belong to.

Marge

[teri]

Hope your dog is doing better. I went thru something similar but my dog wasn't nearly as sick as Pokey. I hope it's so much better now. My very food aggressive dog was not eating her meals as she normally does so I took her into see vet and her electrolytes were out of kilter. Her potassium was too low and had to have two days of i.v. potassium. Taken off of Vetoryl as her body had over corrected itself and had gone into Addisons. Now she's doing the Prednisone and Florinef. Seems to have stabilized at this point but was told the Cushings can come back. That's all I got but I hope and pray your pup is doing much better. Take care and God Bless!

[Pdog]

I appreciate the link to the video. Silly girls but they do cover all of the important points and look like they had fun doing it!
Marge I'm sorry you've lost one but glad that Wally seems to be doing ok at this time. Teri, I'm also glad that your dog is doing well with the Addison's treatment.
Pokey is still not 100%...she's just not 'right'. She is still on the prescription food, both canned and dry and won't touch her old food. She is down to just 3 types of pills now. The probiotic, pepcid AC and 10mg prednisolone. She also had the percorten injection. She has been making it through the night without having to go outside but still drinks more than usual. Her panting is returning, not all the time but a lot more than normal. I don't know what is going on. She just doesn't seem to be enjoying life. She is here and she will come to be pet when we call her and she gets excited at feeding times (but then leaves half of the prescription dry food), gets excited to go for a ride in the car but...I don't know, she's just not right. Inbetween those things she just has that zombie look.
I hadn't wanted to ask about this on here but I could really use some input about bills. Pokey was definitely overdosed by a lot, the office is taking responsibility..sort of. They did give us back all of the money but we have to argue for it each time which makes my stomach hurt. They told us that we needed to pay for the ACTH test she had done weeks ago because 'she would have needed it anyway'. I agreed immediately just to show good faith so that was over $200. They charged us for the prescription foods (not even at cost, at full amount) and when we picked her up they gave us an already opened bag. Not a big deal, but I found it a little insulting. That was over $50 and hasn't even lasted a week. We have spent about $150 on our own for lunchmeats, canned foods, dry foods, a cheap baby gate,carpet cleaner, pepcid, etc. that we haven't asked for but it is all related to the overdose. Not to mention the stress. I don't want to be a drama queen but this has been very, VERY stressful for me worrying about her. Plus all the cleaning, and we couldn't leave her alone at all for weeks..just so many little things that added to the lack of sleep have been really hard. She is supposed to go tomorrow for another electrolyte test and from what I read on the papers they gave us she will have to have a lot of them in the immediate future. I would appreciate input on what you all think about the money aspect. Getting Pokey back to herself is number 1 but if we are going to have to pay I think we should go to another vet. But I don't think we should have to pay, I think they should get her back to her pre-event condition at their cost. Is that wrong? We can't afford over $200 in dog food plus all the other vet costs a month and I don't know how to get her back onto her regular Science diet, she won't eat it.
I don't think they are doing the right thing but I know my judgment may be clouded. I don't want to hear that Addison's is 'cheaper and easier' in the longrun than Cushings. It sure doesn't feel easier to me or to Pokey. I wanted to scream when they said that.
I know that this isn't what this forum is for but I would appreciate any help.
Thank-you all.
Tammy

[Squirt's Mom]

Hi Tammy,

I hope Pokey continues to improve and you soon have your old buddy back. Your stress level will certainly go down then, huh? :D

Ahhhh...the financial aspect...we have all dealt with it at one time or the other. There are groups that may be able to help with vet cost and you can find them here, from our Helpful Resource section:

http://www.k9cushings.com/forum/showthread.php?t=212

You will find some good leads there. Many of us have used Care Credit.

Personally, I have learned that there were a lot of things I could do without or could stretch out the use of so I didn't have to replenish as often. I have had yard sales where the proceeds went to vetting. I have begged, borrowed and thought about stealing ;):p, whatever it takes to get what Squirt needs. I know the day is coming when she and I will be living in a cardboard box, but if that is what it takes....so be it. :eek::p;) But I still have a few vices I could give up, like bubble baths :(:p. The point is, we simply do what we can and that's all we can do. When things get tight, we have to decide if the testing can be put off for a bit and if not, then we find a way. I have a friend who works for her vet in exchange for the vets services. She does everything from cleaning cages to walking dogs to answering phones to assisting in exams...and loves it. She doesn't make a dime, but her dogs are taken care of.

Check out that link and see if there isn't something there that might help.

Hugs,
Leslie and the girls - always

[Harley PoMMom]

Hi Tammy,

I, too, hope that Pokey continues to improve and we will be sending healing and good thoughts your way.

I am sure other members are more versed in the legality of the issue at hand than me so I don't know if the info I will provide will be of any help but...I'll provide a link to the American Veterinary Medical Association (AVMA) website, on here you can find your State and your State veterinary medical association and the Veterinary state board. Maybe you can contact one or both of them and file a formal complaint. Like I said, I don't know if this will help or not but might be worth a try???


AVMA Website for State Legislative Resources: http://www.avma.org/advocacy/state/resources/default.asp

We are here for you and Pokey, always, remember that, ok? ;):)

Love and hugs,
Lori

[Pdog]

Hello everyone. I just posted a message on the Diabetes forum because my parents' dog was diagnosed yesterday and I need some help to help me, help them to help him! :-) Anyway, in replying to the first nice person that answered me I found myself telling how this forum saved Pokey's life. I know I thanked everyone in each message on here but I just wanted to make sure that you all know how grateful I am for all of your help during Pokey's Addison crisis. I feel sure she would not be here if you all hadn't informed me about the need for her electrolytes to be tested and all the other info. It's unfortunate that the vets were so incompetent but thankfully Pokey had a group of Angels on this forum looking out for her.
I have been posting on the Yahoo Addison's forum and they have been helpful too. At this time Pokey's electrolytes show that she doesn't need Perorten but does need daily Prednisone. I'm still tweaking it with our new vet's help to try and find the correct dosage for her. She is doing better but still not 100% although I'm not even sure what that is for her since she was probably Cushings for long before we realized it. She has gotten very stiff since weaning down the Pred but pants on too much. Right now I'm not happy with the stiffness or her eating so I've raised her Pred a bit to see how she does. So she's much, much better but still has some fine-tuning to be done.
I just wanted to thank-you all again...I love her so much and wish I could give you hugs and she could give you some sloppy kisses.
:-)
Tammy & Pokey