11 y.o. Lab/Rat Terrier Mix - "Baby" - Baby has passed

[LacubriousDogs]

Had to take "Baby" to the vet for 6 stitches after a dog fight. Asked about her pot belly and Vet said it was probably fluid but would do xrays and bloodwork. Xrays showed an enlarged liver but all other organs looked good. He also diagnosed an ear infection. Abnormal Labs were as follows:

WBC:
NE K/ul 14.76 (mildly elevated) Range: 2.0 - 12.8
LY K/ul 0.36 (moderately low) Range 0.6 - 5.8

NE% 94.14 H Range 50.0 - 80.0
LY% 2.29 L Range 12.0 - 30.0

ALB 4.5 Range 2.5-4.4
ALP>2400 Range 20-150
ALT 268 Range 10-118
GLU 126 Range 60-110

She's also very thin, hip bone and spine are visible, but has actually gained 4 lbs over the last 5 months.

We estimate that she drinks about 60-70 ounces of water per day. She weighs 44 lbs.

On walks she urinates multiple times, this started about 2 years ago. She also had accidents in the house beginning 2 years ago, went thru urine testing, treated with antibiotics noreal change. Also treated with DES thinking it was female bladder issues. No change, stopped hormones. Her urine also tested high for PH (10) and I was advised to alternate between vitamin C and another product (can't remember the name). I bought test strips and it appears that her urine is in the normal ph range. So treatment was discontinued. She's also developed a really dry, rough nose that I have treated with vitamin E.

I am taking her to a specialist next week for a review of the liver findings. Ultrasound for sure. I am wondering if Cushing's fits, though I know they can do extensive testing. Just looking for some guidance on how to proceed, my vet basically just handed me a pamplet for the specialists so no help there.

Thanks!

[labblab]

Welcome!

I have only a few moments to post right now, but I want you to know that we are very glad that you have found us. I cannot comment on the abnormal blood counts, but the liver irregularities (enlarged organ and elevated enzymes) as well as many other symptoms that you have described are indeed consistent with Cushing's. I agree that an ultrasound will be an excellent diagnostic tool, and I expect that the specialist will also want to conduct at least one Cushing's blood test -- either the LDDS or the ACTH.

To help you prepare for your vet visit, do take a look at our "Helpful Resources" thread:

http://www.k9cushings.com/forum/forumdisplay.php?f=10

Please continue to ask any additional questions that come to mind. And I'm certain that other members will also be by soon to offer their welcomes, as well.

Marianne

[Cindy Thoman]

I just want to welcome you and Baby to this forum. I cannot offer much advice as this is all new to me also. Alex, my nine year old Pom was just diagnosed with Cushing's. We have just started him on Trilostane. His symptoms are elevated liver enzymes (2267), diluted urine, voracious appetite, skin issues, loss of hair, and increased urinating.
I have found that this forum offers a wealth of information, and has the most wonderful, caring members.

Cindy and Alex

[lulusmom]

Hi and welcome to the forum.

First let me say that I am so sorry that Baby got into a fight and was hurt and then to find out she may have cushing's on top of that. I will tell you that the lab work is pretty much what you would see in a cushdog and as Marianne has confirmed an enlarged liver is also common. Cushing's is an insidious disease that sneaks up on a dog. It's slow to progress and sometimes us pet owners don't see the signs until they hit us over the head. :D It sounds like she does have one symptoms that is commonly associated with cushing's and that is excessive drinking and peeing. Do you know if her urine is dilute, meaning clear and pretty much odorless? This is the norm with cushdogs as their kidneys lose the ability to concentrate the urine. Have you noticed any increase in Baby's appetite in the last year? Any panting?

I know that not all dogs have issues with their nose but one of my cushdogs, Jojo, had a crusty, dried up nose which would actually crack and bleed. That went away completely after he was stabilized on medication. I believe there have been one or two other members who reported that same symptom.

My first cushdog was diagnosed back in 2005 and I wish my then gp vet knew how to spell cushing's and would have suggested that I take my Lulu to a specialist. Consider yourself lucky that your vet is admitting that he doesn't have the experience necessary to diagnose and treat a cushdog. Both of my dog treat with an internal medicine specialist and I'd have it no other way.

We're here to help you in any way we can so please know that you are not alone in this. If Baby is ultimately diagnosed and you decide to treat, none of us are strangers to Lysodren and/or Vetoryl (Trilostane), which are the only two effective treatments. We're here to answer questions, hold your hand or just lend an ear.

Please take the time to check out all of the information available in our Helpful Resources section, especially the link Marianne provided you.

Glynda

P.S. A Lab Rat Terrier is a very interesting mix and wouldn't think it would be physically possible without an orange crate. :D I was at an adoption clinic two weeks ago and saw the cutest little dog. I guessed he was a Corgi Chihuahua mix and his mom said I had half of it right. He was a Rottweiler and Chihuahua. :eek::confused::eek: I said "No Way" and she said yes and knows for sure because her mother owns the mom and dad. So there ya go.

[LacubriousDogs]

Yes, she is quite a Jekyll & Hyde kind of dog! We only know that her Mom was a rat terrier and we're assuming the lab on her coloring and the others in the litter. Her little Mom had 11 puppies in that litter! One of her siblings passed a few years ago and I can see now that she possibly had Cushings. She looked like a big, furry, bloated, scruffy thing. The owners vet said it was some sort of internal organ problem...I don't think they had any testing done, she was finally put to sleep. Sad...

Anyhow, my Baby does pant intermittently and it doesn't appear to be in response to being hot or anything. Honestly, I've chalked up most of her issues to being geriatric...which I hear is common.

So, should I make sure that she is actually going to see an internal med vet? I think they only have her scheduled with a radiology person for the ultrasound.

[lulusmom]

Perhaps I was wrong about your vet not having experience with Cushing's. I misinterpreted the part about him giving you a paper with specialist on it. Cushing's is one of the most difficult canine diseases to diagnose which makes it the most misdiagnosed so in my opinion, internal medicine specialists (IMS) are better educated and usually much more experienced than a general practitioner at diagnosing and being intimately familiar with the medications. I am not the only member who feels that way as a very large number of members have an internal medicine specialist on their dog's case. An IMS doesn't have to have exclusivity and are usually very willing to work with a pet owners gp vet.

Glynda

[LacubriousDogs]

The Vet Specialist didn't immediately think that Cushings is what's going on with Baby. They did an ultrasound and found nodules in her liver and spleen, they took aspirations of the nodules, some additional blood for a more exact liver number, also urine as well...waiting time, about one week to get the cytology results to see if the nodules are just age related, cancer, or related to another cause. Vet did mention that if Cushings is considered, there would be testing and her preferred drug of choice is trilostane.

[lulusmom]

We'll be staying tuned in for your updates.

[LacubriousDogs]

Just got off the phone with the Vet Specialist.

Baby's test results were as follows:
ALP: 2800
Cholesterol: High
Platelets: High
Thyroid: Normal
Urine: Dilute
Blood Pressure: High
Liver Aspiration: VH - Vascular Hepatopathy
Spleen: EMH - extramedullary hematopoiesis

So based on all of these findings the Vet is leaning towards Cushings.

Next step is a Low Dose Dex test...next week!

Does anyone have any info on affordable sources for Trilostane? The vet is indicating a cost of about $120 per month. Is this typical?

[Squirt's Mom]

Hi,

Was an ultrasound done on Baby? If so, what were the comments about the adrenal glands? What is the normal range for the ALP value of 2800? Different labs use different norms so it helps to see what each lab uses as a range. ;) For the values listed as "high" can you get the actual results and ranges for those? Nosy old gal, huh? :D Details are important so we tend to ask these sorts of questions. ;)

The LDDS is a great next step! It is an eight hour test so if Baby gets nervous at the vets, you might want to take her for a walk or ride or even back home, if close enough, between draws. They will take 3 blood draws for this test and many folks just make a day of it with their dogs to try to keep the pups stress level as low as possible.

Please keep in touch and let us know how things are going!
Hugs,
Leslie and the gang

[LacubriousDogs]

Yes, she had an ultrasound, that's how they located the liver and spleen nodules. As far as her adrenals, both are enlarged by about 2mm above normal.

The ALP range for that lab is 20 - 150.

I do not have (yet) the detailed ranges for the other tests.

The Vet indicated that I would drop her off for the day. I would think the coming and going would raise her stress level. I live about an hour from the specialist so going home is not an option. :(

[Squirt's Mom]

Thanks for the additional info! I felt like an U/S had been done but with my whacky brain it's always best to make sure. :p

Adrenal glands that are equally, or close to equally, enlarged are typical in the pituitary form of Cushing's. In the adrenal form, one gland is usually much larger than the other, and the smaller one may even be atrophied. There are always exceptions but this is the norm for adrenal findings on U/Ss.

Some pups do fine left at the vet all day for these test and some don't do well at the vets for any reason. Since stress can effect the results of Cushing's tests, we try to offer options that may take some of that stress away for the pup giving the tests a better chance to be unaffected by external factors. Some members have taken their babies for rides, or to a park or pet store, and some have just sat in the waiting room with them between draws. For pups who aren't bothered by the vet clinic, it isn't an issue. Squirt wasn't one to be upset at being left for the day. It bothers me more than it does her! :p

Hang in there! Let us know how things go and if you have any questions!
Hugs,
Leslie and the girls

[LacubriousDogs]

Baby get's excited no matter what we are going to do...the only time she is calm is at home in her bed or on the couch. I guess we'll just see how it goes. If they will let me stay with her I can bring her doggy bed and we can just hang together.

[LacubriousDogs]

Baby seems more agitated this evening. Not sure if she just wants food or if she's in pain or what. Her little belly looks a bit more prominent as well. Do any of you treat your dogs with any pain meds to mediate any pain from the enlarged liver, etcetera?

We are still working out the schedule for next week's LDDS.

[Squirt's Mom]

Hi,

Sorry Baby didn't feel like herself last nite. :( And sorry no one was around to help you last nite; we usually have folks on 24/7 to help members.

Here are some signs of pain in dogs -

http://www.natural-dog-health-remedies.com/dog-pain-relief.html


Signs and symptoms of pain in dogs to look out for are:

Vocalizing
* Whining
* Howling
* Whimpering
* Yelping
* Groaning

Posture
* Hunched (with hindquarters raised and front end down on the ground)
* Limps
* Carries his head or tail off center
* Lays on his side

Facial Expression
* Grimaces, especially when touched
* Vacant stare
* Wide-eyed or looks tired and sleepy
* Dilated pupils
* Flattened ears
* Pants excessively even when resting

Activity Level
* Restless
* Reluctant to move
* Difficulty getting up from a laying position
* Unable to rest comfortably - gets up and lies down repeatedly
* Trembling, circling or lying very still

Behavioral Changes
* Becomes grouchy and aggressive (especially a previously friendly dog)
* Growls, hisses, bites when being touched
* Doesn't want to be held or picked up
* Pins ears back
* Hides (e.g. under the bed)
* Withdraws from social interactions
* Relunctant to play
* Loss of appetite
* Lethargy
* Excessive drooling
* Becomes more "clingy" than usual
* Incessant scratching or licking a particular part of the body

Cushing's itself is not painful for our babies but some of the effects can be uncomfortable for them. Fat collecting in the belly puts pressure on the liver and other organs causing them to pant. The liver enlarges due to the extra work it is being asked to do in processing the extra cortisol present in cush babies further cramping the abdomen.

Restlessness at nite can also be due to thyroid problems, Cushing's, or other issues Baby may be facing, like liver problems.

You're doing a good job of watching Baby and noting the things you see that are different with her. :D That is important in any health concern with our babies since they can't talk to us, especially in conditions like Cushing's. So keep up the good work and stay in touch! :)

Hugs,
Leslie and the gang

[LacubriousDogs]

LDDS test scheduled for the 15th!

In the meantime, Do you all think I should look into homeopathic remedies to support her liver function, like milk thistle, etc.?

We have a homeopathic / wellness vet in our area that I've considered consulting with in addition to the specialists.

[Harley PoMMom]

Many of us give our furbabies liver support supplements such as milk thistle or denamarin but I do advise to seek the approval of Baby's vet before giving a liver support supplement.

Love and hugs,
Lori

[LacubriousDogs]

Had to breakup another fight between the dogs tonight! Seems Baby is getting more aggressive, particularly when she feel hungry. Anyone out there experience aggression or agitation in the Cush dog? I am freaking out over this as the younger dog is very big and strong and it wasn't easy to stop her.

I try to be vigilant but missed the signals this evening so I couldn't head it off early. :(

[Harley PoMMom]

I was just wondering if Baby's thyroid levels, especially her FreeT4, have been checked lately. The reason I ask is because aggressive behavior can be associated with a thyroid problem. Here is a link to an article by Dr. Dodds, who is an expert in thyroid issues in dogs: Thyroid Disease, Diagnostic and Treatment Misunderstandings (Dodds). (http://www.k9cushings.com/forum/showthread.php?t=1627)

Love and hugs,
Lori

[AlisonandMia]

Yes, my dog became very food aggressive under the influence of high cortisol levels. Apparently high cortisol either directly or indirectly tricks the brain into believing that the body is starving - thus the huge, insatiable appetite. A dog that is affected this way by high cortisol (and a lot of them are) is simply not in its right mind and can behave in a desperate and crazy manner with regards food and can even do something really dangerous like challenging a higher-ranking dog for its food. Basically they are just not sane around food, just as a starving dog would not be.

Apart from this understandable food aggression, Cushing's (in dogs) is not related to increased general aggression. As Lori said, that is something that is more usually seen with low thyroid. My dog did not become more aggressive (or aggressive at all) except in regard to food.

I believe the only solution to feeding dogs together when one is affected by Cushing's is to not feed them together! I fed my dogs in crates but there would be other solutions to the problem. The key is to not allow them together in the presence of food or anything that could possibly be regarded as food (such a raw hide chew) or the opportunity for a treat.

Don't despair though - effective treatment of the Cushing's by lowering cortisol will bring the raging appetite back to normal. The relationship between the two dogs with regards food could, however, take a bit longer to return to normal as the dog that has been challenged or stolen from will be understandably on guard or even resentful for some time afterwards. I believe that my Cushing's dog Mia's behavior around food has likely permanently affected my other dog Zac's attitude to other dogs being around him when he is eating. (He was young and impressionable at the time.)

Alison

[LacubriousDogs]

Thanks for the insights. It was not a pleasant night for us. As we reflect on what is happening, Baby is not taking Ivy's food so much as she is "guarding" the food bin itself from a short distance. Shes simply staring down Ivy while lying on the floor. Ivy is just retaliating. I just bought a 2nd crate plus covers so both dogs have their own and we can manage the separation better. Baby
seems content locked up so maybe that is best for now. It's gonna be a rough week.

[jrepac]

Alison is correct; they can get incredibly hungry when they have Cushings and go to ridiculous extremes (like raiding trash, attacking, etc). From my own experiences, I suspected Cushings when my Aussie was barking for food/biscuits at 2:30am...this is what can happen. That plus early rising (5:30) wanting to eat her main meal.

They can get very restless and have difficulty sleeping; partly due to the hunger, I believe. Her sleep patterns were truly wacky.

When she got treatment, the night-time biscuit runs and 5:30am wake up calls diminished, then disappeared entirely.

Jeff & Angel Mandy

[LacubriousDogs]

Thanks for the feedback. We are trying to be patient and get through this. Baby had the LDDS test yesterday but now we have to wait for the results. They said a week!!! But I'm hoping it will be less and we can get on with treatment.

I spoke to our obedience class instructor and she said that after treatment starts and we see some improvement that she would help us reintroduce the dogs and see if we can work out their relationship. It is possible that now that our other dog, Ivy, has retaliated that it may be a permanent reaction but that we could try a few things and see.

I just need to get our house back to normal! Whatever that is!

[LacubriousDogs]

Just got the call from the Vet, confirmed Cushing's from Friday's LDDS test based on failure to supress.

Now we wait on the arrival of Trilostane.

We are doing the 2x per day dosing, forgot to ask what dosage but Baby is around 40 pounds.

Vet indicated that it could take months to see any improvement in her symptoms which surprised me. I kind of anticipated improvement within a few weeks. Can anyone comment on their experiences? Also, side effects?

Thanks for the info,

[lulusmom]

Can you please get a copy of the LDDS and post the results for us. Sometimes the LDDS will tell the vet if the dog has pituitary based cushing's but a lot of the times, it doesn't. Did your vet tell you if Baby has pituitary cushing's?

[labblab]

Take a look at this Technical Brochure published by Dechra (manufacturers of brandname Vetoryl). As you scroll down, you'll see some tables and charts giving summaries of an expected time frame for symptom resolution. Within the first couple of weeks, many owners do see improvment in appetite, thirst, urination, and lethargy. However, it may take a longer time (up to three months)for complete resolution and also for other symptoms to resolve. And of course, the improvement will depend upon arriving at a therapeutic dose of the medication. Too low a dose will extend the time it takes for improvement; too high a dose will increase the risks of side effects. That's why the monitoring ACTH tests are very important. As for potential side effects, you'll also see them listed in that Brochure and attached Product Insert:

http://www.dechra-us.com/files//dechraUSA/downloads/Client%20Literature/38965_Technical_Brochure.pdf

A couple of thoughts about dosing: the technical representatives at Dechra tell us that they are recommending that dogs be started using a formula of approx. 1 mg. per pound. Dechra recommends beginning with just one dose daily (in the morning). However, we know that some vets prefer starting off on a twice daily dosing regimen. In that instance, though, the revised recommendation is to increase the daily total only incrementally and split it in half, rather than doubling the once daily dose. So in Baby's case, weighing 40 pounds, I'm guessing that Dechra's recommended twice daily starting dose might be in the neighborhood of 20-30 mg. twice daily. If you or your vet have any questions about Dechra's revised dosing recommendations, veterinarians in their Kansas office are happy to speak with owners and vets alike.

Marianne

[LacubriousDogs]

LDDS Results:
Time 815
Time 1215
Time 415
Cortisol Sample 1 5.6 RANGE: 1.0-5.0 μg/dL RESULT: HIGH
Cortisol Sample 2 Dex 4.3 RANGE: 0.0-1.4 μg/dL RESULT: HIGH
Cortisol Sample 3 Dex 5.2 RANGE: 0.0-1.4 μg/dL RESULT: HIGH

[lulusmom]

Thank you for posting the LDDS results. The results are definitely consistent with cushing's and to remind everyone, Baby already had an abdominal ultrasound. Both adrenals were equally enlarged so Baby has pituitary dependent cushing's (PDH).

Do you know what dose of Vetoryl your vet has prescribed to be given twice a day?

Glynda

[LacubriousDogs]

I do not know the dose, but when I get home from work today the meds should be there and I will post a followup. I also got a copy of her latest blood tests (from 3/29/11)...here they are. (A bunch!!!)

FORMAT: TEST NAME RESULT RANGE
Superchem
Total Protein 7.0 5.0-7.4 g/dL
Albumin 3.9 2.7-4.4 g/dL
Globulin 3.1 1.6-3.6 g/dL
A/G Ratio 1.3 0.8-2.0
AST (SGOT) 51 15-66 IU/L
ALT (SGPT) 315 12-118 IU/L HIGH
Alk Phosphatase 2792 5-131 IU/L HIGH
Result Verified
GGT 19 1-12 IU/L HIGH
Total Bilirubin 0.2 0.1-0.3 mg/dL
BUN 12 6-31 mg/dL
Creatinine 0.7 0.5-1.6 mg/dL
BUN/Creatinine Ratio 17 4-27
Phosphorus 5.1 2.5-6.0 mg/dL
Glucose 108 70-138 mg/dL
Calcium 10.9 8.9-11.4 mg/dL
Magnesium 1.7 1.5-2.5 mEq/L
Sodium 149 139-154 mEq/L
Potassium 4.8 3.6-5.5 mEq/L
Na/K Ratio 31 27-38
Chloride 105 102-120 mEq/L
Cholesterol 455 92-324 mg/dL HIGH
Triglyceride 239 29-291 mg/dL
Amylase 1000 290-1125 IU/L
Lipase 947 77-695 IU/L HIGH
CPK 218 59-895 IU/L
CBC
WBC 12.1 4.0-15.5 103/μL
RBC 6.7 4.8-9.3 106/μL
HGB 15.2 12.1-20.3 g/dL
HCT 44 36-60 %
MCV 65 58-79 fL
MCH 22.7 19-28 pg
MCHC 35 30-38 g/dL
Platelet Count 524 170-400 103/μL HIGH
Platelet Est Increased
Differential Absolute %
Neutrophils 10769 89 2060-10600 /μL HIGH
Lymphocytes 726 6 690-4500 /μL
Monocytes 484 4 0-840 /μL
Eosinophils 0 0 0-1200 /μL
Basophils 121 1 0-150 /μL
Comment
Blood smear reviewed by technologist.
Total T4
T4 1.1 1.0-4.0 μg/dL
Urinalysis
Collection Method
Not Stated
Color Yellow
Appearance Clear
Specific Gravity 1.007 1.015-1.050 LOW
pH 7.0 5.5-7.0
Protein Negative Negative
Glucose-Strip Negative Negative
Ketones Negative Negative
Bilirubin Negative Neg To 1+
Occult Blood 1+ Negative HIGH
Results have been rechecked and verified.
WBC 0-1 0-3 HPF
RBC None 0-3 HPF
Casts/LPF None Seen Hyaline 0-3 LPF
Crystals None Seen HPF
Bacteria None Seen None Seen HPF
Epithelial Cells None Seen HPF
Urine Microalbumin (Canine)
Microalbuminuria 28.2 <2.5 mg/dL HIGH
The result is between 2.5 and 30 mg/dl, indicating microalbuminuria
(MA).
Microalbuminuria (MA) usually indicates compromise of the
glomerular barrier and is a significant finding when it is persistent
(3 or more positive results obtained 2 or more weeks apart).
Persistent MA, in the majority of pets, is due to primary renal
disease or renal injury secondary to other systemic disease. Systemic
diseases associated with persistent MA include inflammatory disease,
chronic infections, metabolic disease (e.g. hypertension, Cushing's
Syndrome, diabetes mellitus, hyperthyroidism) and neoplasia. False
positive results may occur with pyuria and gross hematuria.
Suggestions for evaluating patients with microalbuminuria:
1. Check for and treat underlying diseases indicated above
2. Recheck MA in 2-4 weeks
3. In the absence of underlying disease, monitor for progression of
MA and development of renal failure.

[lulusmom]

Thank you so much for posting that long list of blood and urine values. Whew, that was a lot of typing! Our lab expert, Debbie, can confirm for us but I believe the abnormal values you have bolded are what you would expect to see in a dog with cushing's.

[LacubriousDogs]

Oh gosh, I really only copied and pasted from the lab PDF they emailed to me!

Also, Baby's prescription is 35mg, twice a day. I gave her the 1st dose tonight at 6:15pm. So far so good!

[lulusmom]

35mg twice a day is on the high side so keep a close eye on Baby for signs that her cortisol may be too low. Those signs would be not eating or eating very little, extreme lethargy, vomiting, diarrhea, weakness, trembling. Initially dogs are very sensitive to the drug and cortisol can drop like a rock in the first couple of days. It stands to reason that if a dog has been swimming in a sea of cortisol for months and months and then all of sudden the levels drop quickly, she's probably going to experience some type of withdrawal which will make her feel kinda crappy for a few days.

Please keep in touch with us and let us know how Baby is doing as we progress through her first week of treatment.

Glynda

[labblab]

I agree with Glynda, and just want to repeat a paragraph that I had written earlier, but this time also including the contact information for the technical representatives at Dechra in the event that you or your vet would like to talk with them directly. Several of us have spoken with Dr. Allen, and he has been extremely helpful to us all.


A couple of thoughts about dosing: the technical representatives at Dechra tell us that they are recommending that dogs be started using a formula of approx. 1 mg. per pound. Dechra recommends beginning with just one dose daily (in the morning). However, we know that some vets prefer starting off on a twice daily dosing regimen. In that instance, though, the revised recommendation is to increase the daily total only incrementally and split it in half, rather than doubling the once daily dose. So in Baby's case, weighing 40 pounds, I'm guessing that Dechra's recommended twice daily starting dose might be in the neighborhood of 20-30 mg. twice daily. If you or your vet have any questions about Dechra's revised dosing recommendations, veterinarians in their Kansas office are happy to speak with owners and vets alike. Here's Dechra's contact information:

http://www.dechra-us.com/Default.aspx?ID=365

Marianne

[LacubriousDogs]

I am emailing the Vet to ask about the dosage. I'll be home with Baby all weekend so we can monitor her closely. I'm feeling hopeful, but that's probably just because we are actively doing something now as opposed to testing and waiting.

Do you think it would be okay to take her on a walk? I've held back on any extended walking thinking she could get overexcited and stroke out!

[Harley PoMMom]

I believe taking her for a walk is fine but if Baby becomes tired I would not push her for a longer walk, I would let her guide you to as how long/far she wants to go. ;):)

Love and hugs,
Lori

[LacubriousDogs]

Thanks Lori,
I took Baby for a 15 minute walk, she has plenty of energy!

She's been pretty calm this evening. We did notice her evening stool seemed runny and I know that the Trilostane can cause that. I'm logging her intake, output, and behavior on a calendar.

[lulusmom]

The loose stool concerns me because of the large dose Baby is getting. If it continues and/or Baby's loses interest in eating, you should stop dosing and call your vet. I'm keeping fingers crossed for firm poop tomorrow. :D

[LacubriousDogs]

Firm stool this evening so all seems ok. Appetite still very good. Panting has stopped!!! Yeah! Took both dogs on a walk together! No food involved so no fighting. Really hopeful that she continues to resolve.

[lulusmom]

Excellent!

[LacubriousDogs]

Schedule Baby's ACTH Stim test for the afternoon of May 3rd. It will be Day 12 of her intial dosage of 35mg BID. So far so good. She's reduced water consumption and NO More Panting! Still food aggressive and hungry :(

[lulusmom]

Just want to make sure that you are aware that you need to have Baby to the vet within about three or four hours after the morning dose of Trilostane. The test needs to be completed with four to six hours after the last dose.

[LacubriousDogs]

The Vet told me 8 hours, is that still ok?

This morning brought a significant change in Baby's appetite. She did not immediately eat her food when it was presented, it took a minute or so for her to get started and when she did it was slowly and she only ate half of it. :confused:

Last night my husband took her out in the yard and she wandered around actively. She's still playing with her toys when prompted. :D

Stools are normal.:)

Water input/output is reduced as well.

The ACTH stim is scheduled for May 3rd.

[lulusmom]

No, 8 hours is not okay. The acth stimulation test must be done within 4 to 6 hours of the last dose of Trilostane. UC Davis' protocol is even tighter, being between 2 to 3 hours after dosing. The only reason I can see doing an acth stimulation test that late after dosing would be to determine if a dog may need twice daily dosing. Trilostane has a short half life and starts to lose it's enzyme blocking ability any time after 8 to 12 hours. When this happens, some dogs on once daily dose never see resolution of symptoms so twice daily dosing would be appropriate. I believe you are way to early in the game for our vet to be making this determination and the first order of business is establishing whether or not the current dose is adequate. Make sure that your vet completes the test within 4 to 6 hours of Baby's morning dose.

[Keiko's Mom]

Please listen to lulusmom....it needs to be sooner than you think. My dog was tested at 4 hours on the dot. Good Luck with your baby.

[LacubriousDogs]

Rather than change the appt. time, can I move her morning dose by 2 hours?

Also, emailed the vet regarding her appetite change this a.m. And she says it could be worrisome (too high dose) and I need to monitor Baby over the next 24-36hours andvpossibly come in Friday for the ACTH stim test.

Tonight she ate readily albeit slower than she has in months.

Can anyone comment as to their experience within the initial 2 weeks on trilo if it was determined by ACTH test that their dog had too high of a dose? Just want to compare symptoms. Thanks! Kim

[lulusmom]

It is best to keep Baby's dose at the the same time every day so I personally would change the appointment for the acth stim test rather than delay the dosing. I'm a little concerned that your vet didn't instruct you on the time frame that is necessary for stims when treating with trilostane.

To answer your question about the first two weeks of treatment, dogs are very sensitive to the drug initially so you can expect the cortisol to drop like a rock. This can cause a dog to feel kind of crappy due to cortisol withdrawal but the dog usually adjusts in a few days. Is it possible that what you are seeing is Baby's appetite returning to normal? I don't know about you but my first cushdog had a voracious appetite for so long, I had forgotten what her normal appetite was so when it dropped off, like you, I had concerns. Your vet gave you some good advice. Watch Baby very closely for signs that cortisol is too low. If she quits eating, gets really lethargic, trembles, vomits or has diarrhea, stop dosing immediately. The good thing about Trilostane is because it has a short half life, a dog usually rebounds rather quickly.

I hope this helps.

Glynda

[LacubriousDogs]

I asked the vet if we could skip a dose to see if her appetite would return. It did not, however my husband figured out that Baby is just rejecting hard food. Not sure why. Maybe she's got jaw pain? Anyhow we are back on the meds and she's eating soft food. She did have one vomiting episode yesterday morning but it was before her breakfast and after she gulped a ton of water! Which is all that came out.

She's also redeveloped an ear infection, we think, so I'm retreating her with the otic antibiotics for 5 days to clear it up.

She's also back in crabby mode and baiting our other dog through her kennel! Arg! I can't wait to see what the stim test shows.

The vet said 8 hours is appropriate because Baby is on a twice daily dose. I know this may be in contrast to what's been mentioned on these forums but we are going with it this time. I did ask about it though.

[Harley PoMMom]

The vet said 8 hours is appropriate because Baby is on a twice daily dose. I know this may be in contrast to what's been mentioned on these forums but we are going with it this time. I did ask about it though.

The timing of the ACTH test is very important, if not critical, for seeing how the medication is working. Waiting 8 hours to do an ACTH test after dosing is not the proper protocol.

Here are some quotes about this:


The timing of the ACTH stimulation test is crucial; for the results to be meaningful, it must be started four to six hours after trilostane administration. You can read this here:Trilostane: A therapeutic consideration for canine hyperadrenocorticism. (http://veterinarymedicine.dvm360.com/vetmed/article/articleDetail.jsp?id=491107&sk=&date=&pageID=3)


After approximately 10-14 days at this dose, re-examine the dog and conduct a 4-6 hour postdosing ACTH stimulation test.
This quote comes from Dechra's U.S. Product Insert. (http://www.dechra-us.com/files/dechraUSA/downloads/Product%20inserts/Vetoryl.pdf)

I really suggest that you urge your vet to have Baby's ACTH stim test done from the above protocol which is 4-6 hours after the dose of Trilostane/Vetoryl.

Love and hugs,
Lori

[labblab]

The vet said 8 hours is appropriate because Baby is on a twice daily dose. I know this may be in contrast to what's been mentioned on these forums but we are going with it this time. I did ask about it though.
I do feel compelled to chime in here in agreement with Glynda and Lori. I have done a lot of reading of various trilostane protocols over the years, and I have never heard of 8 hours being used as the sole initial testing window, regardless of whether a dog is being dosed once or twice daily. My own Cushpup was dosed twice daily, and our specialist still had us abiding exactly with Dechra's published testing recommendation, which is 4-6 hours after the morning dose.

One reason why I am concerned about the 8 hour recommendation is that it is highly unlikely that you will be measuring the drug's maximal effect since it has such a short half-life. Per Dechra's U.S. Product Insert that Lori cited above:


Trilostane absorption is enhanced by administration with food. In healthy dogs, maximal plasma levels of trilostane occur within 1.5 hours, returning to baseline levels within twelve hours, although large inter-dog variation occurs. There is no accumulation of trilostane or its metabolitesover time.
In many dogs, the drug may already be starting to "trough" by the 8-hour mark. And from a safety standpoint, this is crucial. Because the purpose of the ACTH is not only to make sure that the dose is high enough to be therapeutic, but perhaps even more importantly, to make sure that it is not lowering the cortisol into a dangerous range at the point of maximum effect (during that 4-6 hour time period).

I know it feels hard to question a vet, but if he has information contrary to that of the drug manufacturer, it would be helpful to us all to find out about it. For your own peace of mind, I do encourage you to directly contact one of the veterinarians who serve as technical representatives for Dechra. Many of us have spoken with Dr. Tim Allen, and he is happy to talk with owners and vets alike -- by telephone or email. Perhaps he can offer further clarification. Here is the contact info for Dechra's Kansas office:

http://www.dechra-us.com/Default.aspx?ID=365

Marianne

[littleone1]

I just want to chime in with what others have said about the Trilostane dosage and the stim test. When Corky was on twice daily dosing, his IMS always had me schedule his stims within the 4-6 hour time period. Now that he is on three times daily dosing, his stim tests are still being scheduled within that time frame. I always have Corky's first draw along with the Cortrosyn injection done 4 1/2 hours after his first dose in the A.M.

Terri

[littleone1]

My previous post posted twice. Therefore, I removed the duplicate contents.

[LacubriousDogs]

Ok all,

Thanks for all the feedback and good advice! Apparently there is a lot of debate in the medical community right now regarding ideal timing for monitoring patients on twice daily dosing.

My vet is basing her recommendation on the following studies:
http://www.mendeley.com/research/evaluation-twicedaily-lowdose-trilostane-treatment-administered-orally-dogs-naturally-occurring-hyperadrenocorticism/

And

http://www.jaaha.org/cgi/content/abstract/42/4/269

Also she consulted with another vet at Mississippi State and they recommend 4-6 hours to detect maximum inhibition and 8-10 hours to make sure drug lasts long enough.

They recommend 8-10 hours if clinical signs of Cushing's are persistent to assess duration of effect. There is a potential to miss short duration if testing at 4-6 hours.

As a sufferer of an auto immune hormone issue myself, I can totally relate to the issue of duration of medications. When my meds are not timed correctly or I do not dose consistently I feel the effects. Since Baby has nearly all the clinical signs, getting the meds consistent seems the best course to alleviate the maximum amount of symptoms.

I should have her results in a few days.

I also should mention that her Vet IS willing to do the 4-6 hours test if we feel so inclined.

Bottom line, I want my dog to feel better! :)

[labblab]

Ok all,

My vet is basing her recommendation on the following studies:
http://www.mendeley.com/research/evaluation-twicedaily-lowdose-trilostane-treatment-administered-orally-dogs-naturally-occurring-hyperadrenocorticism/

And

http://www.jaaha.org/cgi/content/abstract/42/4/269

Also she consulted with another vet at Mississippi State and they recommend 4-6 hours to detect maximum inhibition and 8-10 hours to make sure drug lasts long enough.

They recommend 8-10 hours if clinical signs of Cushing's are persistent to assess duration of effect. There is a potential to miss short duration if testing at 4-6 hours.

I do believe that the studies your vet is citing only serve to underscore the very same points that we are trying to stress: that testing at 8 hours post-dosing will give you TROUGH results, and not PEAK results. For the purposes of determining whether or not splitting the daily total into two doses is optimal, then a trough reading can be valuable. But your first priority when beginning trilostane treatment is to establish the total dosing amount that is safe and effective for administration during a 24-hour time period. And for that, you must obtain a peak reading. As you will see from the first study, testing was initially performed on the research dogs at intervals of 3-4 and then 8 hours after once daily dosing in order to determine both drug effectiveness and duration. If you do not ensure that the dog's cortisol is not dropping too low at the time of peak effectiveness, you are risking very serious side effects and even Addisonian crisis.

If you wish to go to the expense of performing two ACTH tests on Baby -- one at approx. 4 hours, and one at 8 hours, then of course that is your choice. But if you are choosing to have only one done, then initially it is the "peak" level that is critical in terms of drug safety and efficacy. It is the peak level that the drug manufacturer (and also virtually all clinicians) are taking into consideration for purposes of making adjustments in the total daily dose, regardless of whether or not it is given in the form of a single dose every 24 hours or whether it is split in half into two doses at 12-hour intervals. The purpose of the 8-hour ACTH would instead be to determine whether it is better to break the daily total into two doses, or whether the duration of the effect is long enough to permit giving the daily total all at once, in the morning. However, rather than incurring the expense of a second ACTH test in order to decide whether to shift to twice daily dosing, most vets and owners instead base the decision on whether or not they are visually seeing symptom rebound later in the day in a dog who is being dosed once daily and who has registered a therapeutic ACTH result at the time of peak testing.

If you have remaining doubts about this, I strongly encourage you to call Dr. Tim Allen, a veterinarian who serves as a technical consultant for Dechra in their U.S. office (manufacturer of Vetoryl). I can promise you that he is familiar with every bit of monitoring research that is available. He is really nice, and is happy to talk with owners and vets alike. Here's the contact info for Dechra:

http://www.dechra-us.com/Default.aspx?ID=365

Marianne

[lulusmom]

I read your post last night and was too tired to put together a coherent response so when I came back this morning to give it a try, I was delighted to see that Marianne, in her usual fashion, covered everything I wanted to say. I just wanted to chime in and say that I am in complete agreement with her.

[LacubriousDogs]

I have no doubts at this point. I'm just wondering why this forum isn't more open minded to the possibility that testing protocols should be altered based on the patient. Baby is still exhibiting signs of Cushing's and is not showing any signs of Addisons (intial shock to her system aside), so to test for maximum inhibition seems silly, when what we really need to know right now is if the cortisol is being kept at an acceptable level. I think it's a fine balance between the two, and as I said it's something I can personally relate to.

Even as supportive and informative as everyone has been, I'm beginning to get the feeling that I maybe shouldn't be posting opposing views. :(

[SasAndYunah]

Hi :)

I haven't been posting to your thread but have been following your story. Having been a member of thisforum for about 6 years, I know that these people don't post such "urgent" messages because they don't do well with opposing views or because they aren't open minded, they do so because they are extremely caring and because they have seen many mistakes made in dosing, following protocols, etc.

It's not that they don't "agree" with a test being done at 8 hours...it's that they are concerned about the purpose of the test. You just started to treatment and in that case, you would want to know where the cortisol levels are, at the time the supression is at its highest. Still exhibiting symptoms at the start of the treatment is normal and the levels usually will continue to drop after those first 12 days. And thus symptoms will reduce as well. So first you will have to establish where Baby's cortisol levels are right now (at maximum suppression) and if the levels have gone down you test again in a month (if there's no reason to test sooner of course) Once the cortisol levels are in the right range, it's then, and only then, when there are still symptoms, that the next step would be to check if the medication is working long enough to keep the numbers supressed for the duration that is needed.

So no one is disagreeing with you there, it's just that you are too early in the treatment to take that test yet. You have to wait till the treatment can work fully and that takes more then 12 days. So for the treatment at this stage, the purpose of the test is to see wether the treatment is working in the sense that Baby's cortisol levels are dropping. As I explained, her numbers will keep dropping more in the weeks to come. You have to wait for that before you test for the duration...

I hope that my explaniation was clear and that you don't feel that people are "against" you or your opinions....they are not :)

Saskia and Yunah :)

[Squirt's Mom]

Hi,

I want to second everything Saskia has said so well. Discussions such as these are one of the ways we ALL learn about this disease and the best ways to approach treatment.

We offer you not only scientific support for what we say but also our first-hand experience and knowledge gleaned from living with Cushing's on a daily basis. But what you decided to do for your baby is entirely up to you and we will support you to the best of our ability. Now if you decide to do something that is known to be harmful or highly risky then, yes, we might get a bit excited....even yell to get your attention. ;) And we have seen some vets send their patients into very dangerous territory with disastrous results. :(

We care deeply for every pup that we meet here and want only the very best outcome at all times for that baby and their parent(s). As you are here longer, and I hope you will be, you will see that we don't all agree on all points...but we do all agree that the well-being of that pup is the ultimate goal and we all strive toward that end. We do this by offering you that scientific support for what we say as well as experiences as cush parents ourselves.

Keep your chin up!
Hugs,
Leslie and the gang

[labblab]

I am so sorry if my earlier reply has given you the idea that your thoughts are not welcome here!! If I have made you feel that way, then I have done a very poor job of expressing myself, because that is definitely not my intention, and I thoroughly apologize to you. :o

But in good conscience, I felt obligated to voice my concerns regarding the initial ACTH monitoring protocol that you and your vet are selecting. In no way am I critical of your decision to dose Baby twice daily in a desire to maintain a more consistent cortisol level throughout a 24-hour time period (I made that same choice for my own Cushpup). And if you want to perform testing in order to check her trough level, that is great. But I don't think there is anything unique to Baby's situation that eliminates the need to also establish the peak performance of the drug. All standard monitoring protocols incorporate arriving at a PEAK reading that falls within a specific therapeutic range. If you attempt to make dosing decisions based solely upon a trough reading, you are trying to compare apples to oranges. Because even with twice-daily dosing, the cortisol level will not remain totally consistent throughout a 24-hour time period. Take a look at Dechra's Monitoring Flowchart here, and I believe you will see what I mean:

http://www.dechra-us.com/files//dechraUSA/downloads/Client%20Literature/47902_VETORYL_10mg_Treatment_and_Monitoring_Brochu re_Update_3_2_ps.pdf

I truly would guess that the Mississippi State vets were not advising 8-hour testing instead of peak testing, but rather in addition to it had you opted to first begin with once daily dosing and you were concerned that the therapeutic effect was wearing off too quickly.

During our years on this forum, we have witnessed dogs who have become very ill from overdosing, and sometimes this can happen quite rapidly. The best way to protect against overdose is to ensure that at its peak, the drug is not overly suppressing a dog's cortisol level. You do not want to wait until a dog looks visibly ill to make this determination, because by that point you may have a very serious health crisis to contend with. So please understand that it is primarily out of safety that I am voicing my concerns. But in no way do I want you to leave or feel as though you cannot discuss your thoughts with us.

Marianne

[lulusmom]

Hi again.

I'm not sure what you mean by you have no doubts now but if it means you are going through with the 8 hour stim test, would you please consider calling and discussing Baby's situation with Dechra before proceeding? Marianne has already provided you with their contact information and you have nothing to lose; however, Baby could have a lot to lose if, as a result of the 8 hour test, your vet prescribes a dosing increase or an additional dose without knowing what the post stimulated cortisol levels are at peak effectiveness. Either change could drop cortisol too low and throw Baby into an addisonian crisis.

Studies show that approximately 80% of dogs do well on once daily dosing and the others will respond better to twice daily dosing. With those percentages, it is highly unlikely that the frequency of dosing is why Baby's symptoms have not resolved. It is a much more likely that the dose is either too low, or depending on where the post stim cortisol level is at peak effectiveness, it could be that a bit more time is needed. Of all the dogs we've seen here, only one dog was prescribed thrice daily dosing. His name is Corky and he's Terry's baby. He has an adrenal tumor which secretes cortisol and other adrenal hormones a lot differently than a dog with pituitary dependent disease.

I sincerely hope that you don't think our efforts to keep you informed are because we are contrary, obstinate or inflexible. We are simply concerned because your vet has stepped so far outside of protocol so as to 1) waste your money on a stim test that cannot be assessed properly without knowing the peak effective levels and 2) more importantly, he could possibly place Baby at risk if he makes a dosing change based on the results of that test. Perhaps it might be a better idea if you suggest that your vet contact Dechra himself to discuss Baby's case in detail. I think it would be a great learning experience for him that will be beneficial for Baby as well as any other cushdog that he might treat.

Glynda

P.S. Drugs used to treat autoimmune disease and cushing's in dogs are completely different. Prednisone, a synthetic form of cortisol, is one of the drugs given to a dog with an autoimmune disease in order to suppress the immune system. Should you prescribe too much of this drug, or even the right amount of this drug, a dog can become cushingoid (iatrogenic cushing's) and start to show symptoms associated with cushing's. The remedy for this is to wean the dog back on the drug. Conversely, if you give a cushingoid dog too much Vetory (Trilstane) cortisol drops way to low and the dog can get very, very sick and if too sick, the remedy becomes life saving measures requiring several days in the hospital on fluids and gluccorticoid and possibly mineralcorticoid replacement. This is a serious drug with documented cases of complete adrenal necrosis resulting in death, which is why we're so concerned.

[labblab]

Just to expand on what Glynda has written and also to clarify a couple of things with you, I am thinking that you already had the 8-hour ACTH test performed on 5-3 and you are awaiting results? Also, you have started with twice-daily dosing right from the start -- I believe you said that Baby weighs around 40 pounds and you are dosing 35 mg. twice daily for a total of 70 mg.

I worry that you will think I am being a harpie here, but please do bear these things in mind. First, you are starting out with nearly twice the total daily dose that Dechra is currently verbally recommending at conferences and during direct consultations with owners and vets (they are encouraging that the initial daily dose not exceed a forumla of 1 mg. per pound). And secondly, dogs who are dosed twice daily run a greater chance of cortisol oversuppression than do dogs who are dosed only once daily. Here's a quote from Dr. David Bruyette, a noted veterinary endocrinologist with extensive trilostane experience who has posted on our forum:


With regards to once vs twice a day dosing if we look at all the studies throughout the world you will see that about 80% of dogs do well with once daily dosing. One huge advantage of once daily dosing is owner compliance which goes up substantially when owners only have to dose once a day. While twice a day dosing may result in a lower amount of trilostane being used pre day it will require closer monitoring as the ACTH stimulation tests tend to be lower so we have to look for both hypocortisolemia and electrolyte abnormalities.

When he speaks of closer monitoring, I am confident that he is referring to ACTH testing of peak drug performance due to guidelines that he has provided in numerous publications and presentations.

Again, the last thing I want to do is make you regret talking with us about Baby's treatment. And since I believe you have already performed the first ACTH test at the 8-hour mark, I do not want you to refrain from discussing the results with us. But for future reference and future testing, I really hope you or your vet will consider contacting Dechra.

Marianne

[LacubriousDogs]

I appreciate your passion for the protocols that you are familiar with, thank you for sharing. When I wrote that I have no doubts it was in response to Marianne's statement that IF I HAD doubts I should call Dechra. I had already emailed Dechra and considered their response and I had also contacted others and researched the alternative, plus I corresponded with my vet directly. Based on the information I have gathered, my vet (SHE) is not stepping "so far outside the protocol".

Also, when I mentioned autoimmune disease, I was referencing my personal battle with autoimmune thyroiditis, not the treatment of a dog using prednisone. From my personal experience, the protocols for treating hormone related issues are in constant flux and I struggled to find what worked for me and made my symptoms resolve and it's not the standard protocol that most endo's use to treat hypothyroidism. But in my 20+ years of suffering, the medical establishment is only just recently coming around to embrace the protocol that I am using. Could not the same thing be in play with Trilostane protocols for Cushing's?

I am passionate about investigating treatment for my Baby. Just as you all are using your personal experiences to support your decisions, I too have personal experiences and sources of information. I’m not advocating that anyone else follow them. I am posting them here for reference.

I did find yet another source:

http://www.nvma.org/Dina/newsite/upload/file/Proceedings0610.pdf

"This dosage can be given once daily or divided twice daily (the manufacturer currently recommends once daily administration).
Recent studies, however, have shown that a significant number of patients can require twice daily trilostane to adequately control their hyperadrenocorticism. We generally start all patients on once daily therapy to increase client compliance and change to twice daily if necessary.
Evaluate the response to treatment based on resolution of clinical signs of hyperadrenocorticism and results of ACTH stimulation tests. Examine patient and perform an ACTH stimulation test at 10 days, 1 month, 3 months and every 3 to 6 months thereafter. Complete blood counts and serum chemistry profiles should be regularly evaluated. Perform ACTH stimulation testing 4hours after trilostane if it is being administered once daily and 8-10 hours after trilostane in dogs receiving it twice daily. Appropriate pre and post ACTH cortisol concentrations are between 2 and 6 ug/dl approximately 4 hours after trilostane in dogs on once daily therapy, and 5-10 ug/dl 8-12 hours after trilostane in dogs on twice daily therapy. In these situations trilostane is continued at the current dose. If the post ACTH serum cortisol concentration is >7 ug/dl (once daily dosing) or >10 ug/dl (twice daily dosing) increase the trilostane dose by 25-50%. If the post ACTH serum cortisol concentration is <2 ug/dl (once daily dosing) or <5 ug/dl (twice daily dosing), discontinue the trilostane for 7 days, decrease the dose by 25-50% and repeat an ACTH stimulation test in 10 days. If signs of hypoadrenocorticism occur, discontinue trilostane immediately, consider administering prednisone, and evaluate the dog with an ACTH stimulation test and a chemistry profile (including electrolytes) as soon as possible. During the first 6 months of therapy, at least 50% of dogs can be expected to require a change of dosage (usually anincrease)."

I also want to add that her Vet IS willing to do the 4-6 hours test if we feel so inclined. So I'm considering that next time we go in for testing.

[labblab]

Thank you so much for posting this link to Dr. Kintzer's 2010 presentation given to the Nebraska Veterinary Medical Association. It is definitely an eye-opener for me, as it is the first time that I have seen an alternative ACTH monitoring regimen that is exclusively tailored to twice-daily dosing. So I guess the time is right for me to open my mouth and try to extract my big foot...!!

I am not familiar with Dr. Kintzer, but here is a biography that I found. It sounds as though he has excellent credentials, and I will be on the look-out for additional publications.


Dr. Kintzer received his DVM from Cornell University. He completed an internship at the Animal Medical Center and an Internal Medicine residency at Tufts University. After five years on staff at Tufts, he spent many years as an internist in specialty referral hospitals in New England. Dr. Kintzer is an Internal Medicine consultant for IDEXX Laboratories and continues to practice in New England. He has written articles and gives lectures internationally on small animal endocrine and internal medicine disorders.
I am really glad that you returned and shared this information with us. Just when I think that I've mastered some aspect of trilostane treatment and monitoring, a different approach emerges to surprise me. There truly seems to be an ongoing evolution of care, and I appreciate having the chance to learn about Dr. Kintzer and his recommendations.

How is Baby doing at this point?

Marianne

[LacubriousDogs]

Baby is doing great! She's playful and the bouts of lethargy she had at first are gone. She's still eating well and drinking closer to normal amounts. She holds her bladder all night but is still having accidents (or tantrums?!) in her kennel during the day when we leave. Her tummy does appear less taut and bloated.

Still waiting on the results of her ACTH. I expect a small increase in her meds.

[labblab]

That is great to hear about the positive improvements! Has there been enough time yet in which to notice any changes in her aggressive behavior?

Marianne

[LacubriousDogs]

The aggression has improved somewhat. We have been testing the waters by having them together while keeping Ivy on a leash. This way I can teach her to ignore any signals from Baby. Of course we avoid any timeframe or triggers that are food related.

Still hopeful but not rushing it until Baby is on her proper dose.

[LacubriousDogs]

ACTH stim results:
Pre 2.7
Post 5.6

No change in dosage at this time.

Retest at 30 day treatment mark, including a panel to recheck liver enzymes, etc.

[labblab]

Sounds like a plan! Do not be surprised if Baby's 30-day ACTH is even a bit lower; our experience here has been that for many dogs, cortisol continues to drift downward during the first month of treatment. And since she's already close to the ACTH "basement" in terms Dr. Kintzer's desired twice-daily dosing range, it may even turn out that she may need to have her dose cut back a bit at that time.

But I am certain that you will be watching her closely for any adverse reaction. And for the time being, it looks as though Baby is right on the money! Fingers crossed that you will see continued improvement in all of her behavior.

Marianne

[LacubriousDogs]

Took the girls for a walk together and they were so happy! Baby is in the back and Ivy is in the front! :D
http://photo.blogpressapp.com/show_photo.php?p=11/05/12/3298.jpg

[Squirt's Mom]

awwww....what precious babies! They are both looking at the camera so happily - glad to be out and about with their mom! :D

[LacubriousDogs]

Taking Baby in for another ACTH and liver enzyme test tomorrow. After 6 weeks on Trilostane she looks so good! Pot belly is gone, her dry nose is back to normal, thirst is gone, she still loves treats but the super hunger has abated! Very hopeful that these meds will work for her long term!

[Harley PoMMom]

Such wonderful news that Baby's Cushing symptoms have abated! Wishing and hoping for great test results too!

Love and hugs,
Lori

[lulusmom]

Congratulations! That is great news!

[LacubriousDogs]

Baby's Test results are awesome!

Most notable:

Her ALP was 2800 and is now 635!
Post ACTH test cortisol was 3.8!
Vet confirmed reduction in liver size!

All good news so we're going to stick with the dose and retest in 3 months.

Anyone have suggestions for getting their Cush pup's back in top form weight wise. Baby is still skinny. Can you weight train a dog? ;)

[littleone1]

I'm glad that Baby is doing good and that the test results were good.

Terri

[lulusmom]

Congratulations to you and Baby. That's an awesome update! As far as Baby's physical appearance, is she underweight or has she lost muscle mass? No matter, both can be improved with diet and exercise. Rebuilding muscle mass can take so just keep up the exercise regimen and be patient.

[labblab]

I'm so glad, too, that Baby continues to do well!! :)

I just wanted to double-check one thing, though, and that was the timing of this most recent ACTH testing. Was it once again performed at the 8-hour mark? Because, if so, it seems as though a result of 3.8 is actually too low for a dog being dosed twiced daily according to Dr. Kintzer's protocol:


If the post ACTH serum cortisol concentration is <2 ug/dl (once daily dosing) or <5 ug/dl (twice daily dosing), discontinue the trilostane for 7 days, decrease the dose by 25-50% and repeat an ACTH stimulation test in 10 days.
If this most recent test was performed at the 4-6 hour mark, then I think you're in great shape and you can totally ignore my concern! But if not, then I'd be worried about leaving her dose unchanged after that drop from 5.6 in May to 3.8 now...

Marianne

[LacubriousDogs]

I have a behaviour question...

We have a web cam at home so we can check on Baby. Every morning she gets her food, then her Trilostane. About an hour after that we leave for work and she goes into her kennel, with her treats and water.

After an hour or two she gets really restless, fluffs her bedding repeatedly, pants the whole time. It's like 20 - 30 minutes of OCD type fluffing and refluffing. I don't know if she's uncomfortable or what her deal is. She sleeps calmly all night but in a smaller kennel in our bedroom versus the larger kennel in the living room.

Thoughts?

I am emailing our vet as well.

[Squirt's Mom]

It could be that she simply has more energy now and feels the need to do something. Whether this could have anything to do with the Trilo, I can't say.

My itty bitty man, Brick, does this, too, and he's not a cush pup. He will work and work and work at fluffing a blanket or dog bed. If he's working on a blanket, he will fluff if from one end of the camper to the other! :p And for heaven's sake, Squirt and Trink had better leave him alone while he's at it or he will read them the riot act! :D

Let us know what the vet thinks.

Hugs,
Leslie and the gang

[jrepac]

LOL....my Rat Terriers always "fluffs"; my Aussie terrier did the same thing...it must be a terrier trait! :D

[LacubriousDogs]

Ok all, just had our 3-ish month ACTH re- test on Wednesday.

Post ACTH cortisol was 5.5

BUT...:(:(:(

Her ALP was elevated again to 2100 :eek: ...it had been down to 600+ and she tested as Anemic at a 33 when normal range is 36-60.

Symptomatically she's doing fine...but vet wants to do another ultrasound and possibly biopsy her liver since the last aspiration in March showed some abnormal cells, not cancer at the time but not normal either. She has a name hepatic....something.

Anyhow, she said it isn't urgent but it bears checking out.

Not exactly the results I expected. :(

Other than Cushing's and some minor cataracts, and whatever this could be the dog is healthy and happy. We even went to obedience class for fun this week and to Petsmart which we have NEVER done and she was just awesome. Now I'm dreading the next phase...we lost a dog two years ago to melanoma, well complications from treatment but nonetheless...another dog with cancer would be devastating.

[Cyn719]

:)Penny does the fluffing thing also - sometimes over and over and she lays down and then gets right back up and does it again - I cant tell if its shes not comfy or ?? Confusing cush pups!!

[LacubriousDogs]

Update, Baby went back to the vet for her ultrasound and blood panel rechecks. Good news is that the liver nodules and spleen nodule are unchanged from her March exam! Yeah!

Bad news is that her ALP is still elevated at 1659, ALT slightly elevated at 109, Neutrophil Seg high at 81%....also some of her aggression is reappearing and her tolerance for exercise has dropped (panting more often). She has a good appetite and still drinks plenty of water. Her belly does seem bloated again though.

I spoke with the doctor about adjusting her dose of trilostane, and based on this 2nd blood panel and her symptoms, we are changing her to 45mg BID. She's on 35mg BID now.

Also, her breath is terrible and I suspect she has some dental issues so she is going in tomorrow for a dental cleaning. This is with our regular vet and they mentioned with her age the need to run a blood panel, but I told them she just had one at the specialist and I can bring it with me....I hope they accept it....not wanting to pay for it again.

Just hope my Baby gets to feeling better!

[lulusmom]

Thanks so much for updating us and I'm glad to hear the liver and spleen nodules have stayed static. When was the last time Baby had an acth stimulation test and can you post the results? I am assuming that the increase in dose is due to a rise in the post stimulated cortisol?

[LacubriousDogs]

Yes there was a slight rise in her post cortisol Stim...5.5 when her prior test was 3.....do we feel there's some room to bring it down even though the high allowable range is 6ish per the vet. We feel like she's better in the 3 range.

[lulusmom]

When my dogs were treating with Trilostane, they were great in the 3 range. All dogs are different and I guess that's why there is a range.

I forgot to mention that bad teeth and gums can elevated liver enzymes so you may see an improvement in the Alk phos 30 days after the dental work.

[Cyn719]

Hoping Baby feels better after the dental cleaning - Penny went for one cause her breath smelled funny -first time every she also had great breath:) and Penny needed a few teeth pulled and she felt so much better after that - I hope Baby just needs a cleaning!! Will keep Baby and my thoughts and prayers!! Feel better soon Baby!!

[labblab]

Yes there was a slight rise in her post cortisol Stim...5.5 when her prior test was 3.....do we feel there's some room to bring it down even though the high allowable range is 6ish per the vet. We feel like she's better in the 3 range.

Are you now performing the ACTH tests within a 4-6 hour timeframe, or are you still testing at 8 hours per Dr. Kintzer?

Marianne

[LacubriousDogs]

Stim was on 9/21/11....6 hours post dose.

[LacubriousDogs]

I also posted the incorrect New Trilostane dose. Baby is now taking 40mg twice a day.

She got through her dental just fine, no teeth pulled! She's only eating dog biscuits and isn't interested in her regular food yet...I thinks she knows I'll cut her some slack today.

[Cyn719]

Glad the dental visit went good!! hope Baby will want to eat today!

[LacubriousDogs]

Well, Baby had a weird allergy attack :eek: over New Year's weekend (of course!). She started itching all over her body and rubbing her head the week prior so I started giving her benadryl...but she got very little relief, most likely due to my underdosing her...I got that corrected but not before she ended up with hives on her head and major swelling in her face and neck! No trouble breathing but you could tell she was just miserable! I gave her an oatmeal bath and maxed out her benadryl dose, then first thing Monday packed her up and to the local vet we went. By then some of her swelling was down, but he opted to put her on a 10 day prednisone taper, advised us that it might have been a bug bite (we had changed everything to try and find her relief, washed all her bedding in vinegar, switched her food, bathed her, etc.) By the 3rd day on pred. she was back to her old skinny-faced self, eating well, having a few accidents (grr), anxious to get thru it as I know the pred is offsetting the trilostane now. We also advised her internal med vet of the incident who told us to keep a close eye on her as we taper off...so far so good.

Wondering if her immune system went into overdrive due to overdosing on trilo and supressing the steroids too much. She has always has a bit of a food (we think) allergy and once we switched her to lamb and rice it seemed to resolve...but that may have only corresponded to the beginning of her cushing's, thus the cortisol was supressing her overactive immune system. Not sure, I may be reaching here. I'm just throwing this on the site in case others have had similar incidents. This April will be her 1 year on Trilostane...have to say it has worked great for her, but we have had to tweak her dose and once we are thru this incident, I wouldn't be surprised if we are reducing it to strike a balance with her immune system. Just my thoughts...:)

[labblab]

I've had a very similar incident with my non-Cushpup Labrador Retriever. She has been bothered by seasonal allergies since birth, but on one occasion -- out of the blue -- she had an acute attack during which her face swelled horribly and she developed hives all over her belly. We rushed her in to the vet for a steroid injection, also followed by a ten-day course of prednisone. This happened a couple of years ago, and has never repeated itself. We have no idea what caused it, but in her case it was totally unrelated to Cushing's.

If Baby is otherwise doing well on her current trilostane regimen with good symptom resolution, if it were me, I would not rock the boat and alter the trilostane on the basis of one isolated incident of this type. If she continues to have acute flares, that might be a different story. Has she had a monitoring ACTH performed recently?

Marianne

[LacubriousDogs]

Thanks Marianne...

Well, we WERE about to be scheduled for another ACTH but of course the pred would mess that up so now we have to wait a bit, not sure how long after stopping the pred...weeks? Those results will be telling as to whether her trilo dose is where it should be.

Never a dull moment with our pups!:rolleyes:

[addy]

Must be the time for allergies!!!!!! We all seem to be dealing with them:(

Hope Baby is okay, that must have been scary.

hugs,
addy

[LacubriousDogs]

Well...it's been awhile. Things have progressed to where Baby was doing much better...but her appetite wanes. About every 3rd day she will not eat. She had gained back some weight during her treatment. The internal med vet had had us dial back her dose from 40mg Trilostane to 35mg and we switched to the liquid form as she was getting stubborn about taking her pill.

About a week ago I was away from home and my husband witnessed an episode where Baby got completely disoriented, and could barely stand upright. She was panting as well. He got her to lay down and she recovered enough after an hour to go outside and eliminate, the next day she was mostly back to normal. I did some reading and came up with vestibular syndrome which I guess makes sense considering the tumor in her brain. Within 24 hours she was back to running around the yard.

Now tonight she had another episode, not as severe except there was diarrhea and she did stay on all fours but was very reluctant to moving around and was panting and sort of swaying a bit. I had her outside to try and get her thru the bowel issues, then we came in and she laid down. The panting subsided and we got her to slowly and unsteadily make her way to her bedtime crate.

I am contacting the internal med vet tomorrow to ask what we should do, we are due for another ACTH but right when I was going to call she had the 1st episode and we took her off her meds because she wouldn't eat anything. After she recovered for a few days we started her back up on half doses thinking maybe she is just really sensitive to the trilostane now, as I understand their bodies respond better the longer they are on it and so do not need as much.

I know I am rambling, but now that she is 13 years old I just wonder what to expect as far as how her old age and cushings will progress...we are at 2 years or so of treatment with trilostane.

[labblab]

I think it is good, and very important, that you contact the IMS today. From your description, it sounds to me as though Baby may be having seizures for which there can be many different causes. Depending on the cause, seizures can be well-controlled with medication. But of course the first step is finding out exactly what is going on. Please update us after you've seen the vet, OK?

Marianne

[LacubriousDogs]

This is the IMS Vet's response: To me what you are describing is either a seizure or a cardiac event. Given Baby's history of hyperadrenocorticism, we do have to worry about the potential for a pituitary macroadenoma (large pituitary tumor, rather than microscopic pituitary tumor). I think that it would be best if we see Baby - I would do a neurologic exam on her, listen to her heart and check pulses and also check an ECG to see if there are any abnormal rhythm patterns. From that point, depending on what we find, we may need to consider an MRI of Baby's brain.

Regarding ACTH stimulation testing, if she has lapsed in dosing etc then a stim may not be helpful; however a resting cortisol may be helpful just to rule out development of Addison's disease secondary to trilostane. We can also check regular bloodwork including electrolytes to make sure these are not the source of clinical signs.


The earliest they can see her is next Friday, but on a good note she is more normal this evening, eating, eliminating, just kind of dopey...but no disorientation. I am leaning toward seizures as well. Not sure what meds would be involved with that, especially if it's tumor induced. :(

[labblab]

I have a non-Cushing's labrador who developed seizures of unknown origin at age 6. We are very grateful that her seizures have been totally controlled since beginning treatment with oral medication taken every day. She is being treated with phenobarbitol, but there are other medications which may be preferable in combination with trilostane.

Your vet's comments sound very reasonable to me, but here are a couple thoughts to add. Low thyroid levels can trigger seizures, and Cushpups often suffer from low thyroid in conjunction with the disease. So when you take Baby in for bloodwork, I'd ask about making sure that a check of her thyroid level is included.

Secondly, it is true that an MRI (or CT scan) would be the diagnostic tool that would tell you with certainty whether the size of the pituitary tumor may be an issue. However, this is a very expensive procedure and before proceeding, I'd encourage you to consider whether the results would alter your treatment path since treatment to actually alter the size of the tumor would involve further high costs. So if an MRI is offered to you, definitely discuss the costs/benefits in detail with your vet. We have never been able to determine the cause of our dog's seizures through more routine lab testing. But since she has responded so well to the phenobarb, we decided not to pursue more involved neurological diagnostics at this time. Not that you would make the same decision -- but just to alert you to discuss the available diagnostics thoroughly before leaping into them.

Do let us know how Baby is doing this week, though.

Marianne

[LacubriousDogs]

Thanks for the feedback and I have to agree at this point I kind of thought an MRI might be a bit much because no matter the results there probably isn't much to be done about it. We know she has a tumor, we know its caused the Cushing's, really all we can do is manage that and any other things that crop up from it...or as a result of her age.

I'll know more on Friday. Thanks all!

[LacubriousDogs]

Just an update...I forgot to mention that on Sunday, 4/21/13, Baby was fine, eating, went outside, mostly her normal self...but in the later afternoon she did not want to leave her kennel and go outside before we left for dinner. She was also shivering. I made sure the heat was turned up and left her in there. When we got back she got up, just fine and "normal" for her. So I don't know if she was actually chilly (she has zero body fat, is really skin and bones at this point) or if it was an "episode" or what. Just mentioning it here for the record. I do think since we scaled back her meds that she is eating more, has an appetite and may have put on a pound or two but not much more than that.

[Harley PoMMom]

So sorry to hear that Baby had a "shivering" episode and I hope that will be the last of them.

Adding carbs to a dog's diet can help with weight gain, as long as the dog is not diabetic because carbs can make the sugar higher.

Carbs such as pasta, potatoes, oatmeal, rice...etc.

Love and hugs,
Lori

[LacubriousDogs]

Saw the IMS Vet today. She was unable to do a valid neuro exam because Baby was aggressive and biting! The vet thought that uncharacteristic behavior compared to her prior visits. I was able to hold her still long enough for a heart check, and that seemed fine. As we talked and the vet noted all the symptoms and timeline of events, she asked if Baby had tremors...she has had them for a while on and off but I attributed them to her low body fat and being cold...turns out these could have been an early sign of tumor growth. We opted out of super expensive MRI to confirm, but all symptoms taken into account point to a macroadenoma in her pituitary. At 13, she's had a pretty good life so we are going to let it play out until its apparent we have to make a decision. She's continuing to lose weight and her personality is changing (Vet confirmed)...not sure what this timeline looks like...She will continue on Trilostane and we will try to get her appetite up but she will probably begin declining and having more bad days as the tumor progresses. :(

At 24 months of Cushing treatment, I consider us lucky to have had her this long...

I should add, the Vet did tell me we could have an MRI, and that radiation treatment is available. She even had another patient with similar progression of disease that went thru it and ended up back to "normal" post radiation, but it is very expensive and I just can't see putting her thru all of that at her age.

Also, her thyroid levels were normal at her last bloodwork just over a month ago so no worries there.

[Boriss McCall]

Oh I am so sorry.. I hope Baby will be around for a lot longer & feeling good. I know it must be so difficult to see her personality changing. :(

hugs..

[molly muffin]

Oh I too am sorry that Baby is having a hard time now and maybe a macro too. Hopefully Baby will be around long time. I know this is quite heart breaking.

hugs,
Sharlene and Molly Muffin

[LacubriousDogs]

Your Boriss is a cute boy! Thanks for the kind words...

[Boriss McCall]

Thank you! he is spoiled rotten. ;)
We will all be here for you. I know it is so difficult.

[Squirt's Mom]

Oh, dear. I am just so sorry to hear this. Did the vet say anything about stopping the Trilo? It might be a good thing as Trilo can cause these tumors to grow faster plus the cortisol may act as a sort of treatment on its own - kind of like prednisone. Something to think and talk to them about any way. I hope Baby has many good days ahead, making happy memories to sustain you a lifetime.

We are here anytime you wish to talk or ask anything.
Hugs,
Leslie and the gang

[LacubriousDogs]

There is NO WAY I would stop the trilo...after 24 hours without it she starts panting, drinking tons and peeing on everything. That is no way to live, we just tried it a few weeks ago after her first seizure and it was just awful. The vet actually said they need MORE trilo to counteract the tumors affect on the adrenals. But without doing a proper STIM test we cannot adjust her dose.

[molly muffin]

Oh poor thing. That is so hard.

hugs,
Sharlene and Molly Muffin

[Squirt's Mom]

We have a thread in Everything Else that one of our members who's baby had a macro started. Others have shared their insights and experiences as time has passed as well. You can find it here - http://www.k9cushings.com/forum/showthread.php?t=3567

[doxiesrock912]

Poor baby! Biting though, that must have been so hard for you to watch. Hoping for improvement.

[LacubriousDogs]

Thanks, I will check that out. I haven't had a moment to do any searching on the board for similar situations. Thanks to all for the words of support...i know we all share a deep bond with our pups!

[frijole]

Sending love and strength. You are doing a fantastic job under the circumstances. Hang in there and lean on us as much as you want. Kim

[LacubriousDogs]

Just finished reading all of the previously posted link and the other links that I found there. I do feel like it makes sense that Baby is doing a bit better on a lowered dose of trilo..the rise is cortisol is having a better affect on her appetite and energy and overall attention span...not huge but improved nonetheless.

She is still clutzy, ran into a table this evening, but that is kind of normal for her. Luckily we have not seen another episode. We are going out of town for a few days (in 2 weeks) and a dog sitter is coming to stay with her rather than boarding her and stressing her out. I really hope she can get thru that time normally because I will feel really bad submitting our sitter to one of her seizures...

[LacubriousDogs]

I think the time has come...Baby had a rough night, up restless and panting. Wanted to go out and then drink as much water as possible. She would not settle down and tried to bite at us when hooking up her leash.

This morning she went out twice and we limited her water. She would not get up to go out again and instead ran and hid in her kennel. She is not herself.

My husband and I have decided it is time, but how do I even call and make this appointment?! How do I walk a mobile and spirited dog into the vets office for euthanasia?! I know it is only a matter of time before she has a seizure again and then we will be forced to do it...It was different with our last dog. He had melanoma, no cure so we tried a clinical trial which went badly, he was clearly ill and suffering at the end.

I know she is not going to get better and in fact will get worse...

I also overheard someone here at work who doesn't empathize with pets in general, says bullets are cheap, and thinks we are stupid for spending what we have spent on our animals.

[Squirt's Mom]

Aw, honey, I know how terribly difficult this decision is to make. When I decided to let Tasha go, she was still perky, happy, and loving for the most part - but she had started having seizures when the cancer spread to her brain and I knew it was going to get much worse very quickly. She deserved so much better. I made "that call" and scheduled for a few days away so we would have some time together. During that short time, I did all I could to make her as happy as possible - giving her anything and everything she ever wanted that I could provide. It is those moments I cherish most of all and they help when the pain of "that day" comes roaring back.

We make this most difficult of decisions because we love our babies so very much - it is often the greatest gift we can ever give them. One of our members here once said that we accept the pain so they no longer have to suffer. There is no greater love. Your sweet Baby knows how very much you love her and how very hard you have worked to give her the best life you could...she will never forget. The love you share will never end and one day you will hold her again.

We are with you all, sending prayers, wrapping you in our strength and love always. Please know you can talk to us about anything any time.

Hugs,
Leslie and the gang

[molly muffin]

Oh I am sorry about this. I am sure Baby would be mortified if she realized that she was snapping you, the ones she loves best in the world. It is probably really scary to her when she gets confused like that too. That is probably why the kennel feels like a safe place.
Leslie is right, we do the absolute best we can and this decision is one of the hardest you'll ever have to make, because it hurts so much.
Not everyone will ever get why we take care of our pets the way we do and that is their loss, not ours.
My thoughts and prayers are with you.

hugs,
Sharlene and Molly Muffin

[doxiesrock912]

I am so very sorry! This decision is the worst of the worst, but it is done purely out of love and we know that.

You coworker needs to be slapped:( I have no tolerance for people who think of animals as disposable. Sad that this person will never know that light that our pets bring to our lives.

Thankfully, your husband is supportive and will help you both and Baby through this. Big hugs!!!!

[Squirt's Mom]

Thinking of you today. ((((((((((((((((((HUGS))))))))))))))))))))

[LacubriousDogs]

We couldn't do it and still haven't. :c
Now, the vet will not prescribe any more Trilostane unless we bring her in. Last time she was so stressed they could barely do the exam. This weekend she bit at our dog sitter and while not really clamping down, he said she was quite aggressive. I can't let her loose in the backyard anymore because she runs away when we try to approach her, it's like she doesn't know us. She also runs the yard and jumps off the short walls onto the patio! I'm afraid she will break a leg as she is quite careless about it. We have to "herd" her onto the deck to get her back inside. So now we keep her on a leash and in a kennel, sometimes letting her run around in the house but after 5 rounds she just curls up in her kennel. Some nights she wakes us up barking to be let out, sometimes 2 or 3 times. We get no sleep! She doesn't want to be petted or cuddled, she seems manic almost and just wants to be alone in her kennel. We are still so torn...

[LacubriousDogs]

http://4.bp.blogspot.com/-vaNCfGryQ-U/UmfeHt-i2GI/AAAAAAAABFU/lqDtln-0DmY/s1600/IMG_6047.JPG

[grapey]

I'm so, so sorry you're going through this. I know you'll make the right decision at the right time. Praying for you and Baby.

[Squirt's Mom]

I am so sorry ya'll are going through such a tough time. :( Has the vet considered cognitive problems? My old girl has been diagnosed with doggy Alzheimer's and some of what you describe fits her behaviors. Aggression is common with Doggyheimer's and the description of acting as if she doesn't know you fits as well. (That same sign, not knowing you, also fits with what are apparently seizures my Pug has - she gets almost feral when they happen and everything and everyone terrifies her.)

Squirt's early signs of the cognitive problem were restlessness especially at night and loss of bladder control - tho I didn't pick up on the fact that those things could be related to how her mind was functioning. She would want on the bed then keep changing spots minute by minute. Then she would want off the bed and roam from the bedroom to the kitchen back to the bedroom through the closet and bathroom then want back on the bed where she would start all over. This would go on for hours every night. She she started having what I call "terrors" - absolutely scared out of her mind for no reason. She would shake, drool, pee herself, her eyes bugged out, her ears pulled tight on top of her head, jerking her head to look at phantoms she seemed to see and hear, whimpering, pressed against me as tight as she could get. This would last for hours as well. She bit the vet for the first time in my memory when he trimmed her nails - they now muzzle her when they see her. :(

We have her on a SAMe product called Novifit and Anipryl, and I give her herbal teas; one for the daytime to help her stay alert and one for nighttime that helps her relax. We also have Valium for when the terrors come - which has happened only once since starting the Novifit, Anipryl and herbs, thankfully.

Google CCD or CDS in senior dogs and you will find lots of info that may help you decide if this is a possibility for your sweet Baby.

Keep in touch and let us know how she, and you, are doing!
Hugs,
Leslie and the gang

[LacubriousDogs]

Thanks all...yes I have considered Canine Cognitive Disorder. Isn't Anipryl also a treatment for Cushings? I guess the Trilostane dose would have to be adjusted. Thing is, they can barely do any testing on her because of her aggression. I also hate to put her thru any more stress.

[Squirt's Mom]

Yes, Anipryl is used for Cushing's but was originally designed for cognitive problems. It works in very few cush pups. It was the first drug we used with Squirt and did help her for a while.

I would check with the vet to be sure Anipryl and Trilostane will work ok together. Anipryl works by increasing Dopamine but I'm not sure how that would effect the working of Trilo - Trilostane / Vetoryl confuses the crap outta me. :o Maybe you could make an appt with the vet for a consultation and not even bring Baby with you. You can tell them in detail what is going on, how she is behaving, and see if they can let you try something without seeing her first. If they insist on seeing her, ask for something you can give her that will sedate her a bit before leaving the house. When you get to the vet's, maybe they could come out to the car and give her something a bit stronger then so they can work on her. A headache but you both need some relief. ;)

[LacubriousDogs]

Well, I took Baby in to the Endo Vet last week...and explained that 2 weeks ago she had another episode where she was restless, panting, and uncoordinated and when she came out of her kennel she flopped on her side and urinated, like loss all control. I cleaned her up and after about 10 minutes of rest she got up and was very listless. Later she had another light episode. So I told the vet everything that has been happening, and she agreed that these are likely seizures due to the growing tumor. She said everything I described is indicative of that. I asked for some sedatives to give to hopefully get her and us some more peaceful nights.

The only thing they could do was take her pulse and weigh her...she is down to 27#s! They were going to take a temp but she got aggressive and they did not want to stress her.

My husband wanted me to ask the vet for a professional opinion of whether it is time to let go...she did say that in her opinion, based on Baby's lack of joy in any activity and her aggression that she felt comfortable with saying the not much more can be done to improve her QOL....I'm to the point of sometimes being done with her suffering but then I get sad thinking of how I picked her from a litter and brought home a 6# squirmy pup. Hubs and I were looking through old photos and you can see a marked difference in her eyes from 3-4 years ago...there is no personality now...she is on auto pilot...last night she had another episode and fell flat in the yard and would not get up. I carried her inside and was surprised and how light she was! She is nothing but skin and bones now. I have tried to supplement her food and we backed her meds down to increase her appetite but then she gets manic and super thirsty and then urinates all the time.

Hubby wants to give her another month, get through the holidays. But I don't know if that is fair to her. Plus, if she has a really terrible seizure...I don't know how we would handle seeing her suffering like that.

Even our other dog is more mellow than usual...does she know something we aren't ready to admit? Both my other dogs got suddenly ill and died or had to be euthanized...this time is so different for me because the decline has been gradual and her symptoms wax and wane...very tough to process.

[Squirt's Mom]

It is so hard to see that missing "self" in their eyes, to know they stand at the Great Divide staring into eternity where we cannot yet follow. :( I know you will do the best for your sweet Baby now just as you always have whether that is more time shared, or not. I also know Baby understands your fear and pain, and trusts you completely.

My thoughts and prayers are with you all,
Hugs,
Leslie and the gang

[goldengirl88]

Sorry to hear about your baby not doing so well. This is such a terrible disease, it takes your soul. Blessings
Patti

[molly muffin]

Oh I am so sorry that Baby is not doing well. I think that you will have to see how she is doing to see whether or not you think she can make it through the holidays. You can base this on the collapsing, interaction with others, etc, all the things that make a dog, a happy one.
She will always be Baby to you and when you look at her you will always see that precious little pup that you picked up out of the litter. That won't change ever, in your heart that is how she will always be. What you have to look at is the here and now and whether you think she can go on or not.

hugs, I'm so sorry that you are going through this.
Sharlene and Molly Muffin

[LacubriousDogs]

http://1.bp.blogspot.com/-N89AkLv0RPA/UqZMS5IoXPI/AAAAAAAABGc/INown-CC7gA/s1600/IMG_6789.JPG

[LacubriousDogs]

On Friday, December 20th, we said a final goodbye to our Baby. Calling the vet that morning to make the appointment was very difficult. She went very peacefully.

Three days prior she had another seizure, it wasn't as severe as prior ones but she never really recovered from it. She refused to eat anything. She was weak and wobbly. She looked and acted like she simply did not feel good. She even let us sleep through two nights with no barking to go out. All of this was very unusual and we took it as a sign that it was time to say goodbye.

We now feel very empty at home. We still have our 4 year old black lab, Ivy, which we are spoiling. It is such a difference not having to care for an ailing animal anymore. I keep feeling like I forgot to do something, then I remember. :(

http://4.bp.blogspot.com/-r54T56-Zesc/UreGc1t_hpI/AAAAAAAABG4/kinCU-3mlFk/s1600/photo-718107.JPG

[frijole]

So very sorry to hear of your loss. You really did everything you could for your Baby. It's never easy but this week had to be hard. Know we are here for you.

Run free of pain dear Baby and know we will honor your memories forever. Kim

[flynnandian]

i'm sorry that you had to put down baby to sleep forever. but it sounds right from what you were writing down. you did what was best for her. and indeed you see now how much time it costs to take care of a sick animal. all that spare time that you have now....feels strange....the habit of looking after them is still in the back of your mind. i watched her pictures and you can see that it was her time....i fear that i have to make the same decision tomorrow..

[addy]

I am so sorry. It is one of the hardest decisions to have to make.

God Speed Baby.

[Budsters Mom]

I am so very sorry to hear of your loss. Your sweet Baby has joined our other fur angels at the rainbow bridge. Run Free Baby, run free! Xxxx

[molly muffin]

I am very sorry to hear that this time had come for you and your family.

My sincerest condolences.

Sharlene and Molly Muffin

[doxiesrock912]

My condolences on your loss of Baby. It is important to spoil Ivy because she misses her too.

[Woodydog]

I,m so sorry for your loss

[goldengirl88]

I am so sorry your sweet baby has passed. God Bless You Both.
Patti

[Bo's Mom]

RIP Angel Baby...you will forever be honored and cherished by all who knew you.

[LacubriousDogs]

Thank you to everyone for the messages...we are coping pretty well. The holidays were busy which helped distract us somewhat. We have been spoiling Ivy, letting her up on the couch with us to snuggle. I hate to go down that road as we were doing so well with boundaries but I guess a little bit will not hurt. Ivy does seem different...but not unhappy...just docile and calm...she always followed me around the house but is just a bit more underfoot now. Looking forward to the spring and to maybe work with her on some agility stuff. I think she could be an amazing therapy dog as well.

[LacubriousDogs]

This is Ivy, she will be 4 in March.
http://1.bp.blogspot.com/-KM2T_W-kVEs/UsWdGIMphUI/AAAAAAAABHI/0tCD59aq7CI/s1600/photo-719672.JPG

[molly muffin]

Ivy is gorgeous and I'm sure enjoying special snuggle times on the couch.

Staying busy helps a bit.
hugs,
Sharlene and Molly Muffin