Doli's Mum
12-04-2017, 12:16 PM
Hallo all.
May I introduce my little dog Doli Capax? (Rescue dogs need a fancy name I think, it means ‘capable of crime’! As she’s always been a cheeky, intelligent doglet.) She was dumped at a very early age (4 weeks) and our best guess is that she is a JRTxPatterdale terrier. Apart from trauma to a hind leg as a young ‘un, and some lipomas as she ages, she’s had a pretty uneventful medical history. 2 years ago I was told that she had a mild cardiac murmur, no further testing felt necessary, just try to keep her slim. She’s now 10years and 4 months old.
Apologies for what will undoubtedly be a very long post, but I figure if I tell you everything, you have a better chance of advising us, as I’m sure there is a wealth of knowledge here……
Late July 2017 I left her with my Dad whilst I was away for a week. On return she was noticeably FAT! She also had an unusual interest in food, any food, glaring at anyone who was eating. Initially I thought Dad had overfed her with biscuits and pork pies, and she’d picked up the begging mode quickly, but no, this appetite was voracious and insatiable.
16th Sept I popped to the vet to weigh her and thinking Diabetes Mellitus I got a urine sample tested: This showed no signs of sugar or ketones, microscopy NAD, Specific Gravity 1.018 pH 5. I’d also noted that she was drinking and weeing a lot. Her weight was 16k (probably 1-2k overweight). I put her on a weight reducing diet. She is raw fed. By the 4th October she was down to 15.65k, not much lost for all that effort and hunger!
5th October, to the vet, by now urinating indoors overnight. No cough, general condition good, auscultation normal. Alert. BLOODS ALB 46H; BUN 1.3L; CHOL 8.0H all other parameters within normal range. Total T4 15 (14-52)Normal. To try to shift some weight.
31st October Doing better, drinking 750mls per day (50ml/kg)(Is this because she was on a diet and strictly no carbs??) This was noticeably down on previous amounts IMO, but I hadn’t previously measured the amount. Bloods and urine results lead to differential diagnoses of Hypothyroidism, Liver Disease, Diabetis Insipidus, Hyperadrenocorticism. Recheck in 2 weeks as now drinking normally. Urine pH 7 SG 1.010 Weight up to 16.3
3rd November PD/PU. General condition really good but tends to put on weight.
Haematology all normal range.
Biochem CHOL 9.7 HIGH; ALT 126 HIGH; GLUC 7.2 HIGH
Fructosamine 295 umol/L (160-350)
Total T4 LOW 8.5nmol/L (10.00-55.0)
FT4d LOW 6.1pmol/L (6.6-40.0)
TSH 0.13ng/ml (0.01-0.6)
The total T4 is depressed but the cTSH is within the reference ranges in this sample. This pattern of thyroid hormone values is suggestive of non-thyroidal illness or certain drug therapies, however, approximately 20% of hypothyroid dogs have this combination of results.
9th November Low Dose Dex suppressing test
1st sample Cortisol Basal 139.0 nmol/L (50.0-250.0) 0.015mg/kg given 0.25mg dex.
2nd sample Cortisol 3 hours post dex 85.0nmol/L
3rd sample 8 hours post dx H55.7nmol/L (0.0-40.0)
Post dex cortisol to be less than 50% of basal and less than 40nmol/L. Lack of suppression could support hyperadrenocorticism. Vetoryl treatment should be considered 1-2mg/kg.
10th November Results and discuss: ACTH stimulation test is recommended to assess Vetoryl start dose.
13th November ACTH stim. 12.30hrs 1st blood and Inj 0.85mg ACTH. 2nd sample one hour later. Vet being particular that this initial test is done at what will be 4-6 hours post medications.
RESULTS Cortisol basal 164.0nmol/L (50.0-250.0)
Cortisol post ACTH H 811.0nmol/L (150-550)
Commenced on Vetoryl 20mg 15th November
18th November called vet for advice as she drank 5 litres of water over 24 hours.
Continued on 20mg Vetoryl until further ACTH stim test at day 14.
30th November blood results:
WBC 12.2 x10-9/L (6.0-15.0)
RBC 7.17 x10-9/L (5.0-8.5)
Haemoglobin 17.2 g/dl (12.0-18.0)
PCV 50.9 % (37.0-55.0)
MCV 71.0 fl (61.8-79.3)
MCH 24.0 pg (20.6-26.3)
MCHC 33.8 g/dl (30.4-36.4)
Platelets HIGH 503 x10-9/L (200-500)
Neutrophils 77% 9.4 (3.0-11.5)
Lymphocytes 14% 1.7 (1.0-4.8)
Monocytes 7% 0.8 (0.0-1.3)
Eosinophils 3% 0.3 (0.1-1.2)
Basophils 0% 0.0
Film confirms platelet count.
Total protein 69.2 g/L (50.0-72.0)
Albumin 36.9 g/L (26.0-40.0)
Total Globulin 32.3 g/L (19.0-46.0)
Sodium 149mmol/L (139-154)
Potassium 4.76mmol/L (3.6-5.6)
Sodium:Potassium 31.30 (25.00-38.00)
Chloride 109 mmol/L (102-122)
Calcium 2.52 mmol/L (2.20-3.00)
Phosphate HIGH 2.02 mmol/L (0.6-1.80)
Urea 7.4 mmol/L (1.7-7.4)
Creatinine 94 umol/L (20-124)
Total Bilirubin 2.2 umol/L (0.0-16.0)
ALP HIGH 119 u/l@37C (12-83)
ALT HIGH 93 u/l@37C (13-78)
Gamma GT 9.0 u/l@37C (0.1-9.0)
GLDH HIGH 58.0 u/l@37C (2.0-6.0)
Bile Acids 8.2 umol/L (0.0-10.0)
CK 217 u/l@37C (20-230)
Cholesterol HIGH 9.5 mmol/L (2.8-8.3)
Triglycerides H 4.03 mmol/L (0.34-1.97)
Glucose 3.8 mmol/L (3.5-6.0)
Amylase 346 u/l@37C (100-948)
DGGR Lipase 64 u/l@37C (0-90)
ACTH stim Cortisol Basal LOW 30.6 nmol/L (50.0-250.0)
Cortisol post ACTH LOW 119.0 nmol/L (150.0-550.0)
Total T4 LOW 8.4 nmol/L (10.0-55.0)
TSH 0.13 ng/ml (0.01-0.60)
Serum sample lipaemic.
Interpretation (for animals which have been on treatment for at least a month) depends on time of sampling relative to trilostane administration. The ACTH stimulation test should be performed at 4-6 hours after the last dose and interpreted in the light of history, physical examination and clinical response. Current recommendations are: If the post ACTH cortisol concentration os less that 50nmol/L and the dog is clinically well, the trilostane is stopped for 5-7 days and then reintroduced at a lower dose. If the dog is clinicaly unwell, the trilostane is stopped, serum electrolytes monitored, the case reassessed and an ACTH stim test performed before reintroducing treatment. If the post ACTH cortisol is 50-200nmol/L but clinical signs have not improved, perform an ACTH stimulation test at 22-24 hours after trilostane, to establish if BID dosing is required. If the ACTH stim test is performed at times other that 4-6 hours after trilostane, then the current recommendations are that the post ACTH cortisol concentration should be more than 50nmol/L and less than 250nmol/L
T4/TSH results are comparable to earlier this month.
FLUID measurements daily over 24 hours
15.11.17 4000mls (First day of Vetoryl)
16.11.17 5200mls
17.11.17 5100mls
18.11.17 4700mls
19.11.17 4000mls
20.11.17 4200mls
21.11.17 3500mls
22.11.17 3400mls
23.11.17 3550mls
24.11.17 3000mls
25.11.17 2850mls
26.11.17 4300mls
27.11.17 3250mls
28.11.17 3900mls
29.11.17 4000mls (ACTH stim test)
30.11.17 1800mls
1.12.17 3400mls (Vetoryl reduced to 10mg daily)
2.12.17 5650mls
3.12.17 3800mls
So the conclusions drawn thus far: She has hyperadrenocorticism, vet says from adrenal tumour (he deduces this from low dose dex test results) Commenced on Vetoryl 20mg 15.1.17 reduced to 10mg 1.12.17.
She is not diabetic. Her kidneys are functioning normally. She is hypothyroid, but possibly not a thyroid illness but general endocrine imbalance, we’re watching and waiting on further testing as we go.
As you can see I’m a bit hung up on the amount she drinks! The initial rises to 5L had me calling the vet for advice which was ‘to continue’. Then I saw a response and gradual decline in amounts, and just as I think we are getting somewhere the amounts rise again. This weekend the 5650 is crazy! I don’t know how she is keeping her electrolytes normal at these amounts!
This morning she woke and vomited (small) but yellow, and she never vomits. So I decided NOT to give her Vetoryl today. She had a lethargic morning, just weary is the best way I can describe it. She had some breakfast and was keen to eat. I took her for a short 1 mile walk at midday, and now she seems to have perked up, seeking out her tennis ball for a quick game once home. Her poo is a bit loose, yellow. She doesn’t seem distressed. Doesn’t appear to be in pain. I’d just say ‘she isn’t herself’ for the past 24 hours. I’m waiting for the vet to phone.
Is there anything we’re missing?
Should I put her on a diet again? (Did the pre-diagnosis reduction in drinking correlate with being on a diet or was it coincidence? This memory has just returned to me, pre-diagnosis, her drinking always accelerated after 5pm meal. She WAS only fed once a day, now gets 3 smaller meals)
She’s having to be crated overnight with puppy pads, which she thinks is beneath her! She usually sleeps on my bed and the look I get every night is pure disgust! I’ve tried getting up through the night to toilet her, but as I have health issues myself (Cushings due to steroids!!!!) it was making me ill.
Generally speaking her QOL isn’t too bad, can walk a mile a day (No more or she lags, probably the low thyroid?) But she’s a tired girl, puffy and panting, carrying too much weight, and probably fed up with the drink, drink, drinking and wee, wee weeing!
Oooh a couple of other things I just remembered: Urine was sent for C&S and definitely no infection. No ear or skin problems. Hair on both flanks has paled and got smoother rather than her usual rough coat.
Next ACTH test planned for 2 weeks time (4 weeks after starting treatment).
I shall appreciate any and all observations and ideas.
Many thanks, Doli and Mum.
May I introduce my little dog Doli Capax? (Rescue dogs need a fancy name I think, it means ‘capable of crime’! As she’s always been a cheeky, intelligent doglet.) She was dumped at a very early age (4 weeks) and our best guess is that she is a JRTxPatterdale terrier. Apart from trauma to a hind leg as a young ‘un, and some lipomas as she ages, she’s had a pretty uneventful medical history. 2 years ago I was told that she had a mild cardiac murmur, no further testing felt necessary, just try to keep her slim. She’s now 10years and 4 months old.
Apologies for what will undoubtedly be a very long post, but I figure if I tell you everything, you have a better chance of advising us, as I’m sure there is a wealth of knowledge here……
Late July 2017 I left her with my Dad whilst I was away for a week. On return she was noticeably FAT! She also had an unusual interest in food, any food, glaring at anyone who was eating. Initially I thought Dad had overfed her with biscuits and pork pies, and she’d picked up the begging mode quickly, but no, this appetite was voracious and insatiable.
16th Sept I popped to the vet to weigh her and thinking Diabetes Mellitus I got a urine sample tested: This showed no signs of sugar or ketones, microscopy NAD, Specific Gravity 1.018 pH 5. I’d also noted that she was drinking and weeing a lot. Her weight was 16k (probably 1-2k overweight). I put her on a weight reducing diet. She is raw fed. By the 4th October she was down to 15.65k, not much lost for all that effort and hunger!
5th October, to the vet, by now urinating indoors overnight. No cough, general condition good, auscultation normal. Alert. BLOODS ALB 46H; BUN 1.3L; CHOL 8.0H all other parameters within normal range. Total T4 15 (14-52)Normal. To try to shift some weight.
31st October Doing better, drinking 750mls per day (50ml/kg)(Is this because she was on a diet and strictly no carbs??) This was noticeably down on previous amounts IMO, but I hadn’t previously measured the amount. Bloods and urine results lead to differential diagnoses of Hypothyroidism, Liver Disease, Diabetis Insipidus, Hyperadrenocorticism. Recheck in 2 weeks as now drinking normally. Urine pH 7 SG 1.010 Weight up to 16.3
3rd November PD/PU. General condition really good but tends to put on weight.
Haematology all normal range.
Biochem CHOL 9.7 HIGH; ALT 126 HIGH; GLUC 7.2 HIGH
Fructosamine 295 umol/L (160-350)
Total T4 LOW 8.5nmol/L (10.00-55.0)
FT4d LOW 6.1pmol/L (6.6-40.0)
TSH 0.13ng/ml (0.01-0.6)
The total T4 is depressed but the cTSH is within the reference ranges in this sample. This pattern of thyroid hormone values is suggestive of non-thyroidal illness or certain drug therapies, however, approximately 20% of hypothyroid dogs have this combination of results.
9th November Low Dose Dex suppressing test
1st sample Cortisol Basal 139.0 nmol/L (50.0-250.0) 0.015mg/kg given 0.25mg dex.
2nd sample Cortisol 3 hours post dex 85.0nmol/L
3rd sample 8 hours post dx H55.7nmol/L (0.0-40.0)
Post dex cortisol to be less than 50% of basal and less than 40nmol/L. Lack of suppression could support hyperadrenocorticism. Vetoryl treatment should be considered 1-2mg/kg.
10th November Results and discuss: ACTH stimulation test is recommended to assess Vetoryl start dose.
13th November ACTH stim. 12.30hrs 1st blood and Inj 0.85mg ACTH. 2nd sample one hour later. Vet being particular that this initial test is done at what will be 4-6 hours post medications.
RESULTS Cortisol basal 164.0nmol/L (50.0-250.0)
Cortisol post ACTH H 811.0nmol/L (150-550)
Commenced on Vetoryl 20mg 15th November
18th November called vet for advice as she drank 5 litres of water over 24 hours.
Continued on 20mg Vetoryl until further ACTH stim test at day 14.
30th November blood results:
WBC 12.2 x10-9/L (6.0-15.0)
RBC 7.17 x10-9/L (5.0-8.5)
Haemoglobin 17.2 g/dl (12.0-18.0)
PCV 50.9 % (37.0-55.0)
MCV 71.0 fl (61.8-79.3)
MCH 24.0 pg (20.6-26.3)
MCHC 33.8 g/dl (30.4-36.4)
Platelets HIGH 503 x10-9/L (200-500)
Neutrophils 77% 9.4 (3.0-11.5)
Lymphocytes 14% 1.7 (1.0-4.8)
Monocytes 7% 0.8 (0.0-1.3)
Eosinophils 3% 0.3 (0.1-1.2)
Basophils 0% 0.0
Film confirms platelet count.
Total protein 69.2 g/L (50.0-72.0)
Albumin 36.9 g/L (26.0-40.0)
Total Globulin 32.3 g/L (19.0-46.0)
Sodium 149mmol/L (139-154)
Potassium 4.76mmol/L (3.6-5.6)
Sodium:Potassium 31.30 (25.00-38.00)
Chloride 109 mmol/L (102-122)
Calcium 2.52 mmol/L (2.20-3.00)
Phosphate HIGH 2.02 mmol/L (0.6-1.80)
Urea 7.4 mmol/L (1.7-7.4)
Creatinine 94 umol/L (20-124)
Total Bilirubin 2.2 umol/L (0.0-16.0)
ALP HIGH 119 u/l@37C (12-83)
ALT HIGH 93 u/l@37C (13-78)
Gamma GT 9.0 u/l@37C (0.1-9.0)
GLDH HIGH 58.0 u/l@37C (2.0-6.0)
Bile Acids 8.2 umol/L (0.0-10.0)
CK 217 u/l@37C (20-230)
Cholesterol HIGH 9.5 mmol/L (2.8-8.3)
Triglycerides H 4.03 mmol/L (0.34-1.97)
Glucose 3.8 mmol/L (3.5-6.0)
Amylase 346 u/l@37C (100-948)
DGGR Lipase 64 u/l@37C (0-90)
ACTH stim Cortisol Basal LOW 30.6 nmol/L (50.0-250.0)
Cortisol post ACTH LOW 119.0 nmol/L (150.0-550.0)
Total T4 LOW 8.4 nmol/L (10.0-55.0)
TSH 0.13 ng/ml (0.01-0.60)
Serum sample lipaemic.
Interpretation (for animals which have been on treatment for at least a month) depends on time of sampling relative to trilostane administration. The ACTH stimulation test should be performed at 4-6 hours after the last dose and interpreted in the light of history, physical examination and clinical response. Current recommendations are: If the post ACTH cortisol concentration os less that 50nmol/L and the dog is clinically well, the trilostane is stopped for 5-7 days and then reintroduced at a lower dose. If the dog is clinicaly unwell, the trilostane is stopped, serum electrolytes monitored, the case reassessed and an ACTH stim test performed before reintroducing treatment. If the post ACTH cortisol is 50-200nmol/L but clinical signs have not improved, perform an ACTH stimulation test at 22-24 hours after trilostane, to establish if BID dosing is required. If the ACTH stim test is performed at times other that 4-6 hours after trilostane, then the current recommendations are that the post ACTH cortisol concentration should be more than 50nmol/L and less than 250nmol/L
T4/TSH results are comparable to earlier this month.
FLUID measurements daily over 24 hours
15.11.17 4000mls (First day of Vetoryl)
16.11.17 5200mls
17.11.17 5100mls
18.11.17 4700mls
19.11.17 4000mls
20.11.17 4200mls
21.11.17 3500mls
22.11.17 3400mls
23.11.17 3550mls
24.11.17 3000mls
25.11.17 2850mls
26.11.17 4300mls
27.11.17 3250mls
28.11.17 3900mls
29.11.17 4000mls (ACTH stim test)
30.11.17 1800mls
1.12.17 3400mls (Vetoryl reduced to 10mg daily)
2.12.17 5650mls
3.12.17 3800mls
So the conclusions drawn thus far: She has hyperadrenocorticism, vet says from adrenal tumour (he deduces this from low dose dex test results) Commenced on Vetoryl 20mg 15.1.17 reduced to 10mg 1.12.17.
She is not diabetic. Her kidneys are functioning normally. She is hypothyroid, but possibly not a thyroid illness but general endocrine imbalance, we’re watching and waiting on further testing as we go.
As you can see I’m a bit hung up on the amount she drinks! The initial rises to 5L had me calling the vet for advice which was ‘to continue’. Then I saw a response and gradual decline in amounts, and just as I think we are getting somewhere the amounts rise again. This weekend the 5650 is crazy! I don’t know how she is keeping her electrolytes normal at these amounts!
This morning she woke and vomited (small) but yellow, and she never vomits. So I decided NOT to give her Vetoryl today. She had a lethargic morning, just weary is the best way I can describe it. She had some breakfast and was keen to eat. I took her for a short 1 mile walk at midday, and now she seems to have perked up, seeking out her tennis ball for a quick game once home. Her poo is a bit loose, yellow. She doesn’t seem distressed. Doesn’t appear to be in pain. I’d just say ‘she isn’t herself’ for the past 24 hours. I’m waiting for the vet to phone.
Is there anything we’re missing?
Should I put her on a diet again? (Did the pre-diagnosis reduction in drinking correlate with being on a diet or was it coincidence? This memory has just returned to me, pre-diagnosis, her drinking always accelerated after 5pm meal. She WAS only fed once a day, now gets 3 smaller meals)
She’s having to be crated overnight with puppy pads, which she thinks is beneath her! She usually sleeps on my bed and the look I get every night is pure disgust! I’ve tried getting up through the night to toilet her, but as I have health issues myself (Cushings due to steroids!!!!) it was making me ill.
Generally speaking her QOL isn’t too bad, can walk a mile a day (No more or she lags, probably the low thyroid?) But she’s a tired girl, puffy and panting, carrying too much weight, and probably fed up with the drink, drink, drinking and wee, wee weeing!
Oooh a couple of other things I just remembered: Urine was sent for C&S and definitely no infection. No ear or skin problems. Hair on both flanks has paled and got smoother rather than her usual rough coat.
Next ACTH test planned for 2 weeks time (4 weeks after starting treatment).
I shall appreciate any and all observations and ideas.
Many thanks, Doli and Mum.