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The tip of his tail is bald again and he has a couple of other little bald spots and he's panting like crazy with any exercise - even a slow walk. He's not eating or drinking loads but he is having episodes where he's peeing a lot. He just seems a bit stressy and he's looking a bit bloated in the tummy region.
Oh, and he's whinging a lot - just seems really unsettled
Yes I can see where that would be a concern. Put together with the whining something seems to be going on.
Let us know what the test shows.
Will do - he's not booked in until Tuesday next week but was a bit unsure if doing it so late in the day would be a problem or not.
I'm bracing myself for a battle though - because if he does need to go back on meds, I'm determined that I want twice daily dosing and a very low dose, given what happened the last time and I'm expecting the vet to disagree with that.
Just phoned another vet and they're so much cheaper for the test but they're miles away from us and I'm not sure how stressed he'll get with the car journey.
That's another thing - it's almost like he's got agoraphobia - if he goes on a walk in our own area and it's where he knows, he's happy but if I take him in the car (which he doesn't mind being in) somewhere different for a walk - he's anxious and stressing and wanting back in the car - it's like he can't cope with being somewhere he doesn't know
I believe I would have a CBC/chemistry panel with an urinalysis performed first before the ACTH stimulation test, something might just pop up on that blood panel that could account for those symptoms.
He's in tomorrow to get drops put in his ear - little devil was playing me up when I tried - took him in today and he sat there as good as gold, like butter wouldn't melt - made me look stupid!! LOL
I'll mention it to the nurse tomorrow and see if we can get that organised first
Well, the boy just got his stim test today - we had to cancel it last week. She says he's perfectly fine - she phoned my mum and his levels were 420 (15.22) post stim.
I just did a quick scan through Cairo's thread and saw an ACTH stimulation test was done in July 2014 (pre ~ 120 nmol = 4.34ug; post ~ 400 nmol = 14.49ug), was this stim the last one performed before the one today?
If so, it seems like his adrenal glands have regenerated nicely, YYYAAA!! How are his symptoms?
Hugs, Lori
How is his tail looking now?
They always do play us up and then get to the vets and make liars of us all. :) little buggers. Got to love them! LOL
Yeah, that stim test in July last year was the last one he'd had.
The main symptom was the tip of his tail going bald again and a couple of teeny tiny bald patches - on the backs of his legs (vet says it's where he's lying but he doesn't lie on his legs like that - he lies with them stretched straight out behind him) and on his side and the edges of his ears are ever so slightly bald again. He's not drinking that much, isn't eating much but we certainly can't get the weight off him (though now we're not sure as there was a 3kg difference between two sets of scales at the vet! )
We cancelled last weeks appointment because he was on ear drops and I think they had steroid in them - little devil wouldn't let me put them in, so I was taking him up to the vet so his favourite nurse would do it - and he sat there like an angel for her to do it - in fact, he even turned round to make it easier for her to do the other ear. Mind you, she put the drops in a syringe to administer them and I'm thinking that he didn't like the nozzle of the bottle going in his ear because I did it over the weekend, using the syringe and he was as good as gold.
I'm starting to wonder if he was misdiagnosed in the first place - just don't understand how he could have Cushings then suddenly not have it
Hi everyone,
We've not been around for a while. Cairo has been doing OK but hasn't been on meds now for nearly 2 years.
He's had his stim test repeated a couple of times in that time and they've said that his cortisol levels aren't high enough to warrant putting him back on meds - especially not after the reaction he had.
He broke a tooth and I had him at the vet yesterday and she gave him a good going over and asked if we'd noticed one testicle was a lot bigger than the other - I confess I thought it was normal.
He thinks he has a tumour, so he's to go in and get the tooth out but also castrated at the same time and they'll send the offending items off to the lab.
I'm worried sick. I should have got him castrated years ago but one vet said that because he was such an anxious dog, we shouldn't get him done as the bit of testosterone would help give him a bit of confidence.
Is there anything we need to be worrying about with the anaesthetic and him not being on meds any more and the potential that he still has Cushings?
I'm worried sick for the poor little guy - he's 10 and a half and has never been away from home like that.
Alison. :) How nice to see you and to hear how well Cairo has been doing.
There shouldn't be any issue with Cairo and Cushing's with the surgery as his cortisol levels are fine as the vet said.
Hopefully he will do well with surgery and come through like the champ he is. :).
Poor guy. Getting teeth and castrating. He is not going to be a happy camper to wake up and hurt at both ends. Eeek!
No, poor little soul isn't going to know which end is the worst.
He's not had bloods done in a while - this is his last three stim tests
14th July 2014 Baseline 120 post stim 400
13th May 2015 Pre 104 Post 239
14th July 2015 Pre 126 Post 415
I'm just being a worried, neurotic mum :)
When is he going in for his tooth and castration?
He had it last Wednesday. He seems to be doing fine though it did take him a couple of days to get over the anaesthetic.
On the day of surgery, poor boys back legs kept folding under him. I had to carry him up and down the outside steps and at 30kg, that was no easy task!
His wee mouth was swollen for a couple of days - he ended up having to get two incisors out as he'd broken them and he's got stitches.
We should get the results of the pathology on his testicles on Monday when he goes to get his stitches out.
When he first got home, he fell over and just went to sleep where he landed
http://s41.photobucket.com/user/Alis..._0207.jpg.html
Took him out for a toilet break but was lucky if he managed 100 yards along the street
Going...........
http://s41.photobucket.com/user/Alis..._0447.jpg.html
Going.........
http://s41.photobucket.com/user/Alis..._0449.jpg.html
Gone
http://s41.photobucket.com/user/Alis..._0450.jpg.html
Oh my gosh that poor boy. Just couldn't keep his eyes open.
That would be a real back breaker lifting him. He looks hefty! cute but solid. LOL
So glad he is doing better after his surgical adventures.
He's just been to get his stitches out and the results of the pathology.
All healed up nicely. He had two different types of tumour, both benign and castration should have removed the issue. So relieved.
That is wonderful news!! That the tumors were both benign, that the castration should have cleared up all the tissue and that he is recovering so nicely!
Yay Cairo!!
It's been a long time since we've been on.
Cairo seems to have aged greatly since his castration and the poor boy is very arthritic now.
He's still not on any Cushing's meds - different vet at our practice has indicated that perhaps he never needed it in the first place - though she's never going to go against a colleague and say he was misdiagnosed.
His alk phos levels are high though - she says they're over a 1000 (UK measurements) but he's had a scan and x-ray and although his liver and spleen are slightly enlarged, there doesn't appear to be anything sinister showing up.
Would Milk Thistle help with his alk phos levels? If so, would it be OK for him to be on it all the time? I've read up a bit and I thought it was only meant to be used short term but I need to try and get more educated on it's uses.
Either that, or any other advice would be hugely appreciated.
Welcome back to you and Cairo! Milk thistle is widely recommended for liver support. Fortunately, it is relatively inexpensive -- I have seen dosage recommendations of 2 mg./lb. but you should definitely check that with your vet. In light of your comment about Cairo aging, you might also consider S-Adenosyl which is a combination of milk thistle and sam-E. The latter can often aide with signs of aging. I used to give my Abbie the S-Adenosyl and found that the best price was on Amazon. It is definitely more expensive than just purchasing milk thistle. I stopped giving it to Abbie as her liver tests are not showing any problems. You can definitely give it long-term. Hope this helps!
hi Alison! Long time no talk. Awww, poor Cairo. Sorry that he's having a harder time these days. I'd do the sam-e and milk thistle both too. I used both for molly depending and usually got it via Amazon.
Thank you - I'm not having much success in finding the S-Adenosyl though. :(
He seems to be putting on a ton of weight as well and he really isn't eating much. He used to love his food and now it's hit or miss if he eats anything. He maybe feels a bit off.
Alison check amazon. That is where I always bought it from.
https://www.amazon.co.uk/s/ref=nb_sb...+liver+support
Ahh, brilliant, thank you.
Does this look like the right stuff?
https://www.amazon.co.uk/d/Dogs/Dett...+support&psc=1
No you want to have both milk thistle (silymarin) and sam-e (S-Adenosyl) if possible.
If not, get the S-Adenosyl separate at least but I would definitely want both.
We've got Cairo on a liver support supplement now since his alk phos was so high (over 1000 - 36) but his weight has been going up and up despite him eating very little.
Got another stim test done today and his post stim results were 625 (22.7). Vet isn't keen to start him back on vetoryl after what happened before but we've to monitor his water intake over the weekend and try and get a urine sample.
At these levels, would anyone recommend a restart to vetoryl?
Hello Alison, and welcome back to you and Cairo. Everything being equal, yes, I would consider restarting the trilostane in a Cushpup with that level of rebounding cortisol if he is also exhibiting symptoms, as well. It's true that he had problems with low cortisol before during treatment, but there are plenty of options for him to be dosed with a much smaller amount of medication. As I recall, he previously weighed about 60 lbs. and was dosed no lower than 60 mg. -- and was even started clear up at 120 mg. Since Vetoryl also comes in 5, 10, and 30 mg. capsules, it would be easy to start him off gradually at a much lower dose while monitoring how he does. It is always better to start low and work upward, rather than vice versa, especially since research has shown that large dogs may require less medication, mg. to lb., than do smaller dogs.
My one reservation in all this is his picky appetite. The general rule is to withhold treatment from a dog who is not eating well. One reason is practical: trilostane needs to be taken alongside food to be absorbed properly. However, you additionally worry whether there is some other medical issue going on that needs to be attended to. As you know, most untreated Cushpups have a ravenous appetite. However, having said that, we've seen a few exceptions here over the years: dogs whose appetites have suffered when cortisol is high and that have normalized once cortisol is brought under control (for our veterans, Sue's Zoe is one example). So if it turns out that Cairo's water intake is ramping up again alongside dilute urine, I think I'd be tempted to try a small dose of Vetoryl once again -- no more than 30 mg. and maybe even only 10 mg. as a trial run.
Please do keep us updated as to how he's doing, and also what you decide.
Marianne
Thanks Marianne
The vet said that if she did start him back, it would only be 30mg but I could speak to her about a lower dose.
Can he still take his anti-inflammatories whilst on vetoryl?
He was indeed started at 120mg despite my arguing with the vet (different vet now). He's now weighing in at 34kg (74.8lb) which is far too heavy for a stafford.
The strange thing is that his harness has never been adjusted in all the years he's been wearing it - his weight is all round his belly at the back and I would guess round his neck which to me is typical cushy places.
He is back to eating well since starting on the liver support supplement. I wouldn't even say his drinking was over the top to be honest, which are the two areas that you would expect with Cushings. However, I myself have Addison's and I didn't have the typical symptoms of that before diagnosis (the inappropriate tanning for one symptom).
Thanks so much for this additional info! If you do start back up with the Vetoryl, I don't think there'd be any problem with the anti-inflammatories. In fact, if you're using NSAIDS, I think it would probably be safer for him if you start lowering his cortisol. The combo of NSAIDS and higher levels of steroids (either natural cortisol or supplemental prednisone) is not a good one from a GI standpoint -- gastric irritation, even bleeding, can result.
If he now weighs 74 pounds, starting back at 30 mg. is not at all unreasonable. However, if you wanted to be super cautious, you could try the first month at an even lower dose. Based on ACTH testing at the end of the first 30 days, you'd have a much clearer idea as to how Cairo is tolerating the medication and how large an increase might be warranted. But as I say, I cannot argue with 30 mg., either, since I know you'd be watching him carefully.
Marianne
Hi Alison.
It might not hurt to bring his cortisol down a bit with the NSAIDs. I'd do a couple weeks and test and see how he reacts to it. A lower dose like 30 should be okay technically but you could even try 20 mg if worried. Be sure and do the follow up acth to see how he is reacting though
We measured Cairo's fluid intake over the weekend - only 700mls per day. Got a urine sample as well and the vet says that it's good - not dilute. She's frightened to start him back on any treatment "after what happened the last time".
I'm having a hard job getting through to the vet and my mother that the last time, he was just put on far too high a dose, so between them, they've decided to leave him be - unless he gets any worse.
It's so frustrating for me and I just hope the poor little guy isn't feeling unwell in any way.
Just a quick update and really looking for some more advice or reassurance.
Following Cairo's last stim test where his post stim result was 625 (22.7), the vet wasn't keen to restart vetoryl, but since then she has - only on 10mg to see how he went (he's 35kg).
He had his repeat stim test on Friday and the post stim results are 204 (7.4). Our own vet is on holiday. The vet we spoke to said to keep him on the 10mg and repeat the stim in 3 weeks.
That seems like a worryingly huge drop in his post stim cortisol levels on only 10mg. Is it? Should he continue on it? We're worried after him crashing the last time he was on vetoryl.
Can you tell us how long Cairo had been taking the 10 mg. prior to this test? That will help us judge the effectiveness -- or overeffectiveness -- of this dose.
Thanks!
Marianne
He has been on 10mg for 2 weeks
My mum's just been on the phone to say that she can't get him to eat and he's sitting in a corner shaking. I've told her not to give him the vetoryl today and to phone the vet.
My niece lives with my mum and she went on holiday yesterday - he could be pining for her but sitting shaking was the indicator that his cortisol had dropped too much last time, so better to withhold the vetoryl I think.
If he had been taking the Vetoryl for two weeks, then I would not have been concerned that there was too big a drop in the cortisol. In fact, I would have thought that was a good result and I would agree with the vet about continuing with that dose. After two weeks of treatment, a drop from 22 to 7 would be putting Cairo's cortisol right in the range where you want it to be, with room for it to safely drop even a bit lower.
However, given his behavior right now, I think you are doing the right thing to at least temporarily hold up on dosing until you have a better idea as to what's going on with him. Please do keep us updated.
Marianne
Ahh, it's a relief to know that the drop is OK. It just seemed like a massive drop.
He's very attached to my niece so it could be that he's missing her - she only went yesterday - it's just unfortunate that her holiday coincided with his stim test
How is he now? Does he seem alright? 7.7 is okay, and while a big drop, and he might be feeling the affects of that, it isn't alarming yet. He would continue to drop some for the next two weeks (as they usually drop for 30 days or so)
I'd say it depends on how he is doing and if you can tell if this is physical or missing your niece.
He eventually had a drink and a little bit to eat this morning but he's still miserable looking.
He slept on the floor in my niece's bedroom last night so it's obvious that he's missing her.
He's not had his vetoryl today again as he hasn't had enough to eat to get it
Just checking to see whether Cairo is doing any better...
Surely hoping that he's bouncing back again!
Marianne
Poor little guy is still sad. He's not had his vetoryl since Monday and I've only been able to coax him to eat a little last night and again tonight. He's just thoroughly miserable. His friend is back on Tuesday so I'm hoping he'll perk up when she comes back - she's not going on holiday again, that's for sure!
Not sure how not having his vetoryl is going to affect stim test readings - if he's not had it for a week, is it a case of going back to square 1 and starting from scratch again?
Since he's been off the Vetoryl I don't think it would be beneficial to have an ACTH stimulation test done right now and would wait until he's been taking the Vetoryl for 10 - 14 days. How are the symptoms?