Re: Questions about Cushings symptoms and diagnosis
I had oral surgery this morning so im in bed recovering and Charlotte is laying next to me. She is barely tremoring while she sleeps but its gotten worse when she is awake. I feel like she is having some pain too, although i dont know whats causing it. I wish i knew if the tremors were painful or just a neurological response that are just highly irritating. She is drinking well but hardly eating. The only thing she wants is boiled chicken and ground beef. And giving her pills is a struggle because she doesnt want anything she used to like. Ive tried everything...pill pockets, cheese, hotdogs, peanut butter and even ice cream which worked with one of my old dogs. Ugh!
When she is up moving around she looks stronger than she has in weeks. She is moving faster and her ears are perked up more. But then she will look at me like she is hurting and it breaks my heart. Its hard to think about euthanasia when she doesnt look old and feeble but i dont want her to suffer! And sometimes she is shaking so bad i wonder if we are being humane.
We started her on some pred last night because she was shaking so badly and starting to be more lethargic. She seems a bit better today. We are also giving her tramadol. Oh how i wish these babies could tell us what they are feeling!
Re: Questions about Cushings symptoms and diagnosis
Laurie -- another thing you might want to try re pills is what I resorted to when nothing else worked with my Abbie. My vet suggested I get some very palatable cat food (I used Pro Plan Focus Chicken & Liver Pate) and put that on the outside of the cheese ball (I use american sliced cheese as it is very moldable). Abbie loved it for a while. Now I take the cheese ball and roll it in very, very thinly sliced chicken. Both options I have to stick down her throat (actually in a little pocket at the side of her throat) and hold her mouth shut until she swallows. I also have at the ready another small piece of the sliced chicken to give her as soon as she has swallowed the cheese ball. Every once in a while I don't get the cheese ball in exactly the right spot and she manages to spit it all up -- I rarely try a second time as I don't think it is worth it!
Re: Questions about Cushings symptoms and diagnosis
Quote:
Originally Posted by
judymaggie
Laurie -- another thing you might want to try re pills is what I resorted to when nothing else worked with my Abbie. My vet suggested I get some very palatable cat food (I used Pro Plan Focus Chicken & Liver Pate) and put that on the outside of the cheese ball (I use american sliced cheese as it is very moldable). Abbie loved it for a while. Now I take the cheese ball and roll it in very, very thinly sliced chicken. Both options I have to stick down her throat (actually in a little pocket at the side of her throat) and hold her mouth shut until she swallows. I also have at the ready another small piece of the sliced chicken to give her as soon as she has swallowed the cheese ball. Every once in a while I don't get the cheese ball in exactly the right spot and she manages to spit it all up -- I rarely try a second time as I don't think it is worth it!
Thanks Judy, i will give the cat food a try. Right now she just isnt very interested in anything. I assumed once the cortisol levels incresed she would get hungry again. Right now we are doing pretty much what you described. I hate it though and hope she will start taking something well.
On a side note, i see you are in Florida. We have been thinking of moving there for awhile now (Tampa area) and im wondering about vet care there? Being from California im used to certain things that will be hard to get there but not sure about medical and vet care vs here. Would love your thoughts.
Re: Questions about Cushings symptoms and diagnosis
She was tremoring so badly late yesterday we decided to go ahead and give her 20mg of oral pred last night and again this morning. She is doing better so we will give her a half dose again tonight. Its just kind of trial and error at this point. She took a short walk with my husband and is sleeping really well right now. Exercise seems to help her but i dont want to over do it. She is drinking a normal amount of water but still not too interested in food. Any suggestions Marianne?
Re: Questions about Cushings symptoms and diagnosis
Quote:
Originally Posted by
labblab
Hi Laurie, I just now saw your new reply posted on the "Macroadenoma" thread, and I'm wondering how Charlotte is doing today. You mentioned there that you had started the oral prednisone after all. How are things going for you guys?
Marianne
She was tremoring so badly late yesterday we decided to go ahead and give her 20mg of oral pred last night and again this morning. She is doing better so we will give her a half dose again tonight. Its just kind of trial and error at this point. She took a short walk with my husband and is sleeping really well right now. Exercise seems to help her but i dont want to over do it. She is drinking a normal amount of water but still not too interested in food. Any suggestions Marianne?
Re: Questions about Cushings symptoms and diagnosis
Hi Laurie, I'm glad the prednisone seems to be helping with the tremoring, but my worry is that the dose you are giving her is really, really huge -- 50 mg in the space of 24 hours. Unless your vet has specifically told you that's OK, I don't think you can keep giving her that much and you will need to back off considerably. I really have no idea what the optimal dose is in this situation, but unless I was told differently, I wouldn't feel comfortable with more than 10 mg. every twelve hours. But again, I really don't know what's OK in this situation, especially since she's also off the Vetoryl. I'll be very anxious to get today's update.
Marianne
Re: Questions about Cushings symptoms and diagnosis
Adding Prednisone can temporarily reduce neurological symtoms by reducing the swelling around the macro. It is a tricky situation because it acts like cortisol in the body. Our Cush pups already have very high levels of cortisol. It is sometimes precribed along with Vetroyl as a combo, thus keeping the cortisol at a safe level. It did help my pup for about a month. In the case of an enlarging macro, most of us manage symptoms to keep our pups comfortable for as long as possible. The tumor will continue to grow and eventually take over.
A neurosurgeon with her team of neurologists oversaw Buddy's treatment. He was monitored by phone daily (seven days a week) by this very dedicated neurosurgeon. Dosages were tweaked according to how well Buddy was, or wasn't doing each day. He was on the combo, but even then adding Prednisone was done very carefully. Buddy weighed 16 pounds. Intially was half of a 5mg. Tablet ( 2 1/2 mg. once per day. He was eventually dosed twice per day, but NEVER MORE THAN 5mg. In 24 hours. We tapered down as soon as Buddy started doing better to find the smallest possible dose. He was often taking a quarter tablet twice per day. It was a daily shifting. Too little, he'd be miserable. Wouldn't want to get up. It was a very fine line.
I understand how how hard this is. I lived through it and still relive it often. Please proceed carefully and make sure that someone who knows what they are doing is monitoring VERY carefully. I am so sorry that Charlotte is having such a hard time. This situation sucks! I am so sorry. :o
Kathy
Quote:
Originally Posted by
labblab
If she truly has a macro and Cushing's, you'd be looking for a balance between offering relief from the neurological symptoms and also the classic Cushing's issues. Layering prednisone on top of uncontrolled cortisol could perhaps tip things too far in the other direction. I do think that's why some neurologists prescribe both trilo and pred simultaneously -- in order to control the cortisol level in addition to a specific dose of prednisone.
Re: Questions about Cushings symptoms and diagnosis
Quote:
Originally Posted by
labblab
Hi Laurie, I'm glad the prednisone seems to be helping with the tremoring, but my worry is that the dose you are giving her is really, really huge -- 50 mg in the space of 24 hours. Unless your vet has specifically told you that's OK, I don't think you can keep giving her that much and you will need to back off considerably. I really have no idea what the optimal dose is in this situation, but unless I was told differently, I wouldn't feel comfortable with more than 10 mg. every twelve hours. But again, I really don't know what's OK in this situation, especially since she's also off the Vetoryl. I'll be very anxious to get today's update.
Marianne
The pred is 20mg tablets and instructions from her local vet was to give her 1 tab in the morning and a half tab at night the first 2 days and then back off to a half tab every 12 hours. So you are right on with your thoughts Marianne. He told me that to reduce inflammation in a macrotumor it would be 20-25mg twice daily but if it was a addisonion type crisis it would be much lower, about 5-10mg per day. Of course we dont know for sure but we are assuming its a macro so she will most likely need more than the 5-10mg but we dont want to over do it either. So today she starts a half a tab twice daily which will be 20mg a day.
She slept a lot yesterday, kept me company in bed while i was recovering from my oral surgery. She hardly tremored at all. Her appitite is a little better this morning but still picky and wont eat her dog food alone without treats. Overall the tremors are definitely better from a couple of days ago but still bad when she is resting. She isnt as perky this morning but moving around quite a bit and drinking well.
One day at a time...
Laurie
Re: Questions about Cushings symptoms and diagnosis
Laurie, thanks so much for this additional info, and now I feel very much relieved about the dosing! I'm also so glad that Kathy had the chance to chime in. It looks as though her Buddy was maintained for a time on a prednisone dose that would translate into about 20 mg. daily total for a 60 lb. pound (not sure how much Charlotte weighs, but am guessing), so that's right in the ballpark as to where you're also transitioning for the moment.
I'm sending big well wishes to you on recovering from your oral surgery (BIG YUCK :(). And yes indeed, one day at a time. As you can already tell, I'll start bugging you if I don't get your updates, so please do keep checking in with us...:o ;)
Marianne
Re: Questions about Cushings symptoms and diagnosis
Buddy was also dosing Trilo at the same time. Please consider that when estimating prednisone dosages in dogs with already high cortisol due to Cushings. Trilo kept Buddy's cortisol levels in check. That would make a difference as to how much Prednisone can be safely given. ;) There are many variables. That is why close monitoring is essential.
Kathy
