Zoe By My Side- Our Journey with Cushings

This is reminding me of the time Squirt's vet "lost" her sample to UTK....it was found weeks later in their freezer! :p Of course, the sample was no good by then and we had to redo it, but at no cost to me. It was actually funny....the clinic, me, the vet had all been calling UTK and FedEx raising hell, and there it was all the time right where they had put it! LOL So, ask them to double check their freezer just in case! ;)

I hope you hear back soon! I know how frustrating the wait can be.

Hugs,
Leslie and the girls - always

Boy, it better not be in their freezer:eek:

But thanks for alerting me to ask:D I sure don't want Zoe to redo the test now. Last time she was breathing really fast after we got home for part of the afternoon. She did not do that the first time. I was a bit concerned about it but then it finally stopped.:confused:

Gosh, I sure hate all these tests. If we have to redo it we will but I will complain alot.:mad::mad::mad:

But Leslie, I was so excited to hear of Squirt playing with toys:):):)

Watch out, you might not be able to keep up with her:D

Hugs,
Addy

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But Leslie, I was so excited to hear of Squirt playing with toys...

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Oh, Addy! That was just so, so, so wonderful to see! I was amazed, proud, tickled pink, dumbfounded, giddy....just blown away! :D:D And, a tad bit guilty that I had waited as long as I did to start the Lyso. :rolleyes: I should have started it right after her last UTK panel. But nooooo....I had to fret and worry and research first. The flip side of this is - Squirt didn't start showing signs until a bit after that last panel and her signs were what made me start the Lyso. :rolleyes: I wear guilt so well, tho! ;)

I hope, hope, hope Squirt's story will help others feel better about using Lyso as a maintenance dose with Atypical babies. There is so much fear over Lyso. :( I just wish her story could relate to Zoe and help you, too.

Hugs,
Leslie and the girls - always

Dear Addy
will be praying for you. Make sure you get a copy of the report with explanations , look over and ask the vet to interpret, also get a copy of vets notes if possible. I always ask all sorts of questions.
Hugs Sonja and Apollo

Marianne, Sue, Lori, Glynda, Leslie, Kim and ALL OF YOU, your frank, brutally honest opinion: IMS is a bit stumped and has not yet given me HER plan but left it up to me. UTK advises we can do just about anything except Trilostane. IMS concurs and I have to agree.

May test and January test results listed below-background first:

Zoe now has normal CBC, urine test, gastro panel, her cholesteral and ALK are now normal, in May they were elevated. IMS is stumped on that not sure why that would happen. Her hypothosis is that Zoe has "stress colitis" and the stress is coming from her body's high cortisol. She believes her poos will improve when we reduce cortisol.

Zoe is walking better now and has gained 4 ounces. She still does not want to jump on the couch now. She is having one extra potty break at 10:00am but we think it is because her chewing and licking has gotten worse, she chews and chews her Kong and then goes and drinks water in the morning. Whenever she chews, licks or eats, she goes for a drink afterward so she is drinking more water but not abnormal amounts. Her coat is soft and shiny but remains thin, still has rat tail. No panting unless she has stomach pain. Holds urine for the whole night, no house accidents

MAY 2010 adrenal panel


Cortisol ng/ml 47.7 2.1-58.8 304.4* 65.0-174.6
Androstenedione ng/ml 1.05* 0.05-0.57 7.69* 0.27-3.97
Estradiol pg/ml 114.8* 30.8-69.9 102.2* 27.9-69.2
Progesterone ng/ml 0.99 0.3-0.49 5.91* 0.10-1.50
17 OH Progesterone ng/ml 1.18* 0.08-0.77 20.33* 0.40-1.62
Aldosterone pg/ml *** 33.9 11-139.9 357.1 72.9-398.5



JANUARY 2011 Adrenal Panel -Melatonin and lignans at full dose for 3 months

Cortisol ng/ml 41.6 2.1-58.8 440* 65.0-174.6
Androstenedione ng/ml .33 0.05-0.57 4.29* 0.27-3.97
Estradiol pg/ml 54.5 30.8-69.9 52.2 27.9-69.2
Progesterone ng/ml 0.46 0.3-0.49 4.79* 0.10-1.50
17 OH Progesterone ng/ml .72 0.08-0.77 9.9* 0.40-1.62
Aldosterone pg/ml 33.2 11-139.9 213.6 72.9-398.5


The intermediates have come way down and I can't help but wonder had we been on melatonin and lignans for a longer time, would they not have decreased more. Cortisol went higher.

Choices:

maintenance dose of lysodren

load with lysodren

keep on melatonin and lignans if I feel Zoe is doing well.

Thanks,
Addy

Hi Addy,

Let me start by saying that I'm glad Zoe has you because if she were mine, I'd probably be back in the closet, curled up in a ball, drooling like a worked up St. Bernard. :p I just told a member that I don't do that anymore. :)

In my opinion, a maintenance dose of Lysodren is not going to be effective in lowering cortisol in a dog with a post stim of 44 ug/dl. I personally wouldn't flush $5 a pill down the toilet. I'm probably the odd woman out here but if my dog had chronic colitis and had a post stim cortisol of 44 ug/dl with no overt symptoms, no concerning blood abnormalities and I was being pushed to start treatment to reduce cortisol in the hopes it would cure chronic diarrhea, we'd be starting with a low dose of Vetoryl.

I think I've mentioned before that based on my own experience with Lulu and everything I've read and listened too, I no longer agree with the "don't use Trilostane" if intermediates are elevated" theory. You can pretty much assume that every dog with elevated cortisol has some degree of elevation in intermediates. This fact was confirmed by Dr. David Bruyette, a huge fan of Vetoryl, who very rarely prescribes Lysodren. So if intermediates are always elevated with typical cushing's, then according to UTK, Vetoryl should never be prescribed, or at least not for the reason it was approved by the FDA. :confused: Maybe I should ask Dr. Oliver to explain that to me.

Glynda

:p PLAYING DEVIL'S ADVOCATE!!! :p

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This fact was confirmed by Dr. David Bruyette, a huge fan of Vetoryl, who very rarely prescribes Lysodren.

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Dr. Bruyette's "theory" would carry MUCH more weight if he were a huge fan of Lyso and rarely prescribed Trilo...IMHO. ;) And I would LOVE to hear Dr. O's response. :)

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Ok, Addy,

One point I do now agree with Glynda on, is that a maintenance dose will more than likely not work on Zoe's cortisol - she would need a loading phase.

Zoe doesn't have many signs at all and that would be a concern, for me, in loading since you wouldn't have much to gauge her reaction on. Soft poops or diarrhea would not be much of a clue either. :rolleyes: Is there a sign you see that would tell you if she were loaded?

If Zoe's diarrhea worsened on the loading, what would you do? Do you continue with the load in the hopes she will adjust and the maintenance dose wouldn't bother her, or do you stop the Lyso period? Would you then try the Trilo, hoping that, for Zoe, Dr. B is right and Dr. O is wrong? If she cannot handle the Trilo, that leaves Keto or Anipryl. If those are too hard on her, you are back to where you are today - the UTK treatment only.

I believe the intermediates have gone down due to that treatment - lignans and melatonin working as they are supposed to. :D

As for the cortisol rising - I haven't looked back, but has Zoe had an ultrasound where her adrenals were visible? Has she been diagnosed as PDH or is there a possibility of an adrenal tumor? The reason I am wondering about this is - what if some of her elevated cortisol is a result of the physiological stress her body in under due to the colitis? From Squirt's history, I know this is possible - but she had a tumor causing her elevations when she was first diagnosed. Could prolonged colitis cause the same reaction? I don't know.

As for the cortisol causing her colitis - I don't know about that either. In some research online this morning on cortisol and colitis, what I found was that corticosteriods are used to treat colitis, but in reference to ulcerative colitis, not stress colitis. I have yet to find anything relating to Lyso and colitis.

It might be worthwhile to talk to the manufacturer of Lyso - Bristol-Meyers Squibb if you haven't already. Here is their info:

Bristol-Myers Squibb contact info:

The Americas
800-321-1335 (toll free US only)
609-897-6669

Drug.Information@bms.com

I simply cannot believe that Zoe is the first cush pup to also have colitis...that is just statistically improbable! Those two populations have to have intersected at some point. :confused::confused::confused:

Don't you really wish one of us would just say, "Addy, do THIS!" :p I think I know what I would do....but I haven't lived with Zoe and that could very well change my mind. But I come back to what is known - Lysodren will lower all the intermediates, with the possible exception of estradiol - it does not cause any of them to elevate. ;) I think everyone agrees on this.

Another point I agree with my dear friend on is that I am glad Zoe is yours. Evil, ain't we?!! :p Honestly, I don't know how you deal with all of this - I would be completely bald, my face constantly swelled up from bawling all the time, and my eyeballs spiraling! So you tell sweet Zoe that she is so, so lucky to be with you and not one of the OTHER crazy ladies here. :p

Hugs,
Leslie and the girls - always

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Originally Posted by Squirt's Mom

:p PLAYING DEVIL'S ADVOCATE!!! :p



Dr. Bruyette's "theory" would carry MUCH more weight if he were a huge fan of Lyso and rarely prescribed Trilo...IMHO. ;) And I would LOVE to hear Dr. O's response. :)

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I don't believe Dr. Bruyette's opinion that intermediates are always elevated with pdh, or adh for that matter, is theory. I believe there's scientific evidence of this and now I'm going to have to find the evidence. :D Dr. Bruyette's practice runs 450,000 diagnostics for cushing's each year and I would safely assume that very few IMS' in the So Cal area have near the number of cushing's patients than VCA West Los Angeles. With that said, I would think that a vet who chooses to treat 100's of patients with Trilostane would most certainly have had several cases of dogs with relapses due to Trilostane's effect on the intermediates. Why is it that we're not hearing about this from anybody but UTK? I have been unable to find one reknown specialist in endocrinology that has mentioned anything about this in lectures, reference papers, etc. The list includes Dr. Feldman, Peterson, Nelson, Cook, Behren, Bruyette and a few others.
Now that I know that Dr. Peterson responds to emails, I think I'm going to ask him the very direct question and see what he has to say about it.

Dr. Edward Feldman pretty much sets treatment protocol at UC Davis and despite his bias toward Lysodren, UC Davis' choice of treatment for adrenal tumors is Trilostane. As a rule, a functional adrenal tumor can and usually does secrete excess sex hormones so why is it that UC Davis thinks Trilostane is a better choice for ADH, despite warnings from UTK? Just playing devil's advocate from the other side.

Glynda may be surprised to know that she's got some back-up here, but I'm agreeing with her. Since Zoe's cortisol has increased from 30 to 44 since May, I do not think a maintenance dose of Lysodren is going to serve any useful purpose. So if it were my choice to make for my own dog, I'd be looking at either Vetoryl or Lysodren loading. And with a lack of overt symptoms with which to monitor the Lysodren loading process, I'd probably feel more comfortable giving the Vetoryl an initial try. I know this recommendation puts you in a bind, since neither Dr. Oliver nor your IMS wants to consider Vetoryl. If Vetoryl is truly "out," I guess I'd opt for the Lysodren load.

Just to remind you, my Cushpup was one who did have chronic issues with diarrhea. Even though we didn't do biopsies or specific diagnostic testing related to colitis, my IMS said that he had seen other Cushing's dogs for whom colitis appeared to be associated with longterm uncontrolled cortisol levels. I know this sounds paradoxical since, as Leslie says, steroids are often used to treat such conditions. But there may be a big difference between transitory steroid treatment vs. unremitting high levels of steroid exposure. I wish I could give you more specifics as to what my IMS said. But all I recall is him telling me that he was hopeful that the diarrhea would resolve once treatment was underway (we treated with trilostane). Unfortunately, it did not improve significantly. But neither did it worsen, either. So for my pup, the colitis did not end up being a treatment contraindication.

Marianne

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I'm probably the odd woman out here but if my dog had chronic colitis and had a post stim cortisol of 44 ug/dl with no overt symptoms, no concerning blood abnormalities and I was being pushed to start treatment to reduce cortisol in the hopes it would cure chronic diarrhea, we'd be starting with a low dose of Vetoryl.

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Thank you Glynda. IMS is not pushing me to start treatment, she even said maybe we should not rock the boat and keep things the way they are. If I kept things the way they are I could switch Zoe to tylan and see how that goes. And I am getting gray hair I never had before so I might be in that closet drooling sometime soon:eek: I am worried about the rise in her cortisol which is why I am afraid to leaves things the way they are. What if it goes even higher? Is that possible? I am freaking about that:eek::eek::eek:

I understand your point about vetoryl, I even emailed Dr. Allen Zoe's May adrenal panel. My gut is telling me no right now.

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If Zoe's diarrhea worsened on the loading, what would you do? Do you continue with the load in the hopes she will adjust and the maintenance dose wouldn't bother her, or do you stop the Lyso period? Would you then try the Trilo, hoping that, for Zoe, Dr. B is right and Dr. O is wrong? If she cannot handle the Trilo, that leaves Keto or Anipryl. If those are too hard on her, you are back to where you are today - the UTK treatment only.

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Good point Leslie, and I should really ask the IMS this question.

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As for the cortisol rising - I haven't looked back, but has Zoe had an ultrasound where her adrenals were visible? Has she been diagnosed as PDH or is there a possibility of an adrenal tumor? The reason I am wondering about this is - what if some of her elevated cortisol is a result of the physiological stress her body in under due to the colitis? From Squirt's history, I know this is possible - but she had a tumor causing her elevations when she was first diagnosed. Could prolonged colitis cause the same reaction? I don't know.

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Leslie, ultra sound showed bilateral enlargement of adrenal glands, one slightly larger than the other-IMS thinks pituitary not adrenal tumor.

I have asked Dr. Oliver and the IMS at least three times could another illness be causing these rising hormones and BOTH said each time not at such significant levels, so there answer is no.

Is it possible for the cortisol to come down even to 20 on a maintenance dose? I mean her intermediates came down without much work. Her symptoms are not horrible, maybe 20 would be okay for her right now. She is like me, she over responds to medication, a normal dose is sometimes too high for her.

Need to know: can her cortisol go even higher? what will that do to her? can maintenance dose lower the cortisol at all?

When she was so sick in November and December it was hard to watch and think that it was possibly rising cortisol doing it to her. I can't watch that.:eek::eek:

I don't want you to tell me what to do, just want feedback. The IMS won't even tell me what to do:rolleyes::rolleyes::rolleyes: I know I have to decide on my own. But I went from having a dog that was in good shape nine months ago to a dog that can't even jump on the sofa anymore and chews and licks all day long and then goes and drinks water:mad::mad::mad: She also is looking for food more, forgot to tell you that.



How doe we watch them get worse and do nothing? Do you think I am jumping the gun? Dr. Allen said her symptoms will get worse and she will develop new ones. I don't know if I can wait for that:eek::eek:

Addy

Oops, posted and missed Marianne's comments. Thank you Marianne.

I don't think the IMS will use Trilostane. She is pretty set against it so I would have to go elsewhere and the only other possibility is to have a vet with not much experience work with Dr. Allen for Zoe's trilostane and stims.

I did not forget about your pup but I thought the issues were not as frequent as Zoe's. I even tried to search for your thread but must be in the old site. That was one of my choices, wait on treating cortisol and keep things the way they are and switch to Tylan. I remember it helped you alot even with the drinking and peeing.

Hugs,
Addy

Addy, you're right, I don't have a thread here about my Barkis because we lost him back in 2004. But our decision to treat him for his Cushing's was much more clear-cut and easier than your decision with Zoe. He was a poster child for the disease, and had every classic symptom: excessive hunger, thirst and urination; elevated liver enzymes, hair loss on his haunches and abdomen, panting, seeking out cool places to lay down, hind leg weakness such that he could no longer jump on the couch or even easily negotiate the stairs. He also had frequent episodes of diarrhea with bloody mucous, but I don't believe they were as constant as Zoe's.

He had bilaterally enlarged adrenals on ultransound, and his ACTH was also at least 40+. So for us, it was a no-brainer to treat. And the trilostane did help to relieve many of his Cushing's symptoms, even though the diarrhea was not solved. We ended up losing him due to the development of neurological symptoms consistent with an enlarging macrotumor. But the trilostane did give him several months of quality life prior to the neurological decline.

Marianne

Dear Addy
I am so sorry to read what you are going through. I don't understand why the IMO is not giving you some options. What is his/her reasoning about the Trilostane? Is it the hormones? I am going through the same with Apollo. Does he have SIBO? Do I start the Trilostane again? You mentioned some positive changes in Zoe,and from what I understand , you have not started any medication as of yet. And do you know what form of cushing Zoe has? Like was mentioned , can't remember was an ultrasound done? So many tests we have all had done on our fur balls can't keep tract.
Maybe the hind leg weakness is the muscle wasting? And maybe medication will help?
I will not get into the discussion as to what medication is best. Did Dr. Allen respond to you ? You are getting to much information overload.
I was told Apollo had pancreatitis scarring, didn't even know. He has had bouts of throwing up through out his life and was put on medications that probably did more harm then good.
Zoe is on medication for her colitis? So maybe the question is do you resolve this first and then go on medication or do you see if the medications can be taken with the cushing medication.
I am no a authority, but for me the low dosage of Trilostane made major improvements in Apollo's readings, the drinking, his skin and coat. The only reason I stopped was thought it related to his hind leg weakness. But Corky is going on a three time daily dosage. And now Dena has Simon on LYsodren was on Trilostane. So each case is different.
Being very analytical in nature, myself, first we know Zoe is overproducing cortisol? Then what is causing the overproduction? is it a pituitary or adrenal or medication based?
After Apollo started the TRilostane his readings improved, his drinking improved. But you and I still don't have an answer about the hind leg weakness.
You need to take some time for yourself and only when you feel more confident make a decision. For me , the more input I get the more anxious I get and can not make a decision.

If Zoe is doing better why do anything for now?
Also just a link on Trilostane
http://www.vin.com/proceedings/Proce...nt=1&O=Generic

Hugs Sonja and Apollo

Thanks Sonja:)

I need information because you all bring up good points and questions I did not ask. I need to sort through it all.

In fact just thought of one more thing:

Why would Dr. Oliver list as one of the treatment options "maintenance dose without loading" for Zoe.

Sheet states consider options one through six depending on symptoms.

Well, her symptoms are not full blown and overt. If a maintenance dose will not bring down such high cortisol, why is it one of my options? Wouldn't Dr. Oliver not list it? Wouldn't he know it won't do anything?

Is it then wrong to reason that perhaps based on her symptoms, it is a viable course of treatment? If her symptoms were full blown and her cortisol was over 40, I would not question this option but he is saying it is an option even though her cortisol is over 40.

WHY:confused::confused::confused::confused::confus ed:

Am I driving you crazy yet?

Hugs,
Addy

NO
Wish you would be getting a straight answer. But cushing in the drawer for the weekend and open it when you are ready.
Sonja and Apollo

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Originally Posted by addy

Why would Dr. Oliver list as one of the treatment options "maintenance dose without loading" for Zoe.

Sheet states consider options one through six depending on symptoms.

Well, her symptoms are not full blown and overt. If a maintenance dose will not bring down such high cortisol, why is it one of my options? Wouldn't Dr. Oliver not list it?
Addy

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Addy, I really wonder about this myself -- why maintenance Lysodren is recommended for a cortisol level that is so highly elevated. Maybe you can ask him this question directly.

Marianne

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Originally Posted by addy

Why would Dr. Oliver list as one of the treatment options "maintenance dose without loading" for Zoe.

Hugs,
Addy

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I don't know if Dr. Oliver receives feedback from any vets regarding whether this course of treatment works or does not. I know for Harley it did not. When his vet and I started the maintenance dosing protocol, Harley's cortisol post level was 26.2 ug/dl.

Harley's post cortisol levels kept rising even though we adjusted up his maintenance dose of Lysodren. Harley's last post cortisol level was 49 ug/dl and this was on 125 mg Lysodren being given 4X a week. The span of Harley's maintenance dosing was from January - April.

Love and hugs,
Lori

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Harley's post cortisol levels kept rising even though we adjusted up his maintenance dose of Lysodren. Harley's last post cortisol level was 49 ug/dl and this was on 125 mg Lysodren being given 4X a week. The span of Harley's maintenance dosing was from January - April.

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Lori, thank you. How high can their cortisol go?

Oh Lori,
I expected Zoe's CBC panel to be worse not better. I did not expect her intermediates to come down as far as they did. She was not on the correct dose of melatonin and lignans for that long, she has been so sick. I did not expect her cortisol to bump as high as it did. I had hoped perhaps it would have come down a tad.

The last two mornings she has done her "stretch" you know how they stretch out their back and legs? I have not seen her do that since summer yet she will not jump on the couch at all now. In some ways she seems better, some ways worse. Compared to one year ago, she is worse.

I will email Dr. Oliver Monday for some insight. I am compiling a list of questions for IMS. She is in a quandry I think too.

Hugs,Addy

Hi Addy,

In your list of questions, ask Dr. O if it is at all possible if elevations in the hormones we associate with Atypical can be caused by chronic stress from non-adrenal illnesses.

I would also want to know if Zoe's chronic colitis could cause the cortisol to continue rise yet she not have PDH/ADH.

In short, could her chronic condition be at the root of all these abnormalities on her cush tests?

Hugs,
Leslie and the girls - always

Sounds like you have a good plan of action.
It will all come together slowly.
Wish I could give you more insight.
Sonja and Apollo

Thank all of you for being so kind to give me your thoughts and opinions. I am so very grateful to all and I hope you always keep the discussion going.;) I love a good debate and we all learn so very much.

I have composed an email to Dr. Oliver and hope to get feed back from him to help clear up questions on some of the treatment options he has listed for me. Then I will tackle the IMS. Shouldn't she be offering up something? Why is it my decision? She's the one that went to medical school (I hope):p

Then I am going to go and enjoy my Zoe and Koko whom both had a visit to the groomers yesterday and look so very pretty. I swear Zoe's coat looks a little thicker on her spine but it might be the poof from the blow dryer.

We are to have a bad snow storm tomorrow. Hoping I can't go to work, wow, maybe the roads will be impassible.;) I could use a snow day:)

I love all of you, your knowledge amazes me, I am so proud that you are all so smart;););) I brag about all of you. I'm a big fan.

Love you,
Grateful Addy

Lol, I just typed out this long post thanking all of you for your input and telling you how much you all mean to me and I lost it!!!!!!!:eek:

Okay, I don't think I can retype it all especially cause hubby spoiled the moment by telling me the IMS had the test results Wednesday and was probably studying them and drinking martinis trying to get up enough nerve to call me and Friday at 4:00 she was still afraid to call:eek::eek:

LOL, come on, just because I have some questions? Am I really that bad?:p:p (He said yes, but it is understandable:rolleyes:)

Anyway, what I had said first time around is I love a healthy debate because I learn so much and don't ever stop debating!!! I can't thank you all enough for sharing your opinions and thoughts.

I admire and respect ALL OF YOU and I am always so proud of this forum.:):)

So keep it coming, the girl loves it:)

Love you,
Addy

Dear Addy
You are not losing it . You posted on someone else's thread. I will copy for you and tell where you did it. Don't feel bad I throw my W-2 in the garbage this morning.:eek: We are just stressed to the hilt.
Sonja and Apollo

Dear Addy
You posted on Rene-Endocrinologist San Diego I think?
Pasted this hope I was not out of line in doing so.


Thank all of you for being so kind to give me your thoughts and opinions. I am so very grateful to all and I hope you always keep the discussion going. I love a good debate and we all learn so very much.

I have composed an email to Dr. Oliver and hope to get feed back from him to help clear up questions on some of the treatment options he has listed for me. Then I will tackle the IMS. Shouldn't she be offering up something? Why is it my decision? She's the one that went to medical school (I hope)

Then I am going to go and enjoy my Zoe and Koko whom both had a visit to the groomers yesterday and look so very pretty. I swear Zoe's coat looks a little thicker on her spine but it might be the poof from the blow dryer.

We are to have a bad snow storm tomorrow. Hoping I can't go to work, wow, maybe the roads will be impassible. I could use a snow day

I love all of you, your knowledge amazes me, I am so proud that you are all so smart I brag about all of you. I'm a big fan.

Love you,
Grateful Addy
P.s. I always wished it would so much when I was growing up in Toronto, Ontario , Canada never happened.

Hi Addy!
We are from Toronto & now live near Palm Springs. Snow in Milwaukee, how romantic (lol)!! Maybe you want to come here where we are freezing our b..tts off in the 60's............
Carrol

Hi Carol,

20" inches and unbelievable drifts, I have not seen a storm like this in, I honestly can't remember. The wind howled like a freight train all night:eek: We don't know where to put the snow.

Glad to hear the Embark is working for you and your pups are doing well. I really want to switch Zoe to the Zeal. Did your babies like the Zeal?

I would love to be singing "California here I come":D:D:D
My parents lived in San Francisco for 10 years. I loved going to visit. Did you know Apollo's Sonja is originally from Canada? Toronto, I think.

Well, guess I have to go try to shovel some more before the temperature plummits and everything freezes. Zoe and Koko were real troopers last night and went out for bed time potty break with the wind and snow blowing like crazy in their face. I was going to carry them but they walked.:)

Hugs,
Addy

Hope you are doing well. Don't envy the snow.
Did you get you get a reply yet?
Hugs Sonja and Apollo

Hi Addy!
The dogs are doing really well on the Embark and they LOVE the Zeal even though I think it stinks to high heavens!!! They have absolutely no problems with switching "flavors".
I remember well the freezing cold and shovelling snow.:eek: Be careful attacking that snow, don't overdo it.
Have you heard from Dr O yet?
Love and WARM hugs,
Carrol

Hi Addy,

Boy, I wish I could give you an informed idea of what to do, but since Maddie was also a poster child for Cushings with most of the classic symptoms the loading would be harder for you to judge. I know the later loadings were harder to judge, but still there were just the slightest changes that we could tell. I can tell you this if Maddie had that high of a number I would do the load and try it for maybe half of the 7-10 day load and then test. I know it will cost for the test, but better safe than sorry as the saying goes. Of course with a number of 40 that IMO would take longer than a number of 26 to bring down, but then I would only be going into my 2nd year of treating if Maddie were still here--so I do not have a lot of experience.

I am soooo sorry there is no clear cut decision--let me hold your hand (darn there isn't a hand to show to hold :D). I wish I could figure out a way to make it clear cut or get the answers for you.

Guess I better think about work.....:eek::eek:

Hang in there you are doing a GREAT JOB!!!!!!!

Thanks Marie and I can feel you holding my hand:)

The metronidazole and colitis cloud the picture for me. Her IMS said if we did a load, she would perhaps do a 3-5 day load at a lower dose. If we did maintenance she would do a higher dose.

I worry that if she is on metronidazole long term how would I know if it was the lysodren causing side effects or the metronidazole? Her IMS keeps reassuring me that at the lower doses of metronidazole are safe but I feel I already saw side effects. :confused: I could be wrong.

If it was a perfect world and I thought I had time, I would switch Zoe to Tylan, change her food and reassess those things and then start lysodren maintenance. IMS has said no so far to that. I will hopefully get to ask her my questions next week.:) The blizzard set things back a bit.

Dr. Oliver responded that he felt a maintenance dose was certainly an option for Zoe and that I could try it for 3 months and if it did not work, then load her. WHen I asled her IMS had she ever loaded a dog with colitis and on metronidazole, she said no.:eek::eek::eek:

Thanks for listening, Marie, you are so sweet to listen.

Hugs,
Addy

Forgot to thank Carol and Sonja for checking in!!!!!! Will post to you both after work

Hi Addy,

Is Dr. Oliver the only one who knows this stuff?? There has to be someone somewhere that had this going on with their little one...:confused::confused:

Oh how I wish I had the correct decision to give you. I don't think a maintenance dose will work, but then I didn't think upping Maddie's maintenance dose the last time would have made a difference, but it did bring down her numbers from in the 8's to the 4's and that was for about 3 weeks; so....what could it hurt to try other than money for the pills....I was thinking out loud---haha!!! So not a good decision or maybe...:o

I hope you have dug out from the storm. If it makes you feel better it was 37 yesterday morning so it does get cold at the beach--haha!!!

Hi Addy!
It's still freezin' cold here in the desert but you should see all the tourists/snowbirds wearing shorts:eek: They are bound & determined that they will have a vacation come hell or high water and they're walking around like icicles doing it!
I wish I had answers for you my dear friend, but, since we are still at the melatonin/lignan stage, this is way out of my league. But I will keep following your thread as Zoe is very dear to us and we want to know how she is doing.
Love,
Carrol

Thanks Guys, you sure put a smile on my face.:D

Yup, snow birds think 40 is warm:D :D :D:D I remember one trip to Florida when my daughter was 10, the weather had been cool and the outdoor pool was maybe 72 and the temperature was in the high 60s. I could not get Chris out of the pool:rolleyes: She begged, just let me swim for 10 minutes.:p Everyone thought we were nuts:rolleyes::rolleyes::rolleyes: I told them, hey Lake Michigan is 55 degrees so the pool fees warm to her.:p:p

I want to try maintenance dose for 3 months. I just have to find out where Tylan and a food change fits into the treatment plan. What if this 3 month flare up is from her raw food? Maybe she cannot tolerate the bacteria any more. If I go down the lysodren road now I fear she will never get to change food.

What is more important try a little while longer to cure colitis or leave it go and treat the Cushings? The stress colitis from high cortisol, well, if Zoe has that, why does metronidazole help her? I would not think an antibiotic would mean anything. Maybe I am wrong.

Love you all and hope that California sun shines on all of you:) I won't even mention how cold it will be next week:eek::eek::eek:

Have my interrogation list for IMS. If anyone thinks of a question to add, let me know.

Love ya,
Addy

Wish I could wave a majic wond for you.
It seems like it is getting more complicated. No clear answers.:mad::eek: Will post on my thread.
Hugs Sonja and Apollo

Quote:

---

Metronidazole is able to modify cell-mediated immunity so as to normalize excessive immune reactions, especially in the large intestine. We do not know how metronidazole is able to do this.

---

Is someone able to translate this into layman's terms for me?


I also read it can affect ALP- could it be the metronidazole affected Zoe's ALP making it normal and it is not really?

I am taking the rest of today off for Super Bowl Sunday. I am not huge football fan, hubby is, but our team is playing in the game today and our whole city has gone Super Bowl crazy:rolleyes:

Might as well join them:D:D:D

Have a great Sunday!!!!

Love,
Addy

Hi Addy!
There are 2 types bacteria that can cause colitis but there are other causes of the inflammation as well. Did your vet mention a bacterial infection? Antibiotics can in there own right, cause diarrhea and a bout of colitis. Just putting in my two cents:rolleyes: because I really have no knowledge about the medications.
Wanted you to know that we are thinking of you and Zoe.
Love and hugs,
Carrol

Hi Addy,

Here is info on what is meant by cell-mediated immunity....but what that means in English hopefully Debbie or someone can say.

Hugs,
Leslie and the girls - always

http://www.blackwellpublishing.com/c...473/gandhi.pdf

Quote:

---

Cell-mediated immunity, an arm of the adaptive immune
system, is involved in the surveillance of not only the extracellular
but also the intracellular compartment for the
elimination of pathogens. Its mediators not only help B-cells
produce antibodies to neutralize extracellular pathogens
but also eliminate intracellular pathogens by killing cells
that harbor these pathogens. Targets of cellular immunity
include mycobacteria, fungi, and cells viewed as defective
or foreign, such as tumor cells and transplanted cells. Like
the humoral immune system, the cellular immune system
must be capable of (1) specific recognition of its targets, (2)
processing and presenting antigen to effector cells involved
in the immune response, (3) activating the most appropriate
components of the immune response to optimize pathogen
elimination, and (4) establishing memory of these pathogens
for more rapid elimination upon re-exposure.

---

Just praying for you.
You are doing a great job. Sometimes we need to be cheered on.
Sonja and Apollo

Hi Addy,

I couldn't find any better explanation of cell mediated immunity than this video:

http://www.youtube.com/watch?v=6i9rkTYCHf8

With respect to your other question about metronidazole and alkaline phosphatase, the answer is yes. I have seen Metronidazole listed as a good antioxidant for liver health so it can lower alkp. You also should remember that ALKP comes from the liver, bone and the gut (intestinal lining) so a dog with cushing's and chronic IBS/colitis can have high alkp from both conditions. It seems logical to me that effective treatment for both conditions can reduce alkp.

Thank you Gylnda and Leslie,

It seems that cell mediated immunity is a positive thing about metronidazole. I guess I am trying to find information to make me feel more positive about her being on it. I somehow lost control of her colitis and am so upset I cannot get it back.

I cannot get her off this drug. I did read that Tagament used concurrently with metronidazole will increase the chances of side effects from the metronidazole. I am not clear if that is all Tagament type drugs. If it is that would present a problem treating Zoe with Trilostane or Lysodren.

Thaks you again and have a great day.

Love ya,
Addy