Cairo, 8 year old staffordshire bull terrier just diagnosed

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Originally Posted by Alison

Quick update. We thought he was getting baseline cortisol but she decided to do a stim test to see how his adrenals were working, so he's had first bloods and synacthen injection and we've to go back for 1.30 for second blood draw.

She says she's not putting him back on vetoryl because 60mg is a tiny dose for a dog of his size and he's not coping with it. I asked her about a smaller dose twice a day but she said no.

Obviously his blood results are going to have an impact on where we go next but we can't leave him with untreated cushings so if the symptoms do come back, we have to see another vet, one that will work with us.

She did say about a referral to Glasgow vet school - that's an option.

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I am so sorry to tell you that for an ACTH stim test to have any accuracy, a dog must be prednisone-free for at least 24 hours prior to the testing. Otherwise, the stim result is skewed by the supplemental steroid and is not an accurate reflection of the natural cortisol production. The other alternative is to substitute dexamethasone for the pred during the day/s prior to testing because dexamethasone does not affect the result in the same way.

Was Cairo prednisone-free for 24 hours? If not, I'm afraid your money is wasted. I think a consultation with the vet school is a very good idea.

Marianne

I thought that the ACTH stim test wasn't worth it on the pred - he had a dose this morning at 10am and we said to her was it right to do the stim test with him on the pred and she said that pred had no effect on the stim test.

She's just phoned and his post stim results are 175 (6.3). She says that it's a bit higher than she would have liked.

My mum asked again if the pred would not have affected the test and was told not at all, she wanted to make sure that his adrenals were still working and they were.

I know from an Addison's point of view, we don't get stim tests whilst taking hydrocortisone or pred - it either has to be replaced with dex or stopped (which is risky if you're diagnosed Addison's)

Oh, and just to double check - he's been on 10mg prednisolone. We've to give him 5mg tomorrow, 5mg Sunday, miss Monday and then 5mg Tuesday and then stop it - does that sound right?

Alison have pm,d you my boy went to Glasgow vet school and we saw some wonderful people there

I believe your vet is mistaken.

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ACTH Stimulation Test: Prednisolone, prednisone and hydrocortisone will cross-react in the cortisol assay and give falsely elevated results. Such therapies should be avoided in the 24 to 36 hours prior to the test. Dexamethasone does not have this effect so it can safely be used prior to confirmation of diagnosis without causing assay interference.

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http://thehormonelab.com/handbook/ad...disons-disease

From an article by Dr. Peterson:

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It is possible, however, that you are measuring some of the prednisone in the assay for cortisol, especially if you are giving the prednisone within 24 hours of the ACTH stimulation test. Prednisone and prednisolone will both cross-react in the cortisol assay to falsely increase the measured serum cortisol values.

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I'm really afraid you need to consult with somebody who knows what they are doing, both in terms of Cairo's prednisone taper and also his long-term treatment path.

Marianne

Other than Cairo's adrenal glands are stimulating I'm not so sure if those pre and post numbers are quite accurate with prednisone still in his system when the test was performed. I'm sure there's something that you can print out and show it to her why this test may not be accurate and request for a redo. It is so hard and frustrating, isn't it?
I guess another question for Dr. P. Has he replied to your email yet?:mad:

How far is Glasgow vet school from where you live? Can you go there and get a consultation? I'm really not sure about your vet.

Thank you Marianne.;)

Your mum was right to question the impact of prednisone on an acth stimulation test. Your vet's comment that it has no effect on the test is simply not true. It can either blunt the response or depending on the dose of prednisone, it can falsely increase cortisol on an ACTH stimulation. It is very unfortunate that the stim test you just paid for cannot be used to assess the true cortisol levels. This type of thing upsets me greatly as it's a struggle for most of us to find the money to pay for diagnostics and treatment. Many sacrifice and forego their own needs to give their dogs a better quality of life. We don't need uneducated vets wasting what little resources we have and more importantly, placing our dogs at undue risk while wasting our money. Bottom line is that the dose of prednisone you gave Cairo less than 24 hours before the stim test, could very well have artificially elevated cortisol levels, meaning the post stimulated cortisol would most likely have been lower had you waited 24 hours after the last dose of prednisone. If a vet were to increase the dose based on artificially elevated cortisol, it could throw a dog into a life threatening crisis.

I highly recommend that you share some educational material with your vet on this subject. I have provided a link below to Dr. Mark Peterson's blog entitled, Trilostane, Prednisone, and ACTH Stimulation Testing in Dogs with Cushing's Disease. You can either provide the link to your vet or print out the blog. Either way, I sincerely think she needs some continuing education so as to not do this to future clients and their dogs. If I were you, I would also ask her to waive any charge for the acth stimulation test.

http://endocrinevet.blogspot.com/201...-and-acth.html

Glynda

P.S. I see that Marianne posted before I had a chance to finish my own....that's what happens when work gets in the way. :) In any case, my post validates Marianne's and you now have two links to information for your vet.

If Cairo wasn't still under their "care" at the moment, I'd be kicking up hell. There must've been about 5 or 6 stim tests carried out while he was fasted - he got his vetoryl on the day of the test but we were told he wasn't to get food and then I found out that it was really important that he did have food with the vetoryl - so these tests were all a waste of money - and at £115 per test, I could weep. I don't work any more due to my own ill health and he's not insured so it's not as if I have money flooding in.

Between me and my mum, we asked her three times if the pred would not have an impact on the test and she said not at all - she wanted to make sure that his adrenals were functioning properly after the vetoryl over dosage.

The vet school is probably about 100 miles from us give or take a bit. It's a long journey for Cairo - he's never gone that far before in the car, but if I have to take him there I will. I need to go and start speaking to the other couple of vets here though to see how experienced they are. If they are any good and I can get him moved, then I kick up hell with the vet.

I don't know whether to cry or scream or both.

Ask the vet for a refund from those tests. See what kind of reaction you get from her! Get your money and get rid of her before she kills Cairo, sorry to be so blunt, but this is horrible, she is dangerous. Blessings
Patti

Oh my lord, I feel your pain. That was a lot of wasted money on you and also a lot of unnecessary torture on Cairo. Why don't you just do the opposite to whatever she says from now on if you decide to stay with this vet.:eek: I think Cairo will be safer that way.:rolleyes:
What you need to do is to take a few deep breaths and channel all that bottled up energy into finding a better Cushings experienced vet for Cairo as he needs one ASAP and give your piece of mind to this vet at a later time.
If you end up going to Glasgow, how about breaking up the ride and take a few breaks on the way like every 30 minutes or so. Hopefully that will help him.

I have to say one thing tho. I can see her point of doing the test to see whether Diamond's adrenals were stimulating at all as my own IMS said the same thing and we ran an ACTH test just for that purpose so we didn't skip the pred on the day of the test as it was necessary for her to function but to say that prednisone won't affect the result is so wrong and would make me doubt everything else she says about anything.