Just cared Tessie out to the lawn and she held her own weight and peed. She is still really weak.:)
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Just cared Tessie out to the lawn and she held her own weight and peed. She is still really weak.:)
Please tell us what tests were done to confirm your dogs diagnosis for Cushings. With the way your dog reacted to the few trilostane treatments makes me wonder if your dog has cushings for sure. We have seen it happen here a number of times. Diagnosing Cushings can be difficult sometimes and some vets not familiar with treating cushings have even misinterpret test results.
I am glad your dog is doing better, do you have the test results from when you took your pup in to the vets? When you say all the results were out of wack, please post them, normally with an addisons crisis the Potassium and sodium do get out of the normal range, that is why it is so important to get your dog to the vets asap when that happens.
You will want to be sure you get copies of all the test results your dog has, it is a good idea to keep the copies in a file at home, you never know when you will need it and it is a great reference. I think most of us keep copies, as well sometimes it is hard to remember when the vet talks to us so we have the results.
Please continue to watch your dog, did the vet give you prednisone in case your dog got sick again?
Sharon
I am so relieved that you posted an update as I was horribly worried about Tessie! I am sure that you saved your dog's life going to the ER vet. Thank God you did. Good job.
Please continue to post as this group has seen alot of similar cases over the years and we can help but we need to know as much as possible about Tess, the doses etc.
First off as Mytil said earlier it appears that the dose you were on was significantly too high for your dog's size. Its too late to undo that but Addisons can result from too much vetoryl/trilostane. And if the dose is too high it can certainly happen in just two days. Sometimes it is permanent and sometimes it is not. The symptoms you described we have seen many times here and they are of overdose. Has your vet done any testing to see what the cortisol levels are? He/she can't say if it is addisons or whether its something else without testing.
I assume that in addition to the steroid shot that your vet has given you prednisone to give Tess to help restore her current LACK of cortisol? Also were the electrolytes checked? This is important. Typically after an episode like this it takes treatment with IVs for a day or so for the dog to get stable. Did your dog stay overnight at the ER vet's?
Please get copies of the testing done and we can help you decipher what it all means.
You mentioned another vet saying you should try lysodren/mitotane. Please do NOT give this drug yet. First off you have to be sure the dog is not addisonian. If your dog has Addisons and you give her lysodren the result could very well be fatal. Even if your dog still has cushings you must wait for all of the vetoryl to be out of the system and for the cortisol level to RISE before giving lysodren.
I'm not sure which vet is saying what but one of them is clearly not aware of how to treat cushings dogs. That is why we need to know more. Tell us all you can - we are here to help.
We all found this forum the same way and were scared. Cushings is often misdiagnosed and mistreated - but it isn't bad if you know about it. We'll help you with that part.
Again thanks for getting back to us. We were worried about you and Tess. Please - no more vetoryl or lysodren until we find out what Tess's cortisol level is ok? Hang in there!
Kim
I agree 100%. I wanted to do the 8 hour test for Chusings, but My Vet said that the two hour test was fine to do and normally this is enough. I said this to him today about the test. I will be having the 8 hour test. I don't want to start her on Lysodren ever. I too think the does was to high. Just by going to there web site I could tell from that chart. Thank you for posting that. I had been there before all of this. I did a lot of research before her first test. All signs point to chusings. They still point that way. Addison's would be easier to have for her. Only from what I have read. Can any one tell me from experience how is it with a dog with Addison"s? TY again you guys are great.Quote:
Originally Posted by BestBuddy
Hi,
I'm so glad you took Tessie to the ER and that she is more stable. The Vetoryl Treatment and Flowchart states the following:
Hypoadrenocorticism is the opposite of Cushings and is what the ER vets said happened to Tessie. Many of us have had vets we trusted and had been with who were not knowledgeable about Cushings disease nor followed protocol for treatment. I was one of those people and my dog suffered as he was not sufficiently tested and was incorrectly diagnosed w/Cushings and given Trilostane. It was a nightmare for him and me.Quote:
PRECAUTIONS:
Hypoadrenocorticism can develop at any dose of VETORYL Capsules. In some cases, it may take months for adrenal function to return and some dogs never regain adequate adrenal function.
What tests did your vet do to diganose cushings? Also it would be very helpful if you actually get copies of those lab results and post the results for us.
I will be interested in finding out the name of the other disease your vet is referring to. Tessie needs to recover from this. If it is Addison's disease you would not want to give her any Lysodren. If she is ill with some underlying disease the whole Cushings diagnosis could be skewed.
We're here to help so hope you will continue to post and give us updates on Tessie.
Louise
Hi I left my copies of the lab test with my Vet I will get them back and post them. Yes the Potassium and sodium were to high. The Potassium is down. Can't remember the one that is to high right now. I know I should remember more, but my other dog (Bunny) had a 7 min seizure and they are getting worse. She had this yesterday evening while I was caring for Tes. Then coming back from My Vet Bunny gets bit from my Lab (Lindie) in the neck. Not bad, but back to the Vet's for a shot and Med's. All of this with know sleep.Quote:
Originally Posted by ventilate
Yes I will start a file. Your right it might come in handy. TY Dottie
Forgot my Vet has 5 or dogs right now with Cushings. I have know problem switching vets. There are specialist in Orange Counting I can go to
Hi Dottie,
I hope that Tessie is still doing okay. Sending out healing thoughts and prayers for her. And also for little Bunny. It sounds like you have your hands full. They say when it rains it pours, and we need real rain here in So. Cal, but don't need to pour more problems for you.
I do have a huge concern about your vet prescribing such a small 20 lb pup such a large dose of trilostane and then saying that it could not cause addisons. Each dog reacts differently to any drug, but it seems in particular to trilostane. We've had large dogs on minscule amounts and small dogs on comparatively large amounts and vice versa. But the one thing that we have discovered, is start with the lowest possible dose and work your way up.
Before you attempt to start the medication again, be sure to have her thoroughly tested for cushings. You said that your vet currently has five cushings dogs. I truly hope that they are doing better than poor Tessie. Did he/she ever mention the University of Tenn Adrenal Panel. It will tell you if Tessie has Atypical Cushings, which is NOT treated with trilostane, but instead with melatonin and flax seed. I am not familiar with the dosing, etc., but there are several here that are having great success. And others that are thriving on the correct doses of trilostane or lysodren. It is so important to get the testing done. And you are so right to insist on additional testing.
I hope that you are able to get the ACTH test results and post them. There are several here that can help you interpet most of the lab results.
Continued prayers.
~ Mary Ann
Thank goodness you got Tess to the emergency hospital. When I read your post it was obvious that Tess was in an Addisonian crisis so I am not surprised that the ER vet was able to make this determination. At 20 pounds, Tess should not have been prescribed any more than 30mg once daily so she was getting twice the recommended dose. I must respectfully disagree with your vet and tell you that we have seen this time and time again. Dogs are extremely sensitive to Trilostane in the first few days so with Tess getting almost double the recommended dose, her cortisol and obviously the aldosterone dropped like a rock. Your vet is probably assuming that because Tess' eyes were darting back and forth, it isn't Addison's but peripheral vestibular syndrome and it was a mere coincidence. If the ER diagnosed Addison's then they checked the electrolytes and quite possibly they ran an ACTH stimulation test which would have shown that Tess' cortisol was not registering at all. It is extremely important that Tess continue receiving prednisone or florinef.
It sounds as though Tess had a severe crisis and I am very concerned that she is already home. Most dogs in her shape are extremely dehydrated and in order to correct the electrolye imbalance, the dog is on intravenous fluids for 24 to 48 hours and until the dog is eating and drinking on its own without vomiting. A dog also getting injections of florinef as there is inadequate reserve of cortisol. Once off of the IV and the dog is eating, the injections of florinef can be switched to an oral medication and this must be continued until the adrenal glands can start working on their own. How long was Tess on an IV and was she sent home with Prednisone or Florinef?
I have two cushdogs, both of which treated with Trilostane and while I am not a medical professional, I know the drug like the back of my hand. I was so distraught when my dogs were diagnosed, I became obsessed with learning everything I could about the drug. UC Davis did their own clinical trials and found that there is a great disparity in the dosing by weight recommended by the manufacture of Vetoryl aka Trilostane. They had many dogs that went into Addison crises at these recommended dosing and as a result, their own dosing protocol is much more conservative. Based on their protocol, Tess would have been started on 20mg once daily. 60mg is huge in comparison and I really think that every horrible thing you saw Tess going through was a direct result of her being overdosed.
My dogs treated with the same vet for 10 years and I trusted him implicitly. Unfortunately, I didn't know back then that a good number of gp vets don't have much experience with cushing's and they are a cushdog's worst nightmare. I found out that our bad experience wasn't so rare as many members had alread walked in my shoes. The fact that your vet doesn't realize that the dose he prescribed is too much and that dogs are extremely sensitive to the drug in the first few days is an indication that he isn't that experienced with the drug and perhaps not the disease. GP vets can be the absolute best vet in the whole world when it involves nonadrenal disease; however, when it comes to cushing's or any other endocrine disorder, many haven't had the extensive training, education and vast experience that an internal medicine specialist has. It wasn't until I found a wonderful internal medicine specialist that my dog was correctly diagnosed and stabilized. To this day, I resent and am so terribly disappointed in my old gp vet for letting my Lulu suffer for so long. We can place blind faith in our vets to do what is right by our dog for a lot of things but cushing's isn't one of them. Addison's is a very, very serious condition and I highly recommend that you consider consulting with an IMS in your area.
It sounds like you are in Southern California so I have no problem recommending excellent specialists in Los Angeles and Orange County. If you are in Orange County, I highly recommend that you consider VCA All Care Referral Center in Fountain Valley. I live in Rancho Cucamonga and don't mind the hour to hour and half drive there. My dogs treat with the Director of Internal Medicine, Dr. Michael Moore. If you are closer to L.A., I highly recommend Dr. David Bruyette, Medical Director at VCA West Los Angeles Animal Hospital. Both of these specialists are excellent and I don't know if you have noticed but we have a video of Dr. Bruyette discussing Trilostane in our Resources Forum.
VCA All Care Referral
http://www.acarc.com/
VCA West Los Angeles
http://www.vcawla.com/
I too will be looking forward to hearing more about the tests that were done to diagnose Tess as well as tests done by the ER vet to diagnose Addison's.
I am so sorry that you and Tess have been through such a horrific ordeal but I am glad that you found us. The collective experience and knowledge base here is amazing and you will find no better handholders anywhere.
I will be thinking positive thoughts for Tess. Please keep us posted.
Glynda
Hi Dottie,
I cannot tell you how relieved I am that you got Tessie to the ER. You done good, mom! :):cool::):cool: I really was worried about coming on today and finding bad news on your thread. :(
You have been through a very rough few days here lately and I am worried about you, too. I have four babies and it seems something is always going on with at least one of them so I can understand the strain you are feeling right now. You must take care of yourself, too, Dottie. Sleep whenever you get a chance, do something to help you relax a bit from time to time, and know you are not alone...we are here with you all the way.
You mentioned you didn't want to use Lyso for Tess "ever" and I want you to understand something. What you have just been through on Trilo is exactly what people fear with Lyso. They are often told that Trilo is much safer than Lyso with no "side effects" like Lyso can produce. You have just experienced those exact same "side effects" with Trilo...the "safer" drug for Cushing's. The "side effects" of either of these drugs is usually the result of misdiagnosis, incorrect dosing and monitoring, and lack of educating the parents on the part of the vet and/or lack of diligence on the parents part. You carried your part quite well with the limited information and tools you were given by your vet. IMHO your vet failed miserably on his part. :( My point here is that you have nothing to fear from the Lyso now as you have already been through an Addisonian crisis produced by the Trilo. You now know the worst. The danger isn't in the drugs themselves - the dangers lie with a vet that isn't as cush savvy as they need to be.
That doesn't mean you have to give up on your vet, tho. If they are willing to listen to you and work with you as a team, then this is a BIG plus in their favor. This is where your cushing's education come in. Your vet has the years of experience and training in general animal care to bring to the table; as you learn more about Cushing's, you will bring that specific knowledge to the table along with all of our experience and first-hand knowledge. In this manner, together you will make a formidable team working for Tess. :cool:
I am so proud of you for insisting on further testing! :D This decision alone may prove to be the very thing that saves Tess' life now and gives her many more years of quality days ahead with you. Way to go, mom! :cool::cool::cool: But don't rush the testing. She is in physiological stress right now and that will skew any Cushing's testing, plus those for Addison's. So let her recover from this crisis, if she does, then look into further testing. I HIGHLY recommend that she have the UTK panel done first, then an ultrasound done on a high resolution machine. These two tests will give you more information and a more solid idea of whether you are dealing with Cushing's or not, and which kind if she is cushinoid.
We continue to send healing thought and prayers your way,
Hugs,
Leslie and the girls
Ok I am not sure how to get this info to you all to help me. The lab results aren't any that I understand. So Here goes.
The first one is from the Emergence doctor.
JUNE 6 2009 4:34 A.M
ALB 2.8 2.5-4.4 G/DL
ALP>2400% 20-150 U/L
ALT 377% 10-118 U/L
AMY 907 200-1200 U/L
TBIL 0.3 0.1-0.6 MG/DL
BUN 50% 7-25 MG/DL
CA++ 11.9% 8.6-11.8 MG/DL
PHOS 6.8% 2.9-6.6
CRE 4.2% 0.3-1.4 MG/DL
GLU 85 60-110 MG/DL
NA+ 149 138-160 MMOI/L
K+ 7.2% 3.7-5.8 MMOI/L
TP 6.0 5.4-8.2 G/DL
GLOB 3.2 2.3-5.2 G/DL
QC OK
HEM 0, LIP2+, ICT 0
NA:K=20.7 This is hand written in a separate box by the doctor
PCV/TS- Also hand written in same box
44%/4 g/dl also hand written in same box
Colloids/unit 0.20
Notes from emergence doctor.
S:Lethargic. Has vomited bile approximately eight times in the past 48 hours. Tessie was still walking around 4 hours ago but then became very lethargic. The owner also noticed that Tessie's eyes were rolling around in her head. Trilcstane 60 mg PO SID was started Friday. Tessie received the last does of Medication Saturday at 7 am.
O: EENT: Horizontal nystagmus with fast phase to the right, prolonged CRT with tacky gums, severe dental calculus: integ: full coat, small SQ masses, normal skin turgor. PLNS: WNL; M/S:
recumbent/nonambulatory, cool extremities; N/S lethargic; cardio: NSR, normal pulses, resp: increased bronchovesicular sounds; abdornen: slightly tense; U/G: F/S
A:Vomiting, lethargy- R/O adverse drug reaction to Trilostane +/- iatrogenic hypoadrenocorticism (most likely) old dog vestbular disease, HGE, pancreatitis, ect.
Horizontal nystagmus-R/O secondary to electrolyte imbalances, neurologic signs seconary to cushings, old dog vestibular disease ect.
Poor perfusion-R/O hypovolemic shock
P: Adised owner of guarded prognosis. Placed IVC. Unable to obtain i-Stat to assess electrolytes on presentation because Tessie's blood was too thick and clotted in the cartridge. Administered 250 ml bolus normosol-R IV. Unable to obtain a blood pressure, and extremities were still cool. Tessie began to have frank blood in her stool in addition to dark brown diarrhea. Drew blood again following intial bolus: VetScan- ALP>2400 U/L, ALT 377 U/L, BUN 50 mg/dl, CA++ 11.9 mg/dl, PHOS 6.8 mg/dl, CRE 4.2 mg/dl, K+ 7.2 minol/L, PCV/TS- 44%/4g/dl. R/O Addisonian crisis. Repeated fluid boius and administered 0.15 mg/kg dex sp IV. Administered 75 ml hetastarch IV for oncotic suuport. Transfer to RDVM.
Breed Yorkshire Terrier/ Shitzu
Age 12
Weight 23.20 LBS
My Doctor:
JUNE 1 2007 This is when my doctor ran the Cushings test.
ACTH STIMULATION RESULTS
PRE-ACTH CORTISOL 5.1 UG/DL
POST-ACTH CORTISOL 41.5 UG/DL
CANINE:
2-6 PRE-ACTH (resting) cortisol
6-18 Post- ACTH cortisol
18-22 Equivocal post-ACTH cortisol
>22 Post-ACTH cortisol consistent with hyperadrenocorticism
<2 Post-ACTH cortisol consistent with hypoadrenc corticism
1-5 desired pre- and post-ACTH cortisol on lysodren therapy
Notes from lab:
ACTH response test is only clearly positive (>22) in 30% of dogs with hyperadrenocorticisn (HAC); equivocally positive in another 30% of dogs with HAC, and normal in 40% of dogs with HAC.
If the ACTH response test is normal and HAC is still suspected, proceed with a low-dose dexamethasone suppression test.
Dogs with iatrogenic Cushings disease will have flatline response test results in the low end or below the normal reference range.
I don't have the yesterdays ( 7/6/09) or today (7/7/09) blood work from my doctor. Will get them tomorrow 7/08/09.
Dottie