Medication not working on symptoms anymore but cortisol levels ok?

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Originally Posted by DPow

I just got off the phone with my vet. She told me Rosebud's cortisol numbers before treatment were pre: 3.6 4 hr: 3.0 8 hr: 2.4. Her most recent test (after being on meds about 6 months) was pre 1.1 and post 1.9. Does this sound right? I asked about DI and she said she wouldn't test or treat until we ruled out kidney or liver problems. Her annual checkup/vaccinations are due early May and they can do the liver/kidney testing then, although I'll probably schedule the appointment sooner.

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Thanks for this added information. It appears as though Rosebud was diagnosed with Cushing’s last summer after having had a LDDS test performed (Low Dose Dexamethasone Suppression Test). The test results you’ve provided are consistent with Cushing’s, but as we’ve noted before, the test can return a “false positive” if some other illness is stressing the body. I do want to mention, however, that if Cushing’s is indeed an accurate diagnosis for Rosebud, those results could be associated with either a pituitary or adrenal tumor.

I do agree that it would not be appropriate to increase Rosebud’s dose of Vetoryl given her monitoring ACTH results. You would not want her cortisol to drop any lower than they were at the time of testing.

Therefore, I cannot argue at all with proceeding with some further investigation into her kidney/liver status. However, I would not feel comfortable with waiting until May since the first step is likely a basic blood and urine panel. That can be done pretty quickly and easily. So under the circumstances, I’d push to have that done sooner rather than later. Please do keep us in the loop!

Marianne

Update on Rosebud. She had bloodwork done, and everything was normal. The vet said next steps would be abdominal ultrasound and surgery if tumors were found. I'm not going to put her through surgery. So I guess I have to just deal with the consequences...constant urinating in the house, waking me up at all hours to drink and go out. Thanks for all of your help...I guess in our case there's no solution.

Did you have the chance to discuss Diabetes Insipidus with your vet? Since Rosebud may suffer from a pituitary tumor (which can cause DI as well as Cushing’s), I still think it would be worth considering it before giving up. Again, you could simply try giving the associated medication as a trial. If it doesn’t help, you’ve not lost anything. But if it does help, that would be great!

Marianne

My vet won't test for DI. She said we'd have to do an ultrasound and any necessary surgery before pursuing any testing/treatment for DI. I was thinking of getting a second opinion at another vet, but probably won't happen until all the COVID-19 restrictions are lifted. :(

Yes indeed, the Corona restrictions are having a massive effect. I do think I’d consider a second opinion too, though, when you have the chance. Under your circumstances and after the testing that’s been done thus far, I’m not sure why your vet is so reluctant to try the medication. But there may be puzzle pieces that I’m missing.

Please do keep us updated while we all remain stuck in this Corona purgatory :-(((((.

Marianne

uuhhhhh yeah, a new vet is in order. ;) This one doesn't seem to understand that she works for you not the other way around.

I went to a new vet! I was so appreciative given the circumstances. They agreed that she definitely may have DI, and thought some of her blood and urine test results didn't make sense for Cushing's. They're going to get me the meds and we'll see if it works. She didn't understand why the other vet wouldn't at least try the DI medication, since it doesn't hurt them. I think my old vet just wanted more $ out of me! Anyway, I'm so thankful for the advice you all gave me here, I would never even have known to get a second opinion and ask about DI. I'll let you know if the new meds work!

I'm so glad you got a second opinion from another vet and that this vet is willing to try the DI medication, please keep us updated! You're doing a wonderful job!!

Lori

I agree — I’m so glad you were able to get this consultation! As Lori says, please let us know how things develop ;-).

Marianne

Oh I am so proud of you for taking the steps necessary to get your sweet girl the care she deserves. That can be a difficult thing to do and I know Rosebud is proud as well.

Please keep us updated on how she is doing!
Hugs,
Leslie