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Lulu has regained some of her spunk. Dr. Booth thinks she just had a fall which caused her some stress. He ran some labs. The electrolytes are okay. Her AlkP is high, but that is typical with Cushings. But the number was pretty high. I had a very high value when I had Ulcerative Colitits years ago, but it has been normal since.
http://www.k9cushings.com/forum/albu...pictureid=4519
Lulu is glad to be home and her appetite has improved.
BIG SIGH OF RELIEF ICON:D:D:D:D:D
Sometimes we see that number in the thousands. Glad to hear Lulu has improved.
Very glad to hear that Lulu has regained some of her spunk. I wonder if the higher number on the AKLP might have something to do with the cortisol dropping low.
Sharlene and molly muffin
Sharlene,
I am going to see if I can't get all of Lulu's lab results from the past years. Her liver enzymes have been up before, and I believe the first time was back in 2006 or 2007. This would have been after her ACL surgeries as I believe the Romeo Vet Clinic did the tests. We started using them more after the surgery because their lab costs were surprisingly cheaper than our closer Port Huron vet. Her liver enzyme values then came down. She may have had the start of Cushing's Disease then!
Since our Port Huron vet retired we have pretty much moved her care to them.
Lulu has been fine today. She walked a bit, but was reluctant to even meet her neighbor dog Bella, a cute Jack Russell Terrier. They became great friends over two years ago, when Bella was still under a year old. Those two would play tug-a-war. If I find the short videos I will post them. I do have a video of Lulu opening one of her Christmas gifts. I will post the link. I have uploaded the files so I will just have to create a webpage to point to them.
Hi,
I was poking around DVM 360 and I came across an article which discussed low cortsiol concentrations with Trilostane. I thought I would post the link for you. I have always thought this to be a trustworthy source but if it is not I am hoping one of our administrators will tell us.
http://veterinarymedicine.dvm360.com...date=&pageID=3
Perhaps Lulu will only need half of her 100mgs which would mean only 50mgs.Quote:
If the cortisol concentration is below 0.7 μg/dl, withhold trilostane until signs of hyperadrenocorticism recur, and closely monitor the patient for signs of hypocortisolemia. If the post-ACTH stimulation cortisol concentration is 0.7 to 1.5 μg/dl, suspend therapy for 48 hours, and then restart it with a 50% dose reduction.
Interesting study, Addy. Thanks. I am at the point now to wait and retest in the next couple of weeks or so. But to watch Lulu. Too bad it takes time to get the trilostane if it's mailed, since I try to keep the costs down too.
Just wanted to pop in with my two cents worth. Addy, I also rely on that publication -- DVM360 -- for lots of excellent resource info. And Dr. Audrey Cook is a distinguished veterinary endocrinologist who is a faculty member at Texas A & M and also a consultant to Dechra. She is the researcher who has been studying possible use of baseline cortisol as a monitoring tool for trilostane treatment.
Having said all that, my only reservation about this article is that it was printed in 2008. There has been a lot of water under the bridge, so to speak, during the intervening years re: trilostane dosing and monitoring. So even though the source of this info is highly credible, I'd want to see whether Dr. Cook has updated her recommendations in recent years. At the time of that article, I think the general initial dosing recommendations were higher and also there was less awareness of trilostane's potential for more lasting impact on adrenal function.
It may be the case that Dr. Cook is still making this same recommendation. To our frustration, it is definitely the case that different researchers and specialists have different preferences regarding trilostane treatment. But in terms of this specific recommendation, I'd feel more comfortable if I saw it in a more current publication.
Marianne
Thanks Marianne.
I gave Dr. Booth the URL of this forum, too. I plan to give a Dr. Geiger this address, he is a country vet that we take our cats to. He was very interested in Lulu's Cushing. He said he is treating about 4 or 5 dogs now. His clients don't have a lot of money, so until recently I don't think people treated the disease in his area.
Thanks Marianne, I did think about the date but then it also seemed to correspond to how Dr. Peterson handled Cindy's Penny when she went too low but perhaps my memory is faulty on that;)
I'm glad to know the site is valid. I have used it quite a bit over the years.
Addy, you may very well be right in your memory about Dr. Peterson. You know, since there do seem to be differing recommendations, it would be great if we could find the time to hunt up and consolidate everybody's advice in one spot. That wouldn't necessarily give us the "definitive" answer, but it would be interesting to see how the opinions overlap (or not). Maybe a good project for us to tackle at some point!