Tipper - adrenal tumor/breathing issues

Hi Patti... I'm following your thread. Would Tipper be like this ?http://www.youtube.com/watch?v=CXDledRQ7y4 - Keesh had this episode a couple of times and I thought he was dying. Turns out it's a reverse sneeze.

Molly does the reverse sneeze thing sometimes too. Not often, but it's scary at first. Not sure if that is the same thing Tipper is doing or not.

Gosh, her pre being .9 is not good. :(

Before I switched to a medication that might sedate her more at night, it would be worth it to see if once the thyroid medication is fully working if that doesn't take care of the night time restlessness.

Grrrr, that the IMS didn't answer you about Grace.

hugs,
Sharlene and Molly Muffin

The reverse sneeze.. Terrifying. And my vet can't explain it. Do you girls think its Cushing related?

Also Patti, your vet sounds like a jerk. >:(

Hi Patti,

Let us know what you hear back from Dechra about the .9 pre. I'm very curious about that too, in light of their earlier comment about 1.45 being their lowest.

We have a member on facebook, whose dog has dropped to a .9 now from a 4.2 pre in November, after an increase from 7mg x2 to 9mg x2.

Thanks,
Sharlene and molly muffin

Hi Everyone:
Tipper has done this in the past. It is a sign of tracheal problems, which can be related to Cushing's. Tipper is real loud and making a honking noise when her trachea collapses, which means she cannot get air and she panics. The sneeze has not happened since she gets adequan shots, but if she has to sneeze she tries not to do it, so it must not feel good. I talked to Dechra and they want their vet to talk to mine, so that will happen next year I guess. They told me a base line is not good enough when Tipper goes low for a recheck. They are not as concerned this time as last time her pre was .7 and the post was 3 this time pre is .9 and post is 5. They said she has some wiggle room on the post if she would start to go low. Basically the only two options are with hold Vetoryl for a few days or lower her dose a tad. The with holding only bring then problem back when you resume unless you lower the dose, but it does prevent Addison's by letting the cortisol rise. They know it is hard to do this with Tipper as she respond quickly with strong clinical symptoms. We will have to wait and see what Dr. Bruyette says about it as I emailed him earlier and asked him about this. Hopefully we can all learn something that will help manage this. Tipper is napping, lots of snoring and congested sounds. Blessings
Patti

Hi Everyone:
I just posted this to Sharlene and wanted to tell everyone else. Dechra told me that 1.45 is what they want the dog at for a pre number. Normal untreated dogs are to be .5 to 5.5 on their pre number. I know the next part sounds a little hard to decipher but Tipper was .7 one time and .9 now in her pre number. Since she is still above the .5 of an untreated dog they are not as worried. If it goes below .5 of an untreated dog that is really cause for concern. So in other words as long as Tipper is above the untreated dog pre number threshold she is not in danger, but of course they would optimally want her above 1.45 as in the treated dog threshold. I am waiting on Dr. Bruyette to email me back he is usually fairly prompt and may be busy. I will let you all know when he answers me. Blessings
Patti

Hey Patti, I'm really confused by what they told you. On one hand, they're saying the pre should be above 1.45 for a dog on trilo, but then they're saying it's still OK for Tipper to be below 1.45. So I agree with you -- that seems totally contradictory and hard to figure out. There's a big difference between .5 and 1.45. In honesty, it's been very rare here that I've seen dogs that were listed at <.5, even actually diagnosed Addisonian dogs. So if that is Dechra's true cut-off, it seems as though there are very few trilo dogs with genuinely worrisome pre values.

I'm as confused as Marianne about this. Dechra's US website has a paper written by Dr. Ellen Behrend entitled Update on the Use of Trilostane and it clearly states:

Quote:

---

If the basal or ACTH-stimulated cortisol concentrations are below ideal at any time, trilostane administration should be discontinued temporarily and the dose decreased when resumed.

---

Ideal is 1- 5 ug/dl. That makes perfect sense if the post is also under 5 ug/dl but Tipper's is well outside the reference range. I don't believe I've ever seen a basal (pre) number so low with a discordant post stimulated cortisol. pre .7 and post 9 seems very unusual.

I don't feel comfortable at all with a pre number going below 1.0, as I think it would be way to easy for them to slip further between monitoring tests and end up in crisis very easily. Better safe than sorry I think.

People/vets seem to think, oh vetroyl/trilostane they can bounce back and they can, but only with a good vet and specialist team who recognizes what is happening and administers prednisone and electrolyte tests and fluids as needed. We can't count on all our vets being knowledgable in treating a trilostane induced addisons crisis. That scares me!
I think Dechra should stick to their 1.45 as an optimal range to not go lower than.

Sharlene and Molly muffin

Patti, I thank you for your updates. My Tobey is getting her pre and post number farther and farther apart as well, although not as dramatically as Tipper. I am anxiously awaiting Dr Bruyette's opinion.