Alivia was recently diagnosed with Cushing's - Alivia has passed

Mary Beth, I can answer a couple of your questions. A maintenance dose is the same as a loading dose except the frequency you give it. 200 mg for loading would be give daily, split into an AM & PM dose. Maintenance dosing splits the 200 mg into several doses over a week's time. For instance, 100 mg twice per week, or 50, 100, 50 given 3 days per week.

Neither of Glynda's pups have adrenal tumors, they both are PDH. I have zero experience with adrenal tumors except the information I have read on the forum, along with my own personal research. Everything I've seen concurs with what Glynda posted to you earlier that adrenal tumors can be very resistant to lysodren & require a much higher loading dose. I can sympathize with the appetite issue as my Harley was an extremely picky eater, & loading him was an absolute nightmare because of it. I had to depend on both appetite & water consumption to make my best educated guess about loading. When it comes to trilo raising the associated hormones, it usually does, but even the experts are not sure how significant this is. I will tell you this that all dogs who have an elevated cortisol will most have definitely have one or more of the associated hormones elevated as cortisol is used as one of the building blocks to make these other hormones.

For what it's worth, if I were in your position, I think I would be asking the vet about adrenal tumors being resistant to lyso, requiring higher than the normal loading dose, & how much of a help would doing only maintenance dosing be.

I'm not sure if this has helped, but keep us posted.

Debbie

Addy, Terri and Debbie....I am thinking a bottle of wine is not going to be enough. :confused:

I think not. Break out the Scotch!!!!!

The problem is each dog is different and then if the dog has other health issues going on it really is a pickle.

Corky has elevated hormones and Terri is using Triolstane with no ill effects caused by higher intermediates.

I am going to take you back to the vet you so trust and love that helped Ali. His contact said use Trilostane. Then Dr. Oliver confused you with his maintenance dose. I have come to the conclusion that the University Tenn full adrenal panel should only be used when a dog has symptoms but standard tests are normal or if a dog continues to show symptoms even though cortisol is controlled.

What was your first gut reaction? You have another week. You don't have to start tonight. Go back and reread about adrenal tumors and Trilostane. Ask Terri questions. She has done alot of research.

Then decide and remember, you can always do a wash out and try the other drug.

Pour me a scotch!!!!!! no ice!!!!!

Hugs and Love,
Addy

It seems like the more I read the more I go in circles.

Addy, not sure I understand your point...Alivia did have many symptoms and her LDDS test was completely normal, but the ultrasound wasn't. That is why her IMS did the U of Tenn full panel. On that, everything is elevated, except Estradiol.

Initially, I thought I'd go with Alivia's regular vet's reccomendation of Trilostane. Which was also what his friend said. Then we both read more and learned it could elevate the other levels and there is the possiblity that those elevated levels can cause damage. I'm afraid of masking symptoms, while damage may continue. I also read that with Trilostane there is a risk of DEATH. That really scared me, since Ali tends to have unusual reactions to things.

Wish I liked scotch.....

Quote:

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Alivia did have many symptoms and her LDDS test was completely normal, but the ultrasound wasn't. That is why her IMS did the U of Tenn full panel. On that, everything is elevated, except Estradiol.

---

Sorry, I forgot that part. So then it makes sense to me now. So many of the vets seem to be doing the UTK panel for different reasons, mine included:(

I know exactly what you mean about the more you read, the more worried and stressed you feel. I hope I did not confuse you more:o
All medication has risks. I look at my Advair asthma drug that I must take . It can cause asthma related death and all kinds of bad things according to the label. I take the lowest dose and only when I really need it for the shortest time possible, like when I get sick with the flu or a cold or bronchitis.

Trilostane and Lysorden are both serious drugs, we can't escape that fact. None of us have any way of knowing in advance how our dogs will react to either drug. All we can do is hedge our bets, so to speak.

When I spoke with Dr. Oliver about Zoe (who does not have an adreanl tumor) he thought a maintenance dose could be tried for 3 months and then she could try loading if the maintenance dose did not work. Her cortisol is high. Dr. Oliver is telling you a maintenance dose could be tried with Alivia. I don't know what the down side is to trying that for Zoe or Alivia. I do know that quie a few people including my internist tell me miantnenace does not work. Yet Dr. Oliver sees it work in some cases so it is like a Merry Go Round that you can't get off:eek::eek:

For my Zoe, I cannot try trilostane because my IMS does not use it.
I have no other IMS choices in this city and I need my internist for Zoe's colitis. If I had an internist for Zoe that used Trilostane, I would start Zoe on a low dose and if that did not work, I would switch to Lysodren. I am not telling you to use Trilostane, I am just telling you the conclusions I reached for my dog because I have been in the exact same boat you are.:confused::confused::confused: But Zoe has different isssues than Ali to some degree.

I am just babbling now and I hope I don't confuse you even further:eek::eek: I'm just babbling all the thoughts in my head.



I don't like scotch either:p:p

Love,
Addy

Hi Mary Beth,

I have some thoughts but can you remind me what cushing's symptoms you are seeing at the moment? I may not be able to give my thoughts until later today but I will get back here.

Glynda

Thanks, Addy. I think I am back to square one and leaning towards the Trilostane, which was Alivia's regular vet's first opinion...

Glynda,

Alivia has most of the typical cushing's symptoms. Her fur grows EXTREMELY slow - almost not at all. She has the Cushing's pot belly and redistribution of body mass. The skin on her belly seems very thin and her belly looks bloated. She sometimes pants. She seems listless and very clingy. She has always liked being near me, but it is now seems excessive - she will follow me everywhere, even from my bed to the bathroom IN my bedroom. She stopped sleeping under blankets like she always did; and now lays on the hardwood floor or in strange places. She has hind leg weakness, too, and sometimes has a hard time going up steps. She has increased thirst and appetite...usually. But, that can fluctuate a lot! Sometimes her appetite is ravenous, sometimes normal and sometimes none. That is what scares me the most about loading Lysodren. When Ali was treated with high doses of Prenisone years ago for the IMHA, she did not do well on it. So, if she were accidentally overloaded with Lysodren, I think it would be catastrophic for her.

In my lay opinion, I think Alivia's tumor causes her hormone levels to fluctuate. If she could be tested every day, my guess is they would be high sometimes, low sometimes and normal sometimes. Looking back, she has had symptoms off and on for a long time. But, she will go long periods with either very mild or no symptoms. Her dental surgery on 2/14 seemed to trigger symptoms and this time they do not seem to be subsiding.

And, as an aside. Alivia and my healthy 11 year old JRT, Maxwell, who normally get along just fine, now seem to grumble and growl at each other a lot. Like maybe Max senses her weakness and Ali is trying to assert herself more to hide it?

Enough? Thanks for your help.

Another question....any down side to starting Ali on a little Milk Thistle?

Bad news. Alivia is in the hospital. She wasn't herself all weekend and was very lethargic yesterday. During the night she was panting heavily and shaking and in obvious discomfort. I gave her some pain medication left over from her recent dental surgery and she slept for a little while. When she got up, she was having a hard time walking and you could tell she was in extreme pain. It was awful. She peed on the floor right in front of me because she knew she couldn't walk to go out. She has NEVER done that.

I picked her up to carry her to the car and she yelped in pain. The slightest touch made her yelp. Took her to the emergency hospital. Her temp was 104.2, they gave her a morphine type pain medication so that they could take x-rays of her chest and abdomen. Nothing appeared majorly abnormal in the x-rays. She has an enlarged liver and some degenerative arthritis in her spine and rear legs, but she is 13+, and she said unless there was a pinched nerve - nothing to explain the pain, which the vet characterized as "severe, at least a 7 on a 1 to 10 scale". They couldn't visualize the adrenal gland but said there was no evidence that it had spread. She saw no tumors anywhere and said everything was where it was expected to be. I asked if it could be pancreatitis and she said possibly, but that she doesn't have some of the classic symptoms (vomiting). They kept her so that they could keep the pain down and were going to do blood testing. By luck, her IMS was coming in to do an ultrasound on another dog, so they are going to have her review everything and probably do another ultrasound. Then they will call me. I am hoping that I can bring her home later today, but I am really scared. Please keep her in your thoughts.

Many prayers are being said and sent your way, I am so sorry that Aivia is having these issues.

My boy, Harley, had pancreatitis but never showed the classic symptoms. The test which is the best to diagnose pancreatitis is a Spec PL test. Here is a link to information about this test: http://www.idexx.com/view/xhtml/en_u...jsf?SSOTOKEN=0

Keeping you both in my thoughts and prayers.

Love and many hugs,
Lori

Hi Mary Beth,

I am so sorry to hear about Alivia's problems. :( I hope your IMS can find what is causing her such pain and have a plan to give her some relief asap. Nothing quite so bad as your baby hurting and them not being able to tell you where or why. Keep in touch and let us know what you learn, ok?

About the milk thistle - most pups handle it just fine but be sure to run it by your vet before you start using it. Milk thistle works best in a cyclic pattern as in giving it for 3 months in the spring and fall, and off of it for 3 months in the summer and winter. Basically, give it for 3 months then don't for the next 3, then back on it. Squirt took it for some time but I didn't know about cycling it and she took in daily all that time. She started throwing it back up - the capsule would be dissolved but the herb came back up still in the capsule form! :eek: I tried a liquid form after she had a break from it but it still made her sick and I haven't tried it again since. Like I said, tho, most dogs do just fine with it!

Hugs,
Leslie and the gang

Hi Mary Beth,

I am so sorry that Alivia is ill. I'm sending positive thoughts and healing prayers that the root of the pain will be found, and that it is nothing serious.

Lori, Leslie and Terri -

Thanks for your messages. I strongly suspect pancreatitis, but, I have not heard anything, yet. I have a feeling she will not be coming home tonight. It breaks my heart but, she is probably better off there so they can manage her pain and give her fluids. She had two abcessed molars, with "infection to the bone" and never showed a sign of pain. This pain must have been horrific for her, because it was very evident. :( I hope she never has that much pain again.

It's a good thing I didn't start the Lysodren on Friday. I just knew she wasn't herself.

Thanks for keeping her in your thoughts. I'll let you know when I hear more. Give your pups an extra hug from me tonight.

Oh Mary Beth, I just logged on and saw your post and am so sad to hear this news. I am saying all the prayers I can the Alivia will pull through this and come home tomorrow.

Please keep us updated.

Love,
Addy

Pancreatitis is a very serious disease but it is manageable. Please let me know if you need information about pancreatitis as I have a lot of bookmarks on this disease. :eek::)

Keeping you both in my thoughts and prayers. Sending big loving hugs too...Lori

Thanks for the messages everyone. Alivia spent the day in the hospital and came home tonight. While she was there she saw the ER Vet and her IMS. She had chest and abdominal x-rays, blood work, BP check and a CPL Snap Test. They said she does not have pancreatitis. They both think it is "spinal pain" from some arthritic changes in her spine, but no neurologic deficits. :confused: They gave her an injection of Hydromorphone while she was there and she was released on Methocarbamol and Tramadol and instructions for limited activity and no steps at all for 6-8 weeks.

I am having a very hard time with that diagnosis. To me it doesn't explain why she had a fever of 104.9 when I took her in (I think I incorrectly posted it as 104.2 earlier). When the vet called, I was so relieved that they thought she was well enough to go home that I didn't think to ask about this specifically and I didn't talk to the vet when I picked Ali up. I did call back to ask, but the vet had gone and the tech had no explaination, other than to say her fever came down while she was there. She has not eaten anything since about 5:00 PM Saturday and that was with coaxing.
She is still in a lot of pain. She can barely walk and cannot seem to get comfortable. I am sitting up with her and seriously considering taking her back to the hospital or to the other specialty hospital for a second opinion. To me this does not seem like back pain. Too severe and too quickly. I am also very concerned about some of the changes in her blood work in just two weeks. The most dramatic:

On 3/24
Alk Phosphatase 205 (5-131) U/L
Amylase 1393 (290-1125) U/L

Today 5/8
Alk Phosphatase 693 (23-212) U/L
Amylase 2813 (500-1500) U/L

Her ultrasound 2 weeks ago showed a gall stone. She has an enlarged liver so I am wondering if this might be a bile blockage issue.

She is sleeping off and on. When she wakes up she is in obvious pain. I'm sleeping on the floor with her tonight because I don't want to hurt her carrying her up the steps (she yelped when I lifted her into the car from the vet's).

Oh, they said not to start Trilostane or Lysodren for now, but milk thistle would be okay. She was just sleeping, yelped and sat up. I'm taking her to the other hospital...

Dear Mary Beth,

I am so sorry to hear about Alivia's pain! It must be so difficult for you to watch her suffering. I have not had the chance to write to you before, but I have been following your journey and I am hoping for the best possible result for your little girl. I regret that I have no words of wisdom to offer. But if it is feasible for you to get a second opinion from a reputable specialty clinic, I believe I would opt for that if I were in your situation. Because I agree with you, it surely does sound as if there is something else going on aside from the diagnosis that you have been given. We have had at least one other dog here who suffered from misdiagnosed and untreated gall bladder issues, so I am thinking that you may very well have hit the nail on the head. But whatever your course of action, please know that I am thinking of you both and hoping so much that sweet Alivia soon gets some relief.

Sending many hugs and healing thoughts,
Marianne

Thank you, Marianne. I do appreciate the kind words. I almost took her to the other specialty hosptial last night for another opinion. I laid on the floor with her all night. Just about the time I was sure I was going to take her, she'd start resting a bit more comfortably and then I didn't want to disturb her. The tramadol she is supposed to get every 8 hours seems to only take the edge off of her pain for about 2. She is not much better this morning, so I am taking her for another opinion. Actually, this will be a third opinion since she saw two vets yesterday.

I agree, I would go get another opinion and ask them why that would cause fever. It always helps me to write down all my questions and trains of thought including any possible health issues not discussed previously.

I hope you get some answers today, Mary Beth. I know hard hard it is to feel helpless when they are so sick. You can table both Cushing drugs for now. You could not start until she is better.

Sending prayers and hugs for you and sweet Alivia.

Love,
Addy

Mornin' Mary Beth,

You are very wise to seek another opinion. While I know how painful spine problems can be for humans and that fever can result from trauma causing pain, I would want a better explanation of her condition. I, too, think the gall bladder should be considered in this situation. ;) Methocarbamol is a skeletal muscle relaxer so that tells me the vets she saw do think this is related to her skeletal system in some manner. That doesn't, however, mean they are right nor does that mean there couldn't be something else in addition to the spine so getting that second opinion in the face of her continuing pain and discomfort is a smart move IMHO.

Please let us know how things are going. We are keeping your all in our thoughts and prayers, and sending healing white light and strength to Alivia.

Hugs,
Leslie and the gang

I took Alivia to her regular vet this morning - the one that has treated her for YEARS and who I trust completely. Just got back. He felt up and down her spine and she did nothing. He touched her belly lightly in two places and she yelped and snapped. He has done everything to her over the years and she has never had that reaction. Her fever is 104. He agrees with me and doesn't think it is "spine pain". He has an internist he works with, who goes to various vets to do ultrasounds, as needed. So he will come in ultrasound Ali later this afternoon. Since I am only a block away, he gave Ali a pain injection and I brought her home. They will call when the ultrasound doctor gets there and I'll run her back over. Even with the injection she is still in a lot of pain. I feel so bad for her. :(

We are hanging in there with you, sweetie. Please let us know what the U/S shows and what they plan to do to help her. Know we are here any time you need to talk, even if it is just to vent. Most of us have been in scary situations like this ourselves and understand how you must be feeling. Just know we are here, ok?

Hugs,
Leslie and the gang

I am so glad that you're getting more input about Alivia! I'll be checking back all through the afternoon to see how things are going.

Continuing healing hugs to you both,
Marianne

Thanks, guys! I appreciate you hanging in here with us. I just posted a couple pictures of my baby not feeling well. One from at her IMS office yesterday and three of her just a few minutes ago. She is so sick that there were cats meowing and all the usual commotion at a busy vet's office on a Monday morning and she never lifted her head. The pain injection has helped her to sleep a minute here and there, but she is still in pain. :(

Hi Mary Beth,

I am so sorry that Alivia is experiencing so much pain. I'm glad you were able to take her to your vet this morning. I hope you will get an answer as to what is causing the pain and that your vet will be able to start a treatment for it today.

I'll also be waiting to hear what you find out.

WOW! I e-mailed Dechra (Vetoryl manufacturer) Friday evening and asked questions about Trilostane. Dr. Tim Allen from Dchra just called me and he had reviewed all of Alivia's information. I sent him ALL of her test results! :cool: He offered some suggestions on what her current issue might be - pancreatitis or pyelonephritis (kidney infection). He thought the repeat ultrasound was a good idea and doesn't think I should rule out surgery just yet, but thinks Trilostane is a good altrnative option. Now here is where the small world part comes in. I told him I was waiting for the ultrasound doctor to get to my vet's office and he asked if it was Chip Meyer - it is!!! He knows him and said he is one of the best he knows and that Alivia is in very good hands! That makes me feel so much better. I already knew Ali's regular vet was the best, so I shouldn't be surprised that he has good people around him!

Double WOW!! Talk about a small world, indeed! What reassuring news about Dr. Meyer. And Dr. Allen is sooo nice. He has been really helpful to any number of us here. I've got to run some errands now, but I'll keep checking back afterwards.

Marianne

I am here too Mary Beth and am relived to hear Alivia is in your trusted doctor's hands. It can sometimes be a small world; it always amazes me. Now you can have confidence in the ultra sound.:) I am so glad you spoke to Dr. Tim.

We are all praying for Ali to find some pain relief and that they can now get to the bottom of things. Please keep us posted as we all get very close and protective of you all. When you and your pup hurt, we hurt too. I can only imagine how worried you are. Stay strong. You are doing everything you can for her and she knows that.
We are here for you, you know that.

Love,
Addy

Thanks, Marianne and Addy. It is a help to have you guys around throughout this.

Ali's pain injection must have kicked in and/or she is just totally exhausted and she is sleeping (peacefully!) beside me. :) We are waiting to hear when we can go for her ultrasound, but knew it wouldn't be until afternoon sometime.

I cannot believe Dr. Allen knows the doctor that will do Ali's ultrasound!! I feel so much more comfortable! Dr. Meyer is also the internist my vet consulted with initially. I have not had 100% confidence in the first ultrasound done by her IMS - partly because they did not provide the results at the same time as they sent me the other test results. Then when I finally got them, there were 2 dates on the report, neither of which were dates she was at the IMS. I could understand one might be the date of dictation, but two incorrect dates? And, also, partly because the IMS never mentioned a gall stone that showed in the u/s or the changes to her liver. This will give me peace of mind that this doctor is good at this and Ali's regular vet will be right there watching it, too!

One thing I am learning is that my first instincts have so far proven to be the best. I need to sometimes quit second guessing them. :p

I'm glad to hear that Ali is sleeping peacefully. I do hope that the u/s will show what is causing her this pain.

Please keep us posted and wishing you both the best.

Love and huge hugs,
Lori

Well, my newly repaired laptop is acting up again and my post just went off into the wild blue yonder....along with two documents I was working on! :eek::mad:

It is great that Dr. Peterson knows the one who will be doing the U/S on Alivia. That would be reassuring to me as well! :)

One of our mantras around here is, "Listen to your gut - you know your baby better than anyone." You are doing a GREAT job of this so keep up the good work! Stay in touch....

Hugs,
Leslie and the gang

Hi Mary Beth.

I was going to post a follow up to my prior post but things have changed since I was here last so those thoughts are on the back burner for now. Just know that I'm thinking of you both and will be staying tuned for your updates.

Glynda

P.S. Dr. Allen is great and oh my, it is a small world. I'm glad that he could bring you some comfort because you deserve some relief. Hang in there, kiddo.

Hi, everyone.

Alivia had another ultrasound by Dr. Meyers, at her regular vet's office this afternoon. As I suspected all along, she has pancreatitis. From there we went directly to the hospital and she's been admitted for a minimum of 3 days, but they say it could be longer. They also say it is "life threatening", which of course is terrifying. And, it makes me so angry because if I hadn't pushed the issue, she could have died and she should have been at least 36 hours further into the treatment by now! Fortunately Ali had the good sense not eat anything for 2 days and only drank a minimal amount of water or things could have been even worse.

Because of the inflammation, Dr. Meyers was not able to visualize the adrenal glands as clearly as he would have liked to but he said there is no evidence that anything has spread and it appears to be an right adrenal adenoma, but "cannot rule out atypical nodular hyper plasia since LDDS did reveal suppression" and she has a normal left adrenal gland. Because he believes the Cushing's contributed to this and she will be suceptible to other effects, he thinks surgery should not be ruled out. :eek: Also, he states, "Cannot rule-out concurrent or inciting cholangitis secondary to bile clumping." A "goopy gall bladder" was how he stated it. Dr. Myers and my vet were awesome!!! They let me stay with Alivia for the entire ultrasound (in fact Dr. Meyers suggested it!) and he was even showing me things and explaining what he was looking at. The gave Ali another pain injection prior to the u/s to make it as comfortable as they could. For the awful pain she was in, she was amazing! I rubbed her little head and held her paw and she stayed perfectly still for the whole procedure. She stared at me with her beautiful dark eyes and I think she was calmer because they allowed me to stay with her. I already miss her terribly. :( I am so tired from all this.

Unfortuantely, Alivia is not ou of the woods yet, so please continue sending the possitive thoughts and prayers this way. Thank you all!

I am so sorry. Pancreatitis is a dreadful disease but manageable. Did they do a spec PL test? If so, what was her number?

I truly understand you missing Alivia but right now she is where she needs to be, getting the proper care for her illness.

I will definitely be keeping you and Ali in my thoughts and prayers.

Sending big loving hugs, Lori

Oh Mary Beth, you must be so exhausted and drained! Thank goodness for the care that Alivia received today, and for the care that she will be receiving at the hospital. You can count on a boatload of prayers and well wishes from my house.

Thank you so much for taking the time to update us this evening, and please let us know as soon as you hear more tomorrow.

Marianne

I also wanted to tell you...Great job for getting another opinion on Ali. Always trust your gut!

Love and hugs,
Lori

Mary Beth, I know you miss Alivia right now, but I am so glad that you now know what is causing her pain, and that something is being done to help her.

You are both in my thoughts and prayers that Alivia has a speedy recovery. Try to get some rest.

Oh Mary Beth, you must be so drained. What an ordeal for you and Alivia. I will be saying numerous prayers for your little girl. She is in good hands so we are thankful for that.

Try to get some sleep as Terri suggested, if you can. You will need your strength for Ali. I am so glad they let you stay with her for her test.

Did they allow you to leave something of yours for her with your smell on it while she is in the hospital?

Thinking of you and hoping for the best news and that she improves now that she has the right care.

Love,
Addy

Hi Mary Beth,

I am so proud of you for keeping after the docs until they found what was causing Alivia such pain. You are a great mom!

Squirt had an acute pancreatic attack following a surgery and it was soooo scary! She had to go back to the hospital just one day after coming home and stayed for about an additional four days with the pancreatitis. I called to check on her so often the hospital finally told me they would call me at set times of the day to report on her. :o:p

Ali is where she needs to be right now so they can get the inflammation under control and give the organ a chance to rest and recover. She knew that food and water would just make her worse so she wisely listened to her body....just as her mom wisely listened to her.

We are with you both in spirit, sending prayers and healing white light. Get some rest yourself today - you have to take care of you so you can take care of Alivia when she gets back home. Know we are here any time you need us.

Keep your chin up!
Hugs,
Leslie and the gang

Hi Mary Beth,

Checking in to see if we have any news. I hope you got some rest.

Let us know as soon as you can.

Love,
Addy