Molly, 13 yr, shih tzu - lhasa aspo - Molly has passed

We are back from having the ultrasound today and meeting with the Internal Medicine Specialist.

Good news is that she doesn't have any tumors anywhere. Her adrenal glands are slightly on the large size, and liver a tad large. No sign of liver disease, gall bladder, anything that I asked would cause her ALP's and ALT's to be raised. The IMS, told me that looking at the results and all her other tests (that I have posted here) that Molly does indeed have cushings.

Her recommendation is that another LDDS test (we had the last one two years ago, negative) and see what those results are. If they clearly show cushings, on top of the ACTH showing cushings, then we would start her on low dose, 5 or 10 mg of trilostane. She said that was the low end, and that she is of the mindset that you start low and go up, rather than high and go down and that is what she would advise my vet. (I'll be returning the 30mg box of vetoryl)

If the LDDS is low, borderline, not clearly showing cushings, we'd wait and then retest in about 3 months. She also recommended another full blood panel workup and urine workup, prior to starting molly on any medication. So, if the LDDS is high, we'll move to doing the full blood and urine panels.

I am so much more comfortable with this IMS. I did say I was fine with the vet doing the LDDS, as long as she (the IMS) is consulted. If I feel at any time that my vet isn't on board with the treatment, then I'd rather see her directly. She was fine with whatever I decide.

Interesting, my vet told her in her faxed notes, that I had "read on the internet, much information, that made me wary of treatment" pffffft and hmmmmph

This doctor was fine with my reading up and had just recently attended a conference by the vet association. She said, they compile information from all studies done in the US and I want to say UK too, and then issue statements regarding treatment based upon these findings. She said there would be either a statement or a paper issued soon, a new one I mean, she doesn't think it's been released yet, regarding Cushings treatment. One thing will be not waiting for clinical signs to start low dose treatment if all testing indicates cushings and all other diseases or possible issues ruled out.

She has heard Feldman speak several times she said, after I mentioned papers written by Feldman and Peterson. (she said on you are familiar with the big names in this area and laughed) She said they both are doing excellent work, along with U of Tenn regarding this disease that is so hard to diagnose and hard to treat.

So, in essence, I feel comfortable with her prognosis and her plan at this point and hope my vet can get on board with what we want to do.

Sonja, I'm in Mississauga, but only a stones throw across the creek into Toronto. :)

I've been reading up as much as I can on Cushings, Medicine, treatments, when to treat, when not to treat. It's a big swirly mass of information right now, that doesn't always make much sense. Thanks for the links :)

Quote:

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Originally Posted by molly muffin

This doctor was fine with my reading up and had just recently attended a conference by the vet association. She said, they compile information from all studies done in the US and I want to say UK too, and then issue statements regarding treatment based upon these findings. She said there would be either a statement or a paper issued soon, a new one I mean, she doesn't think it's been released yet, regarding Cushings treatment. One thing will be not waiting for clinical signs to start low dose treatment if all testing indicates cushings and all other diseases or possible issues ruled out.

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Wow, this is huge news and I'm dying of curosity. Is there any way you could find out who the speaker was?

Hi there!

I'm so glad your visit went well today and that you like this vet. Certainly that is a good feeling after your recent experiences with your other vet.

I don't have any input or advice to offer you, but I'm glad you have a vet that respects your thoughts and supports you educating yourself. :)

Julie & Hannah

I don't know who the speaker was, if I missed her saying or what. She seemed to be saying that this would be a new release based upon the compilation of many studies that have been conducted over the last 2 years. (she was explicit that it was based upon many peoples research, mentioned west coast specifically also) She said she had heard Feldman speak a couple times, but didn't say if he is who presented this or if it was a panel discussion or what. She did take one look at molly and say 5 - 10mg to start we can adjust up if it is needed and not risk overdosing, which she felt would be a more dangerous situation.

She said, that she was aware of only 2 cases of adrenal damage to the point of Addisons caused by Trisolane, and that neither had occurred under her or at this hospital. Not 2 world wide or ever, just two that she had been aware of personally.

I looked to see if her email was on her business card but it wasn't, only the general hospital's email.

Next I speak to her I will ask her about who the speaker was. I did mention this board and that everyone here has in the past or is now dealing with Cushings and that all official release of statements or papers are followed carefully so that we will all be watching for that release.

It sounds like you are in good hands and the important thing is you feel you can relate to her and she has experience.

I am so glad you had the appointment!!!!

Oh, this is exciting! New research on our babies disease! I am sure Glynda will be all over this release and bring us all up to date. It is nice to have a resident Cushing's Guru! :D And now they are thinking to start low-dose treatment even with no signs, or mild signs, present, huh? Interesting....

It sounds like you have found a great IMS! I remember how wonderful it felt to find Dr. S in TN after our run in with an IMS or two who were awful so I am very happy for you.

Let us know how things go and what you decide to do!
Hugs,
Leslie and the gang

Thanks gang. I do feel good with this IMS who not only seems to be on board with the same things that I am, low dosing and exhaustive testing to verify results and rule out other possibilities.

Early treatment but Only if positive this what is causing the problems and the levels of all testing should be showing on the high side of cortisol rising, then treatment. At least that is what I understood her to be saying. I wish I knew who was issuing and when and where the statement/report. I'm sure when it does come out, Glynda will be all over it. :)

I found an upcoming continuing education lecture being offered by Dechra that may cover the information on treating without symptoms. This lecture is given by a veterinary dermatologist husband and an IMS wife team, entitled Cushing's Disease: Inside and Out. It's not available to us laymen and I can't see the five modules but they are entitled, 1) Perspectives, 2) Diagnostic Considerations 3) Treatment Options - What We Knew Then 4) Treatment Options - What We Know Now and 5) An Option for Managing Canine Hyperadrenocorticism. The what we knew then and what we know now sounds very interesting. The fact that a dermatologist is contributing is interesting because a lot of dogs with cushing's have severe skin and coat issues with few other symptoms. Even more interesting is that the husband dermatologist's practice is in Pasadena, CA. I had a little Shih Tzu foster dog who had horrific skin problems and few other symptoms, who was ultimately diagnosed and prescribed Vetoryl by another derm vet in that practice. Hmmm?

I have been able to find some of the older Dechra continuing educational material sessions so hopefully, I can find this one at some point. It'll drive me crazy until I find it and I suspect Marianne will be very interested too. Oh how I wish I had a veterinary friend. :(

Glynda

P.S. Sharlene, ask your vet if the names Rhonda Schulman, DVM, DACVIM and/or John Angus, DVM, DACVD sound familiar. One or both may have lectured at the veterinary conference your vet attended.

I'll make a note of that Glynda. I'm not sure when I'll be seeing the specialist again that I had this discussion with. Next I see my regular vet who will be the one to administer the LDDS test and follow up. She is suppose to consult with the specialist at this point. Well, unless she gives me any grief about starting Molly at the lower dose of Trilo, in which case, we could be seeing that specialist a lot sooner than expected. LOL

I'm thinking maybe keep an eye on that Journal of Vet Internal Medicine for any articles too.

I wonder about asking Dr. Peterson or Feldman if they know of anything coming out that will be different than their original recommendations of waiting on treatment. Have you emailed either of them before? Peterson I think has a web blog, not positive.

Sharlene

Sharlene