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I thought I replied to this but can’t find it so I just wanted to thank you for your response and advice. I will definitely let you know what I find out. There are so many things that can cause tremor but I sure want to rule out low cortisol. Thanks again!
Claire
Hello Marianne and everyone. We had a consultation Tuesday with the new endocrinologist at Louisiana State University regarding Remy’s tremors and poorly regulated diabetes. I asked about possible low cortisol causing tremor since Remy has been on Vetoryl for nearly four years. I received the ACTH test results today and his cortisol is indeed low. 25.1 baseline and 27.3 post therapy. This is substantially lower than his April test. So she recommends a two day holiday from the Vetoryl and then tre start at 5 mg morning and evening with a retest in two weeks. I will continue monitoring his tremors. His body score was 4 which is very good and she said he actually looks really good. I think they were all surprised that he’s had Cushings for nearly four years and is doing so well. She discussed switching him to Degludec after Christmas but I think now they will reevaluate after we get his cortisol levels figured out. She spent a lot of time with us Tuesday and we were very happy to have a good consultation. I think we were there four hours. I will keep you updated but I am hopeful that we can help our little guy feel better!! Best to everyone and as always, thank you so much for your advice!
I’m so glad you got to see the specialist, and thanks so much for this update! Overall, it sounds as though the results were reassuring, although you will definitely want to see a rebound in Remy’s cortisol level. For sure, I encourage you to follow through with the retest in two weeks in order to make sure he doesn’t need even a longer break from the medication before restarting at the lower dose.
I’ll keep my fingers crossed that indeed all goes well for you guys. And please let us know how his follow-up testing does turn out. Continued best wishes to you both!
Marianne
A day and a half vacation from the Vetoryl doesn’t seem like much to me but that’s what the doctor ordered so we will resume this morning with a 5mg dose and again tonight. He did not seem to have tremors yesterday which was certainly encouraging. We have an appointment scheduled with the specialist on Dec.27 for a recheck and recheck ACTH so we’ll see how he is doing at that point. If, in the meantime the tremors seem to return even on the lower dose I will contact LSU and see about either cutting back again to only 5 mg per day or extending his ‘vacation’ from the drug.
Thank you SO very much for the advice!! Will keep you posted!!
Oh I hope you are seeing improvement in our sweet boy! If not, I would stop the med and keep him off until I saw cush signs coming back and an ACTH proved the cortisol was indeed again high. Then I would want to start even lower...max of 5mg per DAY. If he needs the split dose then a compounded Trilostane would be the way to go. I am so glad you had a good visit with the specialist and left feeling good! It makes it all seem easier and better when we have a good vet by our side.
Hugs,
Leslie
Thank you so much to everyone who has responded. I always value your opinions so much especially considering the first recommendation for trilostane nearly four years ago was 10 mg twice a day!! I suggested we start with 10 mg per day because of your suggestions. SO….Wednesday we went for the retest visit and Remy is still low cortisol. 28.5 pre and 33.2 post. They called Friday afternoon with test results so no trilostane last night and we will not give it until after another retest January 3rd. I did notice last night for the first time a return of the tremor for a brief time. Other than that I only see it when he is put up on the table for his evening meds and feeding. I suspect that is stress related. And I agree Leslie, 5 mg should be enough to start treatment with IF we can get back to a healthy level. His diabetes certainly complicates things but we have to get the cortisol levels straightened out first and then we can deal with the diabetes. I do with the Canine Diabetes Forum was still active because I could sure use advice there! If anyone wants to jump in on that issue I’m listening!! Remy never had too many symptoms of Cushings because we caught it very early. The last visit we saw a Resident and I don’t feel she was really ‘listening’ to me so much as the Endocrinologist. Believe me, I have learned how important it is to make sure they do listen. No one knows their dog better than their own family and sometimes the vets have tunnel vision. Anyway, that’s my update for now. I will be keeping a very close watch on Remy over the holiday weekend. HAPPY NEW YEAR to everyone and again thank you so very much for your support and advice!! Claire
I am so glad the Trilo has been stopped. Now he has a chance to level out a bit and start over and hopefully with better results. It is difficult when diabetes is concurrent but it can be done. I admit....I am a colossal wuss when it comes to diabetes alone. Combined? someone would find me is a corner with my eyes rolled back and drool running down my chin! Those of you who handle this with such grace astound me. You have my utmost admiration.
Keep up the good work, Mom!
Hugs,
Leslie
I am a ‘wuss’ too when it comes to diabetes. The possibility of Remy becoming hypoglycemic scares me to death especially since we have had little success in regulating him. That said, he has never been clinically hypoglycemic because we always catch it in time. I couldn’t do this without his Libre continuous glucose monitor. And I don’t go more than 10-15 minutes away from Remy just in case he starts to go too low. My phone will sound an alarm at 85 which gives me time to rush home. I also have a “FURBO” which is a wifi enabled gadget with camera and microphone so I can watch him. I can have it shoot little treats to him (I use a type that has some cane molasses in them) so I can start getting some glucose in him while I’m away from home. It’s restrictive for me staying close by but I wouldn’t have it any other way. We are coming up on 8 years with Remy in a couple of weeks and we love him dearly! I am hoping we can get his cortisol levels back into a safe range and then work on the diabetes again. Having you all to bounce things off helps me so much!!
Happy New Year to you all and thank you again!!
Claire
Hi Claire!
My cat was just recently diagnosed with diabetes and has the Freestyle Libre, that sensor is really nice to have, although I did have one that stopped working after only a week, and that was a bit frightening. Fortunately, the pharmacy had one in stock and the vet got him in that day to put a new one in.
Wishing you and Remy best wishes!
The Libres will conk out once in a while but the majority of ours (and this is three years worth!) have gone right to the last minute. We usually change it out within an hour or two that. And they are not always accurate either. But for an unregulated diabetic like Remy they have been a God send and made all the difference. I change his out myself. It’s not difficult to do and only takes a few minutes. I usually buy four at a time. I would suggest you always have at least one on hand!
Best to you and Kitty!!