Tipper - adrenal tumor/breathing issues

Marianne:
Thank you for the help. I needed to hear it from one of you, what you would do, to give me the courage to do this. My Vet called and said he agrees the dose must be increased to 30mg. He said he talked to the Vet at Dechra on Friday and the Vet told him not to increase anything until the urinalysis was done today. Dr. Fox at Dechra said no increase if she has any infection, or crystals. Well no crystals on the test today, and the infection is gone. So I guess the crystals were from sitting in the refrigerator and then being sent out, as my Vet had told me. Well he was right about one thing at least!!!.My Vet said he will re contact Dr. Fox, and see how we should dose this -20mg in the morning and 10 at night, or 10, 10 and 10. Anyone have any experience with, or can shed some light on the dosing I appreciate the help in this decision. I kinda think the 20 10 is the best way to go if she can tolerate 20 at one time. Let me know what you all think, as I am taking baby steps here trying to be cautious. I am the nervous Nelly, I swear this has aged me 10 years. I never had bags under my eyes before this from not sleeping. Oh well, I have no right to complain, as my beautiful girl has suffered tremendously with this, and keeps on going like a trooper. I just need to put an end to this starving all the time as she has to be miserable from it, and it is about to drive me insane as well.

If it were me, I'd go with 20mg in the am and 10mg in the PM. That way, if the next acth stimulation test looks great but symptoms have still not resolved, you can add another 10mg to the evening dose. IMO, baby steps are always much safer for our dogs.

I totally agree with Glynda, do 20 mgs am and 10 mgs pm if you dont want to do 30mgs all at once.

It will be okay, we are all nervous nellies and will hold your hand.:)

See there you go. Some good advice and those who have been through this same thing. :) You aren't alone in the journey.

hugs,
Sharlene and Molly Muffin

Hi everyone: I just got off the phone with Dechra. I talked to Theresa and relayed what is going on with Tipper since I haven't heard from my Vet. She is going to ask Dr. Fox's advice as to raising the dosage. She said since Tipper was a 1.4 pre and 8.7 post she would be afraid of her going too much in the wrong direction. I don't understand this stuff and need help. I thought the only number to worry about was the post. Now I find out thru her that the pre is also important. I do not know what in the heck to do now. Also I called a local Medicine Shoppe, the pharmacist told me she can take a 10 mg capsule of my Vetoryl and make it into 2 -5mgs. That way Tipper would get 25 mg a day instead of 30. I would have to give her 15 in the day and 10 at night. I know this is a baby step and very, very expensive to have the pharmacist do this, but I am now scared after talking to Dechra to give her another 10mg. I am just about ready to melt down. Please advise me if you can I surely need the help and support. Theresa asked if there could be some other underlying issue explaining the hunger, as her numbers are in a good range, and she should not be hungry. I know of none, and the only logical answer is the drug needs tweaked, as this has never been an issue before cushings. Please help, I am so disgusted with all of this and don't know where else to turn, but here.

I totally understand why you are frustrated and upset -- let's wait and see what Dr. Fox has to say. In honesty, what Theresa has told you makes no sense to me and is contrary to Dechra's own published information and guidelines. I wonder who Theresa is, anyway :confused:. Yes, the "pre" can warrant scrutiny if the "post" is also too low. But with Tipper's "post" of 8.7, I don't see how anybody would worry about imminent oversuppression. And Dechra's dosing protocol clearly advises increasing the dosage if the "post" is over 5.4 and symptoms are unresolved.

I am disturbed with Dechra if they are allowing underqualified personnel to answer these types of questions. If "Theresa" needs to confer with Dr. Fox, probably she shouldn't have been fielding the call and giving her own feedback in the first place!

Now, if he tells you the same thing as Theresa, I will need some help with picking my jaw up off the floor! :rolleyes:

Marianne

Marianne:
Thank you for feeling the frustration with me. I am about to go looney tunes. I assume Theresa is a Vet tech., as I think my Vet told me before they field the calls. I am waiting on my Vet to take his good old time to help me get this resolved. Tipper has been very restless, starving and more water than usual. Both of us hardly get any sleep since she sleeps next to me we are up all night. The Vet just doesn't get it. No sense of urgency ,because he is not the one having to deal with all this. Last night I had to leave her in my room and go in my office to make her stop crying for food. It is really wearing both of us down at this point. I am about ready to have one of my sessions with the Vet again about the importance of getting on these matters before they escalate into other things. He and I have had it out several times when I feel he is not doing his job, and not doing right by Tipper. He is one of few Vets around so I can only hold his feet to the fire every so often, or I will have no Vet. It is terrible to have to settle for a Vet like this though. He has a gigantic ego, and thinks because I am so involved in Tipper's care that I step on his toes. Oh well too bad as this is my dog and I will fight to the finish for her care.I am paying him enough too, he is quite expensive, especially if he knows you love your dog -if you know what I mean? As if it is not enough dealing with this disease he has to make it more stressful for me. Since today is Friday he probably will not call back until Monday. Sorry to go on a tirade, but I have had it with the lack of understanding on his part, and he will just act like nothing is wrong when I get upset.

I hate it that you are having to go through all these hassles in order to get informed advice! How were things left with Dechra? Is Theresa going to call you back or will Dr. Fox contact you directly?

Marianne

Marianne:
Theresa said she would grab Dr. Fox as he came out of a meeting, that was several hours ago, She said she would call me back. I am wondering if they are waiting to see if my "take your good old time" Vet is going to call them?? If not I am not too proud to call her again, if I don't hear anything by 4pm ET. I am so sick of struggling with all these people not wanting to do their jobs, I am worn out mentally.As soon as they call or I call them I will post for you to see. Thank you for your help and support, it is well needed.

Marianne:
Dechra's Theresa just called and said my Vet finally called Dr. Fox. She said because Tipper's UTI is gone and she concentrates her urine well, that she can have the dosage raised. I was going to go to 25mg and have the Med Shoppe make the 5mg out of my 10mg- but when I talked to the person who would be doing it they said it would cost like 60.00 a box to do. I told them that is outrageous, and more than the drug itself costs. So that would add like 240.00 more a month. I do not have a money tree in the back yard. Theresa said they were discussing a dose of 30mg split 20/10. She said the final decision in my Vet's, and he has not called yet. So I guess it will have to be 20 in the morning and 10 at night. I pray to God that this is not too much for her since she is so sensitive to drugs. I will just have to suck it up and buy 3 boxes of 10 mgs a month. I will not give her 1 30mg dose that is not even a consideration. I don't want her to be a zombie, or crash so I have decided to do it this way. Although it is way more expensive, it is just safer for her, and that is what matters the most to me. I have already cut back on things so a little more belt tightening will work. Please pray for my Tipper as when the Vet calls and gives me the ok, she will get the 20 in the morning. I am scared to death to do this, but I must help her out of this misery. Please pray for us to get thru this. Thank you all for all the help and encouragement it means so much to me.

I'll bet Tipper will do just fine tomorrow. I know it's impossible for you not to worry, but in most cases, oversuppression from trilostane can be reversed simply by discontinuing the drug for a while and lowering the dosage. There are always exceptions, and we have some here among our membership. But I know you'll be watching her like a hawk, so if you notice something that seems "off," you can always hold the medication that day if you are in doubt. The odds are in your favor that any problems that arise can be remedied.

GOOD LUCK!!!!!!!!!!!!!! :)
Marianne

I totally understand how you feel. Every time I had to do a 10 mg increase I worried about flaring my Zoe's colitis. She has handled the last 3 increases just fine and I think Tipper will do just fine tomorrow as well. After all, she has you in her corner:D:);)

((((((((((((((((((hugs)))))))))))))))))

It will be fine.

Hi everyone:
I was awake all night knowing that I had to give Tipper the 20mg capsule of Vetoryl this morning. I have to do it in icriments of 10mg at a time so it was difficult tricking her with the food twice. I gave it to her at 7:15 am this morning. It is now 8:30 and I am still a nervous wreck. She goes for a walk every morning after she eats and I was scared something would happen on the walk. We are ok so far. I made sure the Vet was going to be in this morning or I would not have given it to her. In case of any complications, because she is so sensitive to drugs I need to have a Vet to take her to in an emergency. God Bless you all for caring about her and helping us so much. I will keep you posted during the day.

Good luck! I just know you will have a good day. Every time we have increased Boriss he has done just fine. ;)
I buy those pill pockets & sneak both pills in his mouth at the same time. He gobbles it down without blinking an eye. It makes it much easier. He takes a 30mg & a 10mg pill every morning at the same time.

Hang it there!

Amy:
Thank you for the encouragement. It would seem there is not too much I cannot do when I have to in my lifetime, but when it involves Tipper I am scared to death. Her system has always been real sensitive to drugs of any kind. She had amoxicillin a few years back for something, and a few months after that ,was given it again, and had such a bad reaction, and went into anaphylaxis. She can be on something ,and the next time react to it. So it is quite scary to give her anything. I am sitting here and keeping her at my side all day. How much does Boris weigh? How many increases has he had? Is he good to go now? Thank you for thinking of my girl. Hoping Boriss is doing well.

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Originally Posted by goldengirl88

Hi everyone:
I was awake all night knowing that I had to give Tipper the 20mg capsule of Vetoryl this morning. I have to do it in icriments of 10mg at a time so it was difficult tricking her with the food twice. I gave it to her at 7:15 am this morning. It is now 8:30 and I am still a nervous wreck.

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Actually Vetoryl peaks quite rapidly, about 1 1/2 hours so if Tipper is okay now, I suspect she'll be okay the rest of the day. Just remember that Vetoryl has a short half life so if she does start to act a little punky due to cortisol being a bit low, she should rebound rather quickly by withholding the dose. I can guarantee you that you are taking this a lot harder than Tipper. Today is no different than yesterday for her and if that should change, she'll let you know. Try to calm your nerves and if you are sitting there wringing your hands, put those hands on the keyboard and continue to educate yourself on Vetoryl, how it works, how treatment is monitored and possible adverse effects. Knowledge is power and with power, comes calmness. You can find a wealth of information in our Helpful Resources section. http://www.k9cushings.com/forum/showthread.php?t=185

We are here if you need us for anything.

Lulus' Mom:
Thank you for telling me all this. I try to educate myself on things, but at times read things I would rather not know, if that makes any sense. I am so relieved that you told me the peak time of Vetoryl. I am calm now, and we can get on with our day. I have put this all in the Lords' hands and do the best I can every day for Tipper. I think I can now take it easy for the rest of the day. Thank you so much.

I know it is really scary!! how is your baby today.

We still haven't gotten Boriss's numbers down were they should be. But, for my sanity & money we took a little break from the tests & increases since he is doing so good.

We started him out on 25mg's & are not up to 40mg's. I never noticed any negative reactions in him. Only positive thanks the LORD!
I am guessing he would really benefit from the morning/evening dose better. Might try that next. He gets a little more hungry in the evenings on some nights.

I am with you.. Watching them cry for food is just heart breaking.
That is the main reason why I was okay with trying the dose increase. I just could not take watching that anymore. He was miserable.
Right now he seems pretty good. I just know at his last test his numbers were still a little high. But, his symptoms are better. So, I am okay with giving him a break from all the trips to the vet.

Keep us posted on how things are going.

Amy:
No problems with the increase of Tippers' dosage so far, thank God! She seems more calm not as jittery, and sleeping better. It seems to be effecting her stomach though. I give her Manuka Honey- I have for about 2 years now. She sometimes can get acid reflux. I noticed a few times her having loud gut noises the last couple nights. Could be from the 2 week antibiotic shot. I gave her some yogurt, and will see if that helps. She was hungry yesterday and today, but not chasing me around and begging all day like she was. It will probably take a week or two before her number comes down to where this completely stops. Last time that is how it worked for her, she kept inching downward for a while. I can already see improvement though. To watch a dog beg you and cry for food all day is so bad. It was heartbreaking and I know it had to be really bad for her. It would be enough to make you crazy being hungry all day long. Sometimes I wonder how Tipper does it- putting up with all this misery, testing, etc. She is a trooper, and I hope both our babies continue to be strong. Hope Boriss finally gets to the dose that will put him in a good place. That is so frustrating, I know. How much does Boriss weigh? I think the break from the tests is a good thing.

Many members give Pepcid AC to their furbabies 20-30 minutes before the cushing medication to help alleviate tummy troubles.

Boriss is at around 28lbs right now. I sometimes have to give him pepcid AC as well. He will throw up bile occasionally. He was like that before he started the meds.

I am SO glad that things are getting better for you already. :):):)
Hopefully the hunger pains are going away for good.

Have a great week.. Can't believe tomorrow is Monday again already. :rolleyes:

How is Tipper doing on the increase?
Hope this week is running smooth for you two.

Hi Lori,

For future reference, since some dogs cannot tolerate the Pepcid, would you feel it is safe to give the SEB on a daily basis and prior to the trilo dose? Not sure if SEB can be used long term?

Thanks for your thoughts if any.

Warm regards. Xo Jeanette

Jeanette:
Tipper cannot take Pepcid, it actually gived her a really, really bad stomach ache. I am interested in the SEB. Can you tell me what it is and where to get it? I will go over it with my Vet. thank you for the help.

Slippery Elm Bark (SEB) is used for many issues, it coats the stomach and helps to diminish the accumulation of acid in the stomach. SEB is a good treatment for ulcers, gastritis, colitis, and other inflammatory bowel problems.

Here is a link about SEB: http://www.littlebigcat.com/health/slippery-elm/

Not to take away from Tipper. I have a quick question I noticed you mentioned ulcers & SEB. I have had reflux bad/GERD my entire life & the meds are really expensive. I wonder if I SEB would help me? What do you think?
Sorry to hijack the Tippers thread with a question. :o

Quote:

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Originally Posted by Boriss McCall

Not to take away from Tipper. I have a quick question I noticed you mentioned ulcers & SEB. I have had reflux bad/GERD my entire life & the meds are really expensive. I wonder if I SEB would help me? What do you think?
Sorry to hijack the Tippers thread with a question. :o

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Although I have never used SEB myself, I think I would give it a try if my GERD bothered me. According to this article it can be used for GERD: http://www.umm.edu/altmed/articles/s...elm-000274.htm

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There has been little scientific research on slippery elm, but it is often suggested for the following conditions:

• Sore throat

• Cough

• Gastroesophogeal reflux disease (GERD)

• Crohn's disease, ulcerative colitis, and irritable bowel syndrom (IBS)

• Diarrhea

• Wounds, burns, boils, psoriasis, and other skin conditions (external)

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Thank you!! I am going to give it a whirl. :)

Merry Christmas to you and Tipper.
Have a wonderful, safe Holiday.

hugs,
Sharlene and Molly Muffin

Hi Everyone:
Hope you all had a good holiday with loved ones. I am getting ready to take Tipper for another ACTH test in an hour. She just had her dosage adjusted to the 30mg 2 weeks ago. We are supposed to get really bad weather- we are in the snow belt, so I changed her appt. to make it earlier so we can get home. I hate to do this to her, but these tests are a must. She is always so upset afterwards. She is doing well on the 30mg, but at night every once and a while she gets hungry. Some of it is habit, as Jack Russells know exactly what time they eat, and what time their snack is. I have a question. I know that the fat redistribution from this disease can push on their lungs making it harder to breathe. Is anyone else's baby experiencing this? Do you have any suggestions for easing her breathing? Also the snoring they do. I have asked my Vet what causes this and he does not know. What is the mechanism responsible for causing this?? I have noticed Tipper sometimes making a "throaty" noise, and when she tried to sneeze the other day, it was as if something was stopping her from doing it, like she couldn't let it out like normal.Also when she drinks, I hear her making a funny raspy sound. Does anyone else have any experience with anything like this? Other than the breathing problems we don't seem to be having any other issues. other than the licking. I haven't been on here in a while, as sometimes this gets too much for me to handle. Tipper is going to get a blood panel done also to make sure no other problems are cropping up. I wish for all of us a better New Year, and for the babies better health. Thank you all and God Bless you and your fur babies, and God help the people from Newtown. I will post Tippers numbers when I get them probably Friday.

Hi Tipper's mom,

I am wondering if the throat, rasping sound and breathing issues could be related to trachea issues (collapsing). Or, possibly allergies.

Terry

Terry:
I do not think so as she never had any problem before she started snoring with the Cushings. Thank you for your help I appreciate it.

Hi everyone:
I got Tippers latest results back today and need some help to go in the right direction. They are as follows:
Tipper is on 20 mg Vetorl morning 10 mg at night
ACTH
Pre: 1.5 Last one was 1.4
Post 5.4 Last one was 8.7

The blood panel is where I need help also:
BC Ratio 30 no lab guide was 18 on last one in October
Triglycerides 625 { 20-150} lab guide Last blood work in October - result was 494
HGB 19.9 {12-18} in October this was 19.1
HCT 59.5 {37*55} in October 54.9
Reticulocyte 153 {10-110} in October 97
Absolute Lymphocyte 985 {1000-4800}
Albumin 4.3 {2.5-4.0} October it was 4.3

Could this possibly mean that Tipper is starting into Hemolytic Anemia??? These were all the highs and lows. Everything else was normal. On all her other blood work this is the first time she had a high Reticulocyte reading.
Is her ACTH where it should be. She is doing fine and every once in a while gets hungry at nite before her evening Vetoryl 10 mg. Has anyone else had experience with this and what should I be doing ?? If this means Tipper is becoming anemic what do I need to do immediately??? Thank you all kindly in advance, and God Bless all your babies.

Was Tipper fasted for the bloodwork? Was there any mention of hemolysis? I hope Debbie drops in to share her experience but I have commented below about the results:

Quote:

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ACTH
Pre: 1.5 Last one was 1.4
Post 5.4 Last one was 8.7

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These are great results, especially if all of Tipper's symptoms have resolved.

Quote:

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BC Ratio 30 no lab guide was 18 on last one in October

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I realize there is no reference range but does the labwork say that 30 is high or low? I believe normal values are between 10 and 20 but I have no idea if this differs between labs. This value is a comparison of BUN and Creatinine. Do you have the individual results for these? A low value indicates an increased creatinine or low bun. The bun is commonly low in cushdogs so a low ratio is what we are used to seeing. A high ratio is consistent with low creatinine or high BUN.

Quote:

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Triglycerides 625 { 20-150} lab guide Last blood work in October - result was 494

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I asked about hemolysis and fasting because excessive fat in the blood that can cause an elevation and so can a recent meal. Cushing's and other systemic diseases like diabetes and hypothyrodism can also cause this increase.

Quote:

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HGB 19.9 {12-18} in October this was 19.1

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This would be considered an inconsequential elevation which can be caused from mild dehydration. I'm not completely sure but I think if Tippy had anemia, HGB would be low. Where are you Debbie? :D

Quote:

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HCT 59.5 {37*55} in October 54.9

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This would also be considered a mild elevation and again, can be caused from mild dehydration. As with HGB, I think this value would be low if anemia was involved.

Quote:

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Reticulocyte 153 {10-110} in October 97

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I have to take a pass on this one as I'm unsure under what circumstances other than anemia, this value would be elevated.

Quote:

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Absolute Lymphocyte 985 {1000-4800}

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Not a very significant abnormality and I believe that stress can cause this.

Quote:

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Albumin 4.3 {2.5-4.0} October it was 4.3

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Again, not a very big elevation and mild increases are commonly chalked up to mild dehydration.

Did your vet discuss the results of the blood work with you? If so, what did s/he have to say about it? I'll send Debbie a PM and ask her share her thoughts on the bloodwork. She'll let you know if I'm full of it. :D

Glynda

Glynda:
Yes the lab considered 30 on the BC high. She never had this before, all these elevations are recent. Tipper did however have a meal before the bloodwork, as she was having the ACTH the same day and had to eat for that test. Her Triglycerides are so high though, could a meal cause them to be this high? It scares me. The Vet really never gets into a discussion with me about the results. He says he is going to go over all this with the vet at Dechra, and will get back to me. I question him thoroughly on everything, and I think he doesn't like me doing that. So he tries to put me off. He is as slow as molasses so that is why I was scared about the BC if I needed to do something right away that is why I came here. I trust the people on here before the vet as his experience with this is very limited. If I don't get the right answers off of him soon, I will call the vet at Dechra myself, as I have done in the past. My Vet never seems to have any sense of urgency for anything. The Bun was 27 the range was 7-27 and the creatinine was 0.9 range was 0.4-1.8 Glucose was 95. Thank you Glynda I always can count on you for the straight information. Let me know what else you think after reading this.

I think some of the abnormalities are definitely because Tipper was not fasted. That includes the high Bun Creatinine Ratio. The Bun was at upper limit of normal but creatinine was very normal so non fasting would explain the higher ratio. Not fasting can also cause fairly high triglycerides, especially if Tipper is on a higher fat or higher carb diet.

The acth stimulation test results are good so if all symptoms are much better or completely resolved, a call to Dechra would not normally be necessary. If your vet has to call Dechra so they can interpret Tipper's other bloodwork, I'd be pretty concerned about his experience or lack thereof. IMO, there is absolutely no reason why any vet should get annoyed with a pet owner for taking a proactive participation in their dog's treatment and asking questions. If your vet is not willing to sit down with you to discuss the results of the blood work and answer any questions you have, without copping an attitude, I would suggest you either 1) ignore his unmerited annoyance and don't leave the office until he's answered all of yoiur questions or 2) find another vet who is very experienced with cushing's and appreciates an educated pet owner. Believe me, I've interviewed more than a few vets over the years and none of them have thrown me out of their office....a few probably thought about it but managed to keep their composure. :D I trust very few gp vets to know their butt from a hole in the ground where cushing's is concerned so I'm very picky about who treats my cushdog, and my other medically needy kids for that matter.

Glynda

Glynda:
Thank you for taking the time to help me. Tipper is on a low carb diet. She eats Hills WD and some chicken breast, that's it. When she first started with the Cushings and was tested her Triglycerides were high, somewhere I read Cush dogs do get these higher numbers. I don't see how it could be her diet, as she gets nothing else except maybe a piece of carrot or a bean. The Vet I have is the best of the ones around here, and I try to put up with him for the sake of an emergency situation with Tipper. I think the reason he wants to check everything out with the Dechra Vet is that he knows I research everything he tells me, and am sure he wants a second opinion. He never called me today, so I will call the Vet at Dechra. Basically I am the one who finds the solutions and just use him for any meds etc. That is why I got Dr. Peterson as a consultant, I am aware of the short comings of my Vet and I always double and triple check everything before I let him do anything. We live in the country and this is the best way I can manage things. I never, never ever trust him under any circumstances. It's a shame, but it is what it is. There is also a younger Vet in the practice that I talk these things over with. This is the best situation I could come up with. I am with Tipper 24/7 I never leave her, so that is one saving grace. I am able to see any problems and deal with them quickly. I do all the work, and the Vet collects all the money. Oh well enough I cannot dwell on it. I will have some answers on all this tomorrow, and will post then. Again thank you for all you do for me.

Just wanted to mention that WD is not a low carb diet. It is actually kinda high in carbs with corn being the first ingredient. Corn has a fairly high glycemic index which I believe will increase triglycerides after a meal. You are correct that cushing's can be responsible for high triglycerides but once the cortisol is reduced, those elevations should normalize. It could be a combination of both.

I totally understand your predicament with your vet and all I have to say is Tipper is sure lucky to have you as her mom and excellent advocate. Before long, you will be qualified to run your vet's office and see patients. :D Keep up the good work.

Glynda

While I haven't a clue about the blood work results and what they mean, it's really good to see Tippers ACTH results, being so good compared to last time and symptoms abated.

Sharlene and Molly Muffin

Sharlene and Glynda:
Thank you both for your help. I questioned my Vet when he put Tipper on WD and he said the nutritionist at Hills said this is what she should be on. I told him the first ingriedient was corn and that did not make sense to me to put her on this. She was eating Newmans Own for Senior dogs prior to this. Can anyone recommend a good low carb diet for her??? I am going to contact the Vet at Dechra now and will let you know what he says. I thank God for you all every day, you are so much help considering the Vet problems I have to deal with. To think I got him and all his staff some baked goodies for Christmas, to try and break thru to them that I am not trying to be a bitch, I am just trying to save my dogs life. None of them even thanked me so I guess that is a message in itself. All I want form them is a little cooperation, fighting this uphill battle with them is daunting to say the least. My Dr. has had to give me a mild tranquilizer because of my blood pressure being high from all this stress.