This is just for me to keep track of: Gable was 77.1 lbs on June 8.
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This is just for me to keep track of: Gable was 77.1 lbs on June 8.
Those are great ACTH stim results!!!! GREAT job, Joan!!!!!
Thanks to you, Lori!
Joan, I haven't been commenting but have been following along for a bit. Worrying that Gabe may have Cushing's, testing, starting treatment, and now today when he is doing SO well ... what a ride it has been! My hat is off to you, dear lady. Your experiences with Lee, and all the knowledge you gained then and since, are paying off for you and your sweet boy now. Way to go!!
Thanks, Shana...I miss seeing your comments on the forum, but totally get it.
He is doing really good so far. Still pants a lot, but he is a big boy and the weather is pretty hot some days. His drinking has definitely slowed down. He is sleeping through the night and not getting up to drink every few hours, and even though he will still kill for people food, he's not gobbling up all the kibble. I was buying a bag of dog food every week, but now it's every other week. He started playing again, too. Him and Cooper have their old wrestling matches and Gabe will pick a toy out of one of the bins and get a tug of war going...of course after a few minutes of that he's exhausted! He just seems happier.
I wish I had known more with Lee.
Next week will be the 30 day test. It will be interesting to see what the numbers are.
I hope that you and Jackson and Kira are all doing well. Would love to see some pics!
Gable, Cooper and Sibbie love those frozen green beans you are always talking about. Would they be able to eat them unfrozen, too? He's also decided he likes carrots! Our local farm is opening up for the season this Saturday and I was wondering what other veggies they all could have. He also tasted beets a few days ago and liked them.
Right off hand I can't think of any veggies to avoid other than onion, garlic, leeks, etc. If they like something let them have a little of it til you see how they do with it - ie any digestive upsets, bad breath, etc. Some veggies are tricky, ya know....like pumpkins; a little will help form up stools but too much will cause constipation OR diarrhea. Learn about the veggies you try like the beets so you know the nutrients they supply - ie beets are naturally high in sugars so that would be a factor in determining how much to let them have. Just remember - dogs are carnivores, not omnivores so they need to have meat as their primary source of energy. We humans can survive on meatless diets and most do well but that is not the case with dogs. Unless there is a valid reason, all dogs need a solid meat diet with veggies and fruits a small addition. Fresh veggies go over BIG time in my house! Bud has loved everything I've given him! When he see a banana he goes bonkers! :D:D:D
Thanks, Leslie. He has his kibble, but he likes to sit at my feet while I am preparing veggies for our dinner, that's why I wanted to check to see which ones are okay. And if he has something, the rest of them want it too. They all love bananas, except for Doree. She just looks at them like they're crazy!
Gable is going for his 30 ACTH test tomorrow. I hate to say this, but we've noticed an increase in his drinking for the last couple of days. At first I thought it was my imagination, but no, I'm filling the water bowls frequently again. Will be interesting to see what the numbers are.
With the increased drinking Gabe's dosage may need a tweak but an UTI could be brewing which would cause a dog to drink more. Since cushdogs are prone to those UTI's, I believe I'd take an urine sample along to rule out any issues.
Will do. Thanks, Lori!
Gable's second ACTH results on the Vetoryl. This time I brought him home in between and he was much less stressed.
Sample 1: 0.9 (LOW) ref range: 1.5 - 9.1
Sample 2: 2.3 (LOW) ref range: 8.0 - 17.0
Vet wanted to lower it to 30mg, but he's still panting and drinking a little bit more than the first couple of weeks. What do you think? He's not lethargic, not throwing up and no diarrhea. He said if he seems fine then he doesn't need to see him for 3 months.
He also said that he read the new testing paperwork I gave him and that's what made him look at the range for the resting cortisol which is 1 - 5, so he wasn't too worried about the 0.9.
Is it too low? Should I lower the dose? This is so different from Lena's results....it's freaking me out!
You know, Joan, I’m kinda thinking out loud here, but given the contradictory results — lowered cortisol but increase in symptoms — before lowering his dose I’d be interested to see what his cortisol level is when tested using the new pre-pill protocol. With that, he’d have his resting cortisol tested right before taking his morning dose as opposed to that 4-6 hour window afterwards. As long as his pre-pill level is not lower than 1.5, I’d be inclined to not lower the dose since he remains symptomatic. In that event, one option might be to split the dose (like giving 30 mg. in the morning and 10 mg. in the evening). Dosing twice daily might provide more consistent symptom relief throughout the day.
If, however, his pre-pill level is < 1.5 while symptoms remain, then the picture is more confusing and a call in to Dechra by your vet might be warranted.
As I say, I’m kind of musing out loud, and probably the last thing you want to do is to haul poor Gabe back to the vet. But I’m thinking this new pre-pill protocol may provide useful feedback, especially in instances such as this where ACTH results do not seem to pair up very well with observed behavior. We’ve had another new member here recently whose dog appeared to be borderline low based on ACTH results but who was showing good improvement clinically. They ran a pre-pill test on the dog, and I believe the cortisol was > 1.5 so the dose was left unchanged.
I’m guessing it might be kind of nerve-wracking to let Gabe be a guinea pig with this new protocol, but I just wanted to throw the suggestion out there. Here’s a link to the monitoring chart associated with this protocol:
http://www.k9cushings.com/forum/atta...4&d=1522201966
But you don't think it's too low, do you Marianne? I can't get back to the vet now until the weekend because of work. Should I keep him at the current dose until then?
I always feel uncomfortable making recommendations that are contrary to those of a dog’s vet. But if Gabe was my own dog with a post-ACTH of 2.3 and I didn’t see symptoms consistent with low cortisol, I’d probably talk with my vet about sticking with this same dose for a while longer. If that makes you feel antsy, though, you can certainly go ahead and lower to 30 mg. and see what happens, both behaviorally and also in terms of cortisol level.
I guess my decision would at least partly depend upon whether or not I did intend to go forward with pre-pill testing in the near future. If so, I’d be more likely to leave Gabe at the 40 mg. until that testing was done. If not, I might feel more nervous about leaving him at the higher dose for an extended period of time.
I know I’m being kind of wishy-washy here, but these are some of the considerations I’d take into account if Gabe was mine.
I told him on the phone yesterday that I wanted to keep him at the 40 mg. He's still eating good, he doesn't show any signs of lethargy and was even playing with Cooper outside last night, so I think we're good.
My company is having a conference here in Glen Cove and I'm working from the Glen Cove Mansion tomorrow and Thursday so I'll be able to come home and check on him during the day.
Thanks, Marianne...
Then I think you’re fine leaving him on the 40 mg. for now. That’s what I’d be doing if he was mine ;-).
Knowing that makes me feel better...thanks, Marianne. I just want things to go better this time.
Hey Joan!
FWIW, I agree with Marianne. Some dogs do better when their cortisol is in the higher therapeutic range and others in the lower end so this may be the case with Gabe. Were his electrolytes checked too?
I don't think so Lori. I didn't tell them to, so I doubt it. He still seems fine, eating good, didn't get up last night to drink at all. I must say that his fur looks beautiful. It's getting softer and is starting to look red, even my grandson noticed that. I'll keep watching him and decide over the weekend what to do.
I'm going to try the pre-pill test on Saturday. Since I work from home on Fridays, I can give him the pill around 9:30 or 10:00 and bring him to the vet on Saturday. Is it exactly 24 hours? Or is there a window? I'll have to let him eat or he'll be stressed. I printed out the pre-pill monitoring chart and will bring it with me so they know what to do. Is there anything I should know, that they might not from the chart? It's just a blood test from what I gather. They should be able to figure it out, yes?
So far he's not showing any signs of too low cortisol. Still eating good, no vomiting or diarrhea, no lethargy. I think his drinking has slowed down a little, but his panting hasn't...it has been unbearably hot here though.
This is a little weird, but he has been getting erections that take a while to go away when he gets up in the morning, sometimes he can't move for a few minutes. He was fixed before we got him at one year old. He used to get them once in a while, but they seem to have increased lately. Not sure if it means anything, so I'm just putting it out there. Anyone else had this kind of thing happen?
I think you will want to be as close to that 24 hour period as possible and try to keep the tests done at the same time.
I just re-watched the video, and here are a couple things I thought were worth re-mentioning: Professor Ian Ramsey states that the dog should not be stressed at the time of testing so since fasting Gabe stresses him than feeding him is a good idea. Also Professor Ian says that it is very important that the blood sample be sent to an external laboratory participating in an external quality assurance scheme (e.g. ESVE- or SCE- programmes) and preferably that uses a Siemens IMMULITE® – or a method that has been validated against this machine, he says to call and verify this with the lab.
Wishing you both good luck!!!!
I re-watched it too, Lori~ Just as a refresher. My vet does send the samples out. The lab is Antech...they do all the ACTH, LDDS testing. Maybe I'll just check with them myself.
I noticed Gabe's got some hot spots on his belly. They are bacterial infections. He gets them about twice a year so I went and got him some antibiotics yesterday, luckily the vet I like was there and just let me buy the pills without bringing Gable in. One of his ears is red, sore looking, but I don't think infected. Since the drops for that have steroids, we're not going to do anything until after the blood test on Saturday. I'll just wash it with warm water for now.
I think my vet is excited about the new testing. He's put a call into their endocrinologist, I think that's who he said, to make sure of the protocol and to check with him.
I called the lab and they won't talk to me. I'll have my vet do it.Quote:
Originally Posted by Harley PoMMom
I had noticed those comments about the quality assurance programs, too, but I wonder if those certifications may be specific to the U.K.? I’m thinking they may not be applicable here in the U.S. but your vet should be able to find out.
As for Gable’s erections, I wonder if his adrenal glands may be overproducing testosterone or other sex hormones in addition to the cortisol? Just a thought that your vet might want to discuss further with the endocrinologist...
Marianne
I will mention that to them, Marianne. I wondered about that too. I think I asked here once about what the elevated sex hormones meant...that was because of the erections, which I was a little embarrassed to ask about ;)
The unfortunate thing with any non-adrenal illness is that it does have the ability to raise cortisol levels, I'm not sure by how much those hot spots or his sore ear will do that, just something to keep in mind if his pre level would be really elevated.Quote:
Originally Posted by Joan2517
Okay, thanks!
I was on a conference call at 10 that didn't end until 11:30 and only gave him his Vetoryl then. What time do you think i should get to the vet to get the test done?
I guess I'd hope to get his blood drawn around 11:00. Can you make an appointment for a specific time, or do you just have to wait in line at your vet?
For a blood draw, I can just walk in. They already know i'm coming in sometime. This is just to test the cortisol level, right? My vet won't be in and i just want to make sure they know what they are testing for.
Yep, that’s my understanding, just a pre-pill resting cortisol. I can’t remember whether he had his electrolytes checked with his ACTH? If so, I wouldn’t see any need to repeat them so soon. If not and if it’s been a while, they could always run a basic blood chemistry panel, too, just to make sure everything’s OK in that department. That way, you’d have added reassurance that he’s not being oversuppressed.
If he had it with the ACTH test, they didn't tell me, so i'll assume not. I'll tell them to include it tomorrow. Thanks, Marianne.
My vet called this morning with Gable's results:
His resting cortisol is 4.1 (ref range from 1.0 - 5.0)
Alk Phosphatase is 403 High (ref range 5 - 131)
Testosterone is less than 20.0
The vet was so excited about the pre-pill testing. He checked with a Dr. Nichols, who seems to be the "it" endocrinologist around these parts, who was also very excited about the pre-pill testing and said that they have found that bigger dogs sometimes do better on lower doses....gee, where have I heard that before?? LOL!
So, I don't know what that high Alk means...
The elevated Alk Phos is a typical finding of Cushpups, and reflects steroidal effects on the liver. Gable’s elevation is actually fairly mild compared to many dogs, and really nothing to worry about. It may or may not ever return to being within the normal range. But again, that’s no big deal.
The really interesting thing is Gable’s cortisol level! Thank you guys so much for being our guinea pigs with this new testing protocol. From these results, there are no worries that he’s being oversuppressed, and that’s something that we were fretting about after his ACTH. In fact, based on the new monitoring chart, theoretically you could actually increase his dose since he’s still exhibiting symptoms! Given where his result fits into the chart below, you’ll see that they talk about increasing the overall dose and/or dosing frequency. If you don’t feel comfortable raising his dose just yet, one thing you might consider is to divide his current dose into morning and evening administrations, unless feeding him and dosing him twice daily is a pain for you. For instance, given the capsules you already have, you could give him the 30 mg. in the morning and the 10 mg. at dinner. Dechra says that if twice daily doses are not equal, give the bigger dose in the morning.
It might be worth a try, just to see if that improves his symptoms any. If not, you might go ahead with an overall dosage increase. Just some thoughts to consider. And yes, Dr. Rhett Nichols is a huge name among American endocrinologists and Cushing’s researchers. If your vet can actually consult with him, you are in super good hands! I’d be curious to know what he’d recommend doing, given Gable’s results.
Oh, and I guess we can rule out testosterone as the cause of Gable’s erections. Really dunno what else to think about that...
Anyway, good job, Joan! This new testing is exciting, for sure! Oh, and here’s that monitoring flowchart:
http://www.k9cushings.com/forum/atta...5&d=1521562345
Marianne
Great job, Joan!!! And yes, thank you so much for trying this new protocol out!!!
I agree with Marianne on splitting his dose if he is still showing signs; 30 mg in the morning and 10 mg in the evening.
And again....GREAT JOB!!!
Thanks, Lori! Really, the only thing I've done is listen to you all and put my foot down with the vets about how I want the treatment to go this time.
Came home to vomit today in the kitchen, two spots. Not sure if it was Gable or not, didn't seem big enough to be his, so I didn't give him the 10mg tonight with dinner. He seems fine, not lethargic, was playing with Cooper this morning, and he ate dinner.
Could have been one of the others...Doree has wax buildup in her ears and is acting a little funny, sleeping so soundly that sometimes I think she might be going deaf. This morning my husband thought she was dead. She's eating though, but drinking more than usual.
If Gable still seems okay, I'll give him his 30 mg in the morning with breakfast.
Good call, Joan. How are Gabe's symptoms? Sorry to hear about Doree and hope she is back to normal soon.
He's still good, Lori. It probably wasn't him. He seems fine. We can't believe how much he's been playing...with Cooper, with toys again.
Doree is acting strange...she seems confused. I will probably take her back to the vet tomorrow. I forgot to show them something else that's on her face besides the lump on her lip. And I think the cream is too much for her ears. They are getting gooky with it and it seems to be building up. Of course my husband could be putting too much in, but I made him stop last night. The worry now is her heart murmur went from a 3 to a 4, but she's not symptomatic, no coughing, just sleeping more soundly than she ever did. She became the matriarch after Lee died, and she's more attached to my husband. He will be devastated if anything happens to her...our little Doree Darling.