Printable View
It's quite worrying really - maybe I'm doing the wrong thing not giving the dose the vet said but poor Cairo was sitting bolt upright in his bed last night, eyes wide open, looking totally wired - and that was on half the dose the vet said, so goodness knows what' he'd have been like on the full dose.
We'll continue to keep an eye on him and fingers crossed for Friday.
Just checking in on Cairo. Hope he is doing better each day. Are you tapering him off the pred? Did Dr. Peterson answer you? Blessings
Patti
How is Cairo today Alison
Dr Peterson didn't reply :( I'll try again - nothing like stalking somebody.
He seems to be not bad though he was a bit slow on his walk tonight. Mind you, I had been shopping and just took him straight out and told him no running cos I had 3 inch heels on - so not sure if he didn't fancy me falling over on him or if he was just not in the mood. He seems alert enough but he was content just to stroll up the road, snuffling in the grass.
Vet's tomorrow.
We've not started to taper him yet as I'm not sure how quick to do it for him - plus he's not been on the dose they said as I felt it was far too much. He wouldn't be able to sleep if I'd given him that big dose.
Fingers crossed for your vet visit tomorrow
Hi Alison
My dog has been on prednisone recently, admittedly for a different reason. He was on it for allergies which were out of hand. He weighs 13.5kg, his dose was 5mg twice a day for a 5 days, the 5mg once a day for 5 days, then 5mg every 2nd day for three doses. We did get him off it quick as it played havoc with his liver numbers that he had tested while on it his ALP shot up to 4000+. This dose may well be different to a dog in Cairo's situation so don't go by that, just showing you how my vet weaned it down.
Good effort walking Cairo in 3 inch heels! I'm impressed :)
It wasn't easy! Admittedly, they were platforms so you could take a bit off the height but I must've looked ridiculous, mincing along!!
That's useful to know for the weaning down - it gives me something to compare what the vet says tomorrow. My gran takes pred for an inflammatory condition and I know how I wean her down if she's had to increase her dose but I'm guessing it's not the same with the dogs because with her, the lower she gets to her maintenance dose, I go to 2.5mg and then 1mg tablets.
I'm hoping his bloods tomorrow are good. I can't believe how anxious I am about it!
One other bit of info, my vet also told me that when he discusses prednisone doses with his clients who are also nurses (like me) they freak out (also like me :D) at how high they are compared with people. He said dogs bodies are different in the way they metabolise prednisone and hence often need more than what we think when compared to human doses. :)
Ahh, you see I freaked out at the vet wanting him on 20mg pred a day - that's a massive dose as far as I'm concerned but nobody explained what your vet explained. They just said that the pred woudn't cause him to be hyper - which is a lot of hooey because it does and he is!!
Flynn did not go hyper on it at all, he acted fine and I was real happy it sorted out his allergies so fast and this is after trying a ton of different foods, creams, showers etc so it was a kinda last resort. But not liking the liver numbers going sky high. Apparently happens a lot and we are testing again soon to make sure they come down. He also has IBD and his IMS recommended treating that with pred if it got out of control. Recommendation for the IBD treatment was 1mg/kg twice a day initially, so that would be quite a big dose. Hopefully we do not have to go there. So these doses of pred can change depending on what they are treating them for, I think the experts here have a record for what the rescue dose should be for addisons dogs though, maybe someone has mentioned that earlier in your thread and I have not read back far enough! But I think if my dog was hyper and sitting up in bed in the middle of the night with his eyes wide open would freak me out!!! You do what you gotta do :) Good luck at the vets today and I will be looking for the update later!
Quick update. We thought he was getting baseline cortisol but she decided to do a stim test to see how his adrenals were working, so he's had first bloods and synacthen injection and we've to go back for 1.30 for second blood draw.
She says she's not putting him back on vetoryl because 60mg is a tiny dose for a dog of his size and he's not coping with it. I asked her about a smaller dose twice a day but she said no.
Obviously his blood results are going to have an impact on where we go next but we can't leave him with untreated cushings so if the symptoms do come back, we have to see another vet, one that will work with us.
She did say about a referral to Glasgow vet school - that's an option.
If it were me I would not listen to this vet. She has given you so much bad information. I would go to the vet school or to another vet. Hope it all works out so Cairo can resume feeling better. Blessing
Patti
Take the referral and run! She not only doesn't sound like a team player but also stubborn and not up to date. Get all the copies.
sort of a result!!
His baseline cortisol was 96 nmol (3.5ug I think). She's away to run his next blood to see what he stimmed to and then phone us.
She said she's going to phone the cushing's expert at the vet school and ask his advice. She says that her concern is that putting him back on vetoryl may damage the adrenal cortex which is why she's hesitant but she's going to seek expert advice. I said me and my mum had been talking and wondered if 20mg in the morning and 20mg in the evening might be the way to give a lower dose and more stable result. She said that could well be the way to go but she's going to speak to the experts at the vet school.
Now that sounds a lot better than what was said in your previous post. Getting an expert's guidance is always the way to go if you are now sure so I feel a lot better with this approach.
It's much better - she only suggested it when we went back for the second blood draw. My first message was after the first blood draw and we were in a bit of a panic at the thought of him not getting any treatment at all.
It's good that she's changing her tone but we still have to keep on eye on her with every decision she makes to keep Cairo safe.;)
I know. But I'll be checking every suggestion on here first!!
Yeah, unfortunately that's what we have to do with so many incompetent and inexperienced vets with cushings these days.
I'm so thankful that these expert angels are watching over us for our fur babies 24/7. Bless them for their constant dedication.:cool::cool::cool: With many thanks.
I'm still waiting on her phoning back with his stim results. I guess she's still trying to get a hold of the guy at the vet school.
We did confess that we hadn't given him the 20mg pred per day as he was fine on the 10 and she was fine with that. Said not to worry because he obviously had done fine on the 10mg and it made it easier to wean him off it.
I am so sorry to tell you that for an ACTH stim test to have any accuracy, a dog must be prednisone-free for at least 24 hours prior to the testing. Otherwise, the stim result is skewed by the supplemental steroid and is not an accurate reflection of the natural cortisol production. The other alternative is to substitute dexamethasone for the pred during the day/s prior to testing because dexamethasone does not affect the result in the same way.Quote:
Originally Posted by Alison
Was Cairo prednisone-free for 24 hours? If not, I'm afraid your money is wasted. I think a consultation with the vet school is a very good idea.
Marianne
I thought that the ACTH stim test wasn't worth it on the pred - he had a dose this morning at 10am and we said to her was it right to do the stim test with him on the pred and she said that pred had no effect on the stim test.
She's just phoned and his post stim results are 175 (6.3). She says that it's a bit higher than she would have liked.
My mum asked again if the pred would not have affected the test and was told not at all, she wanted to make sure that his adrenals were still working and they were.
I know from an Addison's point of view, we don't get stim tests whilst taking hydrocortisone or pred - it either has to be replaced with dex or stopped (which is risky if you're diagnosed Addison's)
Oh, and just to double check - he's been on 10mg prednisolone. We've to give him 5mg tomorrow, 5mg Sunday, miss Monday and then 5mg Tuesday and then stop it - does that sound right?
Alison have pm,d you my boy went to Glasgow vet school and we saw some wonderful people there
I believe your vet is mistaken.
http://thehormonelab.com/handbook/ad...disons-diseaseQuote:
ACTH Stimulation Test: Prednisolone, prednisone and hydrocortisone will cross-react in the cortisol assay and give falsely elevated results. Such therapies should be avoided in the 24 to 36 hours prior to the test. Dexamethasone does not have this effect so it can safely be used prior to confirmation of diagnosis without causing assay interference.
From an article by Dr. Peterson:
I'm really afraid you need to consult with somebody who knows what they are doing, both in terms of Cairo's prednisone taper and also his long-term treatment path.Quote:
It is possible, however, that you are measuring some of the prednisone in the assay for cortisol, especially if you are giving the prednisone within 24 hours of the ACTH stimulation test. Prednisone and prednisolone will both cross-react in the cortisol assay to falsely increase the measured serum cortisol values.
Marianne
Other than Cairo's adrenal glands are stimulating I'm not so sure if those pre and post numbers are quite accurate with prednisone still in his system when the test was performed. I'm sure there's something that you can print out and show it to her why this test may not be accurate and request for a redo. It is so hard and frustrating, isn't it?
I guess another question for Dr. P. Has he replied to your email yet?:mad:
How far is Glasgow vet school from where you live? Can you go there and get a consultation? I'm really not sure about your vet.
Thank you Marianne.;)
Your mum was right to question the impact of prednisone on an acth stimulation test. Your vet's comment that it has no effect on the test is simply not true. It can either blunt the response or depending on the dose of prednisone, it can falsely increase cortisol on an ACTH stimulation. It is very unfortunate that the stim test you just paid for cannot be used to assess the true cortisol levels. This type of thing upsets me greatly as it's a struggle for most of us to find the money to pay for diagnostics and treatment. Many sacrifice and forego their own needs to give their dogs a better quality of life. We don't need uneducated vets wasting what little resources we have and more importantly, placing our dogs at undue risk while wasting our money. Bottom line is that the dose of prednisone you gave Cairo less than 24 hours before the stim test, could very well have artificially elevated cortisol levels, meaning the post stimulated cortisol would most likely have been lower had you waited 24 hours after the last dose of prednisone. If a vet were to increase the dose based on artificially elevated cortisol, it could throw a dog into a life threatening crisis.
I highly recommend that you share some educational material with your vet on this subject. I have provided a link below to Dr. Mark Peterson's blog entitled, Trilostane, Prednisone, and ACTH Stimulation Testing in Dogs with Cushing's Disease. You can either provide the link to your vet or print out the blog. Either way, I sincerely think she needs some continuing education so as to not do this to future clients and their dogs. If I were you, I would also ask her to waive any charge for the acth stimulation test.
http://endocrinevet.blogspot.com/201...-and-acth.html
Glynda
P.S. I see that Marianne posted before I had a chance to finish my own....that's what happens when work gets in the way. :) In any case, my post validates Marianne's and you now have two links to information for your vet.
If Cairo wasn't still under their "care" at the moment, I'd be kicking up hell. There must've been about 5 or 6 stim tests carried out while he was fasted - he got his vetoryl on the day of the test but we were told he wasn't to get food and then I found out that it was really important that he did have food with the vetoryl - so these tests were all a waste of money - and at £115 per test, I could weep. I don't work any more due to my own ill health and he's not insured so it's not as if I have money flooding in.
Between me and my mum, we asked her three times if the pred would not have an impact on the test and she said not at all - she wanted to make sure that his adrenals were functioning properly after the vetoryl over dosage.
The vet school is probably about 100 miles from us give or take a bit. It's a long journey for Cairo - he's never gone that far before in the car, but if I have to take him there I will. I need to go and start speaking to the other couple of vets here though to see how experienced they are. If they are any good and I can get him moved, then I kick up hell with the vet.
I don't know whether to cry or scream or both.
Ask the vet for a refund from those tests. See what kind of reaction you get from her! Get your money and get rid of her before she kills Cairo, sorry to be so blunt, but this is horrible, she is dangerous. Blessings
Patti
Oh my lord, I feel your pain. That was a lot of wasted money on you and also a lot of unnecessary torture on Cairo. Why don't you just do the opposite to whatever she says from now on if you decide to stay with this vet.:eek: I think Cairo will be safer that way.:rolleyes:
What you need to do is to take a few deep breaths and channel all that bottled up energy into finding a better Cushings experienced vet for Cairo as he needs one ASAP and give your piece of mind to this vet at a later time.
If you end up going to Glasgow, how about breaking up the ride and take a few breaks on the way like every 30 minutes or so. Hopefully that will help him.
I have to say one thing tho. I can see her point of doing the test to see whether Diamond's adrenals were stimulating at all as my own IMS said the same thing and we ran an ACTH test just for that purpose so we didn't skip the pred on the day of the test as it was necessary for her to function but to say that prednisone won't affect the result is so wrong and would make me doubt everything else she says about anything.
Feel free to do both and loudly. I mean Wail it out out. :) Sometimes its can be very therapeutic.
You do know the things to ask any other potential vet going forward though. So that is good. You can ask, how much experience do you have with cushings, what sort of treatment, fast with testing or non fast with test, do you think pred has any affect on acth testing, what kind of dosage would you recommend with a 30kg dog, etc etc and just see what they say.
hugs
Sharlene and molly muffin
It's a holiday here this weekend I think but I'll go to the other two vets in the area and speak to them. They might even be a bit cheaper for all the necessary tests - I can live in hope.
I maybe didn't pick her up properly when she said the pred wouldn't have an effect on the test - she maybe meant that she'd still be able to see if the adrenals were functioning - though I realise the actual numbers would probably be out because of the pred.
It's just a nightmare. I feel like I'm letting him down but we've been with that vet for so long that I'm almost scared to go elsewhere in case they're worse - you know, better the devil you know? I can't let this go on though for his sake.
Thanks Sharlene. One of the other vets here used to be a partner with the vet we're with but he left many years ago and set up on his own. I'm not sure why - though somebody I know goes there and she said it was because he wanted to keep the personal touch - the practice we're with got huge and less personal.
You need peace of mind especially since you are not well yourself. Cairo needs to feel better and be safe. This vet cannot provide either. It will be OK, and it will work out, just go to the other vets and ask the proper questions before committing to them. I understand you don't want to go from the frying pan to the fire so just ask questions up front this time. How is Cairo acting now? Does he seem like himself? We are all in this with you, so it will work out. Blessings
Patti
I left our vet who we'd had an excellent relationship with for over 10 yrs once I'd realized my Ginger's safety was at risk if we went with her instructions and I didn't think twice about it and I'm so glad that I did when I did. Sometimes you just know it and this is coming from a person who second guesses everything she does.:o
From the sound of it tho I don't think she will be topped easily. I'm sure you will be able to find a better vet and you are not failing him.
We all can see how much you love and care for him and trying do do everything possible to make him feel better and safe. You just can't give up. Things will get easier and better so hang in there.:)
Thank you so much guys. I'm welling up at the support we're getting.
It's kind of hard to say how he is. In the house, he's just lying in a sunbeam sleeping (snoring his head off) but if anyone moves, he's up and moving too. He's eating like mad - but then that'll be the steroids - but he's not scrounging food (unless it's something he likes, like toast). He's panting on walks but I'm not sure if he's just panting with the heat or not - I'm starting to doubt myself. He normally walks at a heck of a rate with me but he's not doing that and this is where I don't know if he's not hurrying because he's not feeling good or because he's gotten used to us making him go slow this week.
He seems happy enough - got a glint in his eye. He seems to be very slow on the way home but is it because he's pooped or because he doesn't want to go home? I'm not sure. In the vet, he was absolutely hyper and frantic. I was sitting on the floor with him and he nearly killed me, jumping all over me and panting and licking - but he was in the vet.
Well there you go Cairo knows a bad vet too!!!! Maybe his body is still recovering from all of this and he is slower because of that. He has been thru a lot, so it's good he is up and still doing his walk. The heat is bad for Cush dogs so it could be that too.I think he deserves an extra special treat, maybe his favorite food?? Blessings
Patti
He's very much a ladies dog. I caught him about to have a bit of a nip at the male vet the other day!! He's a monkey.
He's got another sore ear as well. First it was the left ear and now it's the right, so that's me back to ear drops - he's gonna love that. I have to bribe him with mini sausage rolls to get his ear done. He's got me wrapped around his paw!
And that's the way it should be Alison :D hang I there you are doing fab, maybe in the heat just give him a little walk see how he goes with the panting :)
You have heat in Scotland?? :D Alison, I am glad Tracy has sent you a message about the Glasgow vets, I remember I was very impressed with them when she took Woody there. It sounds like your vet is not very well versed in cushings disease. My vet has said he does not see a lot of it, the testing is complicated too if they are not doing it all the time. I think seeing the specialist would be an excellent decision. With what they say and suggest what your vet does they may be able to work together with you, but you need a good plan in place. Or maybe after all this you will be more comfortable with a new one. I think I would be in your shoes, but defnititely get that referral to Glasgow. What dog would turn down a sausage roll, needs must :)