You and Tipper are in my thoughts today.
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You and Tipper are in my thoughts today.
Thank you Jen I appreciate it.
I don't know how you do it? It exhausts me just reading your posts and you have Noah's Ark to take care of. :eek: xxxx
Oh Patti, sending you big hugs. I know that must be exhausting mentally and physically to have to go toe to toe with your vet every time something needs to be done.
I really do hope that this helps Tipper and how long before she gets her thyroid retested? Maybe you can do the BP then, because it is probably a good thing you didn't have it done today actually. With the lack of sleep and her being so upset and then you upset would bother her more. Just not a good BP check day.
Crossing fingers this works and you all get some much needed rest.
hugs,
Sharlene and Molly Muffin
Hi Everyone:
I just called the vets and they said Tipper's blood pressure was 190! That scared
The crap out of me. This is a first. Better be a last too. Tipper had a nap, and I keep checking her heart rate to make sure it is not racing. It will be about 3 or 4 weeks before this Soloxine makes her feel better. I just think it is pitiful that I have had to fight for everything this dog has needed, and it has worn me out today. I am thankful we got started on this as I have never seen Tipper like this and don't want to ever again. You think he would have some respect for someone knocking themself out to help their dog. I believe in Karma and one day it will visit him. This depresses me that it is one thing after another for my girl. She needs a break. I forgot to mention when I told him thyroid symptoms can mimic Cushing's symptoms and he said that's not true, but he calls himself an expert????? Blessings
Patti
i am tired, and so must you, so i hope tipper is sleeping well after an exhausting day, and you can have a few weeks break from the vet to relax a bit.
It certainly not easy with your vet. I'm glad that Tipper does not seem to have a racing pulse right now. Did her thyroid test show that she is hypo thyroid? Sorry if this was answered already...I may have missed some posts over last week.
I hope both you and Tipper can get a restful sleep tonight. Is she still super hungry? Anything from the IMS about id Grace was contagious? I hope she's not!!
Barbara
I am so glad you finally got the thyroid meds for Tipper. I feel your frustration and wish you can see a more accommodating vet. I hope she feels better and better in the next few days on the thyroid meds, I take thyroid medication and it took a few days before I started feeling better. Hugs and kisses to Tipper I hope you both get some week needed sleep and rest.
Wow Patti,
you would think that your vet would trust you by now and realize that you do your research before asking for anything. What a condescending JERK!
I am so glad that you got what is needed for Tipper though and I hope that someone else in his office tells him to lighten up and fly right.
Hoping that both of you get some much needed rest tonight.
Hi Everyone:
Vicki: I don't even care about him being accommodating, he is just plain rude and he should have more respect after all the research I put into anything I approach him with. Does he really think I would do anything on God's earth to hurt my girl? If he would just hear me out and try to be open minded instead of thinking he knows it all and is far from it.
Valerie: I think he knows I research all this but gets angry that I know what I am approaching him about, and he likes it when the people come in there and think he is great and knows everything. I am more of a challenge and want things done correctly and know what is correct so that is the problem. I am challenging his authority and he does not like it. I never go in there with an attitude that I know everything and he is and idiot. I try to approach him in a non threatening manner and her always gets nasty about it. Yesterday I said to him I need your help, to make him feel important. Then I said this is what I have learned, can you help me with this? Then he immediately started about me schooling him. So there is not dealing with him, he nit his way and when I know better I will not allow it so it is a stand off.
Last nite I gave Tipper the 2nd pill. She seemed to sleep better and not moving all around the bed all nite. I am scared about that high blood pressure and hope it was the circumstances yesterday that brought it on. This better not be a new problem! I kept checking her heart rate and all seemed ok. I am hoping in a few weeks this is all good, and she is back to herself.
The IMS emailed me and answered a question I have been wondering about from her checking Tippers tumor. I wondered how she can say it had never grown if Tipper is not in the same exact position each time. She said she goes thru a series of checks to make sure she is in the exact position when measuring. She said she was answering for the neurologist and said they can change Tipper's meds but this one would sedate her a bit it is called clomipramine and from a quick glance can sedate, make lethargic, and depression. I am wondering if that would be good so she sleeps better if it sedates? Would like everyones opinion on that . I will research the drug first. She also said she wants me to video Tipper's honking episodes so she can see them. I told her Tipper gets frantic cause she cannot breathe as anyone would and it is worrying me. Tipper has to go back in 3 months for another US. She forgot to answer me about Grace, just my luck. So I am going to call a cat expert and ask them when I get time. Tipper's pre number is low again .9 and the post is 5 so I am calling Dechra today. I may have to back her down to 20 Vetoryl and 5 trilostane as she was getting 8 trilostane. This is such a hard balancing act. Tipper seems more calm now So I am getting ready to dose her at nine. The research said 2 times a day dosing 12 hours apart and 1 hour before meals or 3 hours after meals. Well she eats at 6:00 and I cannot make her wait an hour and I am not getting up at 5:00 as she will stay up for the day then. So I am doing it 3 hours after meals. It said there is calcium in the dog food which interferes with the absorption of the Soloxine and that is why it must be done this way. I read Soloxine is the newest and supposedly the best drug for this. We do not have to go out until next Wednesday for BP and I will make sure I go early so I do not see the vet as my blood is still boiling. I am taking a few days rest and figuring out Graces future. Blessings
Patti
Hi Patti... I'm following your thread. Would Tipper be like this ?http://www.youtube.com/watch?v=CXDledRQ7y4 - Keesh had this episode a couple of times and I thought he was dying. Turns out it's a reverse sneeze.
Molly does the reverse sneeze thing sometimes too. Not often, but it's scary at first. Not sure if that is the same thing Tipper is doing or not.
Gosh, her pre being .9 is not good. :(
Before I switched to a medication that might sedate her more at night, it would be worth it to see if once the thyroid medication is fully working if that doesn't take care of the night time restlessness.
Grrrr, that the IMS didn't answer you about Grace.
hugs,
Sharlene and Molly Muffin
The reverse sneeze.. Terrifying. And my vet can't explain it. Do you girls think its Cushing related?
Also Patti, your vet sounds like a jerk. >:(
Hi Patti,
Let us know what you hear back from Dechra about the .9 pre. I'm very curious about that too, in light of their earlier comment about 1.45 being their lowest.
We have a member on facebook, whose dog has dropped to a .9 now from a 4.2 pre in November, after an increase from 7mg x2 to 9mg x2.
Thanks,
Sharlene and molly muffin
Hi Everyone:
Tipper has done this in the past. It is a sign of tracheal problems, which can be related to Cushing's. Tipper is real loud and making a honking noise when her trachea collapses, which means she cannot get air and she panics. The sneeze has not happened since she gets adequan shots, but if she has to sneeze she tries not to do it, so it must not feel good. I talked to Dechra and they want their vet to talk to mine, so that will happen next year I guess. They told me a base line is not good enough when Tipper goes low for a recheck. They are not as concerned this time as last time her pre was .7 and the post was 3 this time pre is .9 and post is 5. They said she has some wiggle room on the post if she would start to go low. Basically the only two options are with hold Vetoryl for a few days or lower her dose a tad. The with holding only bring then problem back when you resume unless you lower the dose, but it does prevent Addison's by letting the cortisol rise. They know it is hard to do this with Tipper as she respond quickly with strong clinical symptoms. We will have to wait and see what Dr. Bruyette says about it as I emailed him earlier and asked him about this. Hopefully we can all learn something that will help manage this. Tipper is napping, lots of snoring and congested sounds. Blessings
Patti
Hi Everyone:
I just posted this to Sharlene and wanted to tell everyone else. Dechra told me that 1.45 is what they want the dog at for a pre number. Normal untreated dogs are to be .5 to 5.5 on their pre number. I know the next part sounds a little hard to decipher but Tipper was .7 one time and .9 now in her pre number. Since she is still above the .5 of an untreated dog they are not as worried. If it goes below .5 of an untreated dog that is really cause for concern. So in other words as long as Tipper is above the untreated dog pre number threshold she is not in danger, but of course they would optimally want her above 1.45 as in the treated dog threshold. I am waiting on Dr. Bruyette to email me back he is usually fairly prompt and may be busy. I will let you all know when he answers me. Blessings
Patti
Hey Patti, I'm really confused by what they told you. On one hand, they're saying the pre should be above 1.45 for a dog on trilo, but then they're saying it's still OK for Tipper to be below 1.45. So I agree with you -- that seems totally contradictory and hard to figure out. There's a big difference between .5 and 1.45. In honesty, it's been very rare here that I've seen dogs that were listed at <.5, even actually diagnosed Addisonian dogs. So if that is Dechra's true cut-off, it seems as though there are very few trilo dogs with genuinely worrisome pre values.
I'm as confused as Marianne about this. Dechra's US website has a paper written by Dr. Ellen Behrend entitled Update on the Use of Trilostane and it clearly states:
Ideal is 1- 5 ug/dl. That makes perfect sense if the post is also under 5 ug/dl but Tipper's is well outside the reference range. I don't believe I've ever seen a basal (pre) number so low with a discordant post stimulated cortisol. pre .7 and post 9 seems very unusual.Quote:
If the basal or ACTH-stimulated cortisol concentrations are below ideal at any time, trilostane administration should be discontinued temporarily and the dose decreased when resumed.
I don't feel comfortable at all with a pre number going below 1.0, as I think it would be way to easy for them to slip further between monitoring tests and end up in crisis very easily. Better safe than sorry I think.
People/vets seem to think, oh vetroyl/trilostane they can bounce back and they can, but only with a good vet and specialist team who recognizes what is happening and administers prednisone and electrolyte tests and fluids as needed. We can't count on all our vets being knowledgable in treating a trilostane induced addisons crisis. That scares me!
I think Dechra should stick to their 1.45 as an optimal range to not go lower than.
Sharlene and Molly muffin
Patti, I thank you for your updates. My Tobey is getting her pre and post number farther and farther apart as well, although not as dramatically as Tipper. I am anxiously awaiting Dr Bruyette's opinion.
I don't know, but it sounds scary to me. I am worried about Tipper having these low pre numbers. I am afraid to take her off the Vetoryl right now as she just started thyroid meds and some of those symptoms as we know are the same,and I don't want to be wondering what is causing what. I need a good plan here??? It would seem their information is so contradictory. I really don't want an Addison's crisis either as Sharlene said some vets don't even know how to treat One, and my vet would probably be in that category. I do have a question in light of all of this. Since blood work has to be sent to a lab, when your dog has one of these Addison's crisis, how can they balance the electrolytes right away if they don't know what is high or low? Is it just assumed the potassium is high and the sodium low until results come? I am wanting to know this in case I would have an emergency with Tipper that I am able to over see things are done correctly. Very scary stuff. Blessings
Patti
This is just me chattering away based on nothing, but it seems to me that a person really needs to take the whole picture into consideration and not just the pre in isolation -- meaning the post as well as the pre. If my Cushpup was registering a post higher than 5, I'd be hard pressed to think that I couldn't stay the course even if the pre dropped a bit below 1.45. I mean, that just doesn't make sense to me -- that a dog with that high of a post is suddenly going to become oversuppressed. But of course the other piece is looking at patterns and trends -- has the pre stayed pretty constant or has it suddenly dropped. All I can say is it sure was a lot easier when nobody seemed to care very much about the pre at all. :rolleyes:
Marianne
Patti, can you do me a favor? Can you give me a quick recap on Tipper's last two or three acth stim tests where her pre was less than 1? Can you also tell me what dose she was getting at each of the stim tests? Did you inquire about this with Dr. Bruyette?
Glynda:
I did ask Dr. Bruyette about this. I asked him quite a few questions and that is probably why he has not replied yet. Here is a run down of what was going on with Tipper.
August 13th 2012 - Vetoryl 30mg -ACTH pre- 0.7 Post 3.0 Off the Vetoryl until August 17th restarted on 20mg
August 28th not controlled went to 10/10 split dose morning and nite.
Septmeber 9th gave 10mg morning and 10 mg 8 hours later to see if that helps
October 1st gave 20 mg Vetoryl morning and 5mg trilostane nite
October 27th went to 20 morning and 7 mg nite
December 4th gave 27 mg dose in morning
December 18 gave 20 vetoryl and 8 trilostane in the morning
She has been on the last dosage up to this current Acth
January 30th ACTH .9 pre and 5.0 post
I have dropped her down to 20 mg Vetoryl and 7 mg trilostane after these results so that is what she is on now. This was all done in an effort to try ad control her symptoms, and was done by consulting Dechra.
I am wanting to know if you think I should stop the Vetoryl and wait a few days start her back on total of 27 again then gradually drop down to 25 total? If so I need to order 5mg. I thought starting back on the 27 would not the cortisol down enough that maybe 25 will be adequate then? I really am not knowing what to do as my vet never called as usual. Anyone with any perspective on this or ideas pleas help.
Tipper seems better at nite with the thyroid medicine. Last nite she had a lot of seizure activity, one shook her whole body. It is so scary to watch, so I kept waking her. I was going to with hold her Vetoryl for a few days, because of her low pre number again, but her symptoms were so bad from the thyroid I don't want to do it unless I have no choice. I am so worn out trying to figure the right combination out.
Blessings
Patti
Hi Everyone:
As you can see I am working hard with Glynda ( or should say Glynda is working hard to help me with Tipper's dosing.) I am trying to get her to a place where she is not exhibiting symptoms and her pre number is not low. I can tell you Glynda is miraculous at all this, and big hearted to take time to help me. I honestly don't know what I would do without this forum and it scares me that there are people out there dealing with this on their own, it's sad. I am going to feed Tipper only twice a day and see if that helps with the hunger. I am thinking of a way to get her exercise in this weather. She would not do well on my exercise bike! I need to get her a treadmill or something. I will work on it. A friend that lives near me may no someone for Grace. I am waiting to hear. I am calling the Cat Expert in Pittsburgh tomorrow as I had a lot to do for Tipper today. I will ask his opinion on this. Tipper did ok last nite but still had some seizure activity. She did sleep better but up at 4:30 and I made her lay down till 6:00. She seems to be doing ok on the Soloxine and her heart seems ok and not racing. It is a mild dose and I am glad, that is what I wanted in case things went south.
She is not panting, and whining anymore so maybe it will help her. So with some help maybe I can get her straightened out here. She seems to have a better attitude today, and happier. Blessings
Patti
i can not help you, since i don't do the tests with ian. he is doing well on 2 mg/kilo and that is ok with me.
in a way i am glad i don't have the money to pay for those tests, because worrying about the numbers/results would drive me nuts i quess.
besides ian will suffer a heart attack if i would take him to the clinic for this. he is so frightened!
hope you and tipper will have a quiet night.
Glynda has a lot more knowledge than I do when it comes to cushings and dosing. I wonder though if the way the results have been, low pre and in rangeish post is because she has the adrenal tumor now and that is a lot harder to control.
Hopefully the thyroid medicine will start to kick in and help control the symptoms too and then you'll know better what you have to do with the vetroyl.
Hang in there! You ARE doing good, even if it drives you nuts sometimes. :)
hugs,
Sharlene and Molly muffin
Glad you noticed some improvement with panting and racing heartbeat..that's a positive sign. I hope that tonight Tipper has a good, relaxed sleep.
It is so hard to deal with getting these pups their exercise between the extreme cold and the snow which is has an ice shell over it.
Trixie and I met up with a friend and her dog and took a walk to a playground area that has fenced in ball courts. We let them run around and a puppy came in and they were all going crazy chasing around. Trixie hasn't chased like that in a long time but I was so afraid she would slip and hurt herself on the ice.
I guess she really needed some good exercise, especially as we have another storm starting tonight so she won't be out much tomorrow.
Hoping you're having a good night with all your babies.
Barbara
Barbara,
awwww, that sounds like such doggy fun!
Hi Everyone:
Not too bad for Tipper last nite. Some early seizure activity and it seems to happen a lot when she first goes to sleep. I have decided to have an online consult with Dr. Dodds about Tipper's thyroid. I wanted my vet to use her in the first place if you remember and he wouldn't do it and insisted on Michigan. I believe as other so that she is the top expert and can find things over looked by others. I need to cover all my bases here and makes sure Tipper is safe and getting the correct treatment. My vet was supposed to call Dechra 2 days ago, now he is off till next week and he had never called me. He just simply does not care about Tipper, that is why I always have to go to outside sources for help. I am working with Glynda to help Tipper and she knows a gazillion times more than my vet so I am better off without him. It's just the idea of paying him all this money and he feels he has no obligation to do anything for it. He knows Tipper is low and could go Addisons and still no calls. Thank God for this forum as my Tipper would not be here if I had not received all this help. I do try to pay forward whenever I can. I am consulting with the Cat specialist today on Grace too. It will be a busy day. It is supposed to get nice next week in the high 30's and Tipper can walk which will make her much happier. I will be in the hole so far after this consult I will need a ladder to get out. I need to do this for my girl so I will bare the burden of it for her gladly. I am wanting some opinion on this subject. Tipper was at 28 mgs one dose in the morning when her pre went low again. 20 vetoryl and trilo. I am wondering if I go to 5mg trilo and do 15mg in the morning and 10 mg at nite. That gives her a split to even the cortisol all day and drops the dose down by 3mgs to let her pre come up a tad. Please I need some feed back. I am wanting to do this because I am afraid she is close and can slip in Addisons and want to lower her post without lowering her pre. I welcome some ideas. Again her pre was .9 and her post was 5.0. Blessings
patti
I don't know if the thyroid can have any effect on the pre number in an ACTH or not, but if I were you, I would focus on that organ for now. I would give her enough time on the new thyroid med to give it time to work and see how her signs, which both conditions share, are after her thyroid is regulated. The post number does NOT indicate Tipper is in any danger of an Addisonian crisis so I wouldn't waste a great deal of time worrying about that happening right now. The pre has come up and Dechra didn't seem overly concerned when you talked to them about it.
I don't understand Vetoryl (Trilostane) as much as I try but I have to wonder if even division of the dosing might not have a positive effect on the pre number - if she were given an even dose am and pm if that number might not come back in better range? :confused:
If thyroid has the same symptoms as cushings and we know it does, then it might be that the hunger and definitely the aggression is due to the thyroid being off and not the cushings. This would mean that you could safely lower the dosage of vetroyl and if the thyroid is controlled, then those symptoms could go away.
I really wonder if that 5. isn't due to the adrenal tumor, and the .9 due to the suppression during the day by vetroyl.
It certainly can be a very tricky situation to be in.
hugs,
Sharlene and Molly Muffin
Just my two cents worth, but I would not add yet another variable of twice daily dosing into the mix when you have so much else going on. We have been told by Dr. Bruyette that there seems to be a greater risk of oversuppression with twice daily dosing, and that is exactly what you are trying to avoid. I am only speculating as to the physiology of that, but perhaps it is because the cortisol never has the opportunity to rebound very greatly at any time during the daily cycle with twice daily dosing. At any rate, this is what he's told us:
Since this last test was done with once daily dosing, I would stick with that for the time being so you will have some head-to-head comparison with the next test. I agree with Leslie that since Dechra wasn't too worried about these recent results, I wouldn't worry unduly right now, either. I would want to change only one variable at a time, and right now that would be adding the thyroid supplementation.Quote:
While twice a day dosing may result in a lower amount of trilostane being used per day it will require closer monitoring as the ACTH stimulation tests tend to be lower so we have to look for both hypocortisolemia and electrolyte abnormalities.
Just wanted to add that we have been told all along by the experts that ACTH stim testing may not be the ideal gauge for monitoring optimal trilostane dosing, but it's the best thing we've got right now. (I'll try to find a quote that better explains why, and come back later to add it). These kinds of weird discrepancies between low "pre" and higher "post" numbers may be a reflection of an inherent problem with using the test for trilo dosing decision-making. But so far, nobody has come up with a better alternative. So there you have it...
Thank you Marianne that does make sense to me and like you said don' add another variable to the mix. I am hoping to get this thyroid thing sorted out this week. Tipper seems to be doing a little better on this drug but do not want to jinx things! She was lethargic, dull coat, panting, restless, drinking, sensitive to cold and weight gain. She has all the classic symptoms and she lets me know for the past few weeks something is off and she is not feeling well. It's enough to make your crazy all this stuff! Blessings
I am waiting for a return call from the cat expert!!
Patti
Hi Everyone:
I have some not so great news. Gracie must go to another home. After consulting with the cat expert he confirmed what I have already known. Since my cat Chance is 13 years old, he could have a compromised immune system. Therefor putting him at risk for picking up this virus and having it mutate into FIP. The first sign of them having the corona virus would be severe diarrhea. I have spent enough money trying to turn Graces' situation around, but in all god conscience I cannot knowingly make my boys sick, and have the expense of that yet! I am crushed as her and I have become quite close and she never has acted up trying to get out of this one room God Bless her. This is devastating to me as she has suffered enough in her lifetime. I wish I could change all this, but the illusive magic wand is no where to be found. I must kick this into high gear and find her a forever home. This is making me cry as I type these words. I am sad for her and for me. I am waiting to talk to Jean Dodds and get Tipper squared away. Blessings
Patti
Oh Patti, I am So sorry. I know we were all praying for a miracle. Maybe try some other rescues and put notices up at various places.
Sending you big hugs and hoping for the best
Sharlene and Molly Muffin
Patti, I am so sad and sorry, too. This is so not fair for either Grace or for you. What I will turn my hope towards is that you can find somebody out of your own circle of acquaintances so that at least you can still visit her from time to time...
I really am so sorry.
Patti,
I'm so sorry.
I would try other rescue groups and whoever finds Grace a home first gets to place her. The place that you mentioned was concerned about getting a lot of money concerns me and I wouldn't trust them to screen candidates properly.
hi patti, i will catch up with your thread tomorrow. sleep well!