Thinking of you and Molly!
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Thinking of you and Molly!
So back from the vet's.
Molly's BP - good in the 140's consistently so that is Very good.
Eye doctor - Molly's retinal bleeds that she had previously have scarred over, with no retinal detachment (breath huge sigh of relief)
Some new smaller retinal bleeds
The small cataracts have not changed in size.
All of that is very good and I really do think that her Ocu-Glo eye supplement has helped to maintain the size of the cataracts as the eye doctor was explaining that is what it helps to do, keep them from growing too large, real fast.
If she gets red in her eyes, then she is getting irritation and we'll need to bring her right in for a topical treatment. If we can catch anything with her eyes early, it is better.
So, now we are waiting on the ACTH and the UPC results, which I should have tomorrow. The IMS will call.
You know two weeks ago I was in the same spot, everything was going well, and bham that UPC was high, so I'm almost afraid to get my hopes up that things are progressing well there too..nah..I'm too optimistic. I do have high hopes that things are well in the UPC deparment and hopefully the cortisol department too.
hugs all!
Wow her BP number is great!!! Hoping with you, that you get excellent results from her other tests, however, we all know how that UPC can become falsely elevated, so if it is, we'll just not worry so much about that, ok? ;)
Love and hugs, Lori
So glad BP and eye exam results are so good--will think good thoughts for the UPC!
Attagirl Molly!
Auntie Suzie is proud of you! <<< Doing the Happy Dance
Whew! What a relief! Such great news! Go team Molly!!! ;):o
Sharlene,
I hope all goes well w test results, and so happy for you re: eye issues. Reminded me that some good news is better than no good news.
YAY! I have no idea if this is valid or not but we are gonna say it is - with the BP good, the kidneys will have calmed down and that UPC will also be good. :cool:;)
Hi gang,
I don't have the written results yet but I have the call in numbers.
She isn't responding to the increase in her kidney medication, with her UPC going from 2.4 to 2.7. Not a significant increase, but considering the increase in medication, she should have gone down, they were hoping for a decrease of 50% not an increase.
So question, has anyone switched from benazepril to enalapril and seen a change? The general thought of the IMS is that there would be no difference.
The next option is to add on an ARB - Losartan. There isn't a lot of studies in dogs on this. In the US they have seen good results, and my IMS has one dog on it here that is responding. There aren't too many choices left in the protein losing kidney medication area though.
So, I don't have the pre number but she told me over the phone the post numbers for the ACTH.
20/22/2015 (2 weeks ago)
pre - 166
1 hr post - 339
2 hr post - 389
03/18/2015
pre
1 hr post - 326
2 hr post - 356
So a small drop this time but not much. The drop after 30 days on the first dose was greater than this one of an increase of 3 mg.
So, for the moment she is staying on 11mg, because with the wedding and company at the house and boarding during different events that require a lot of people at the house, we'll keep her on current dose, then increase to 15mg and see if bringing down the cortisol more, might help the kidneys as we are running low on options there.
That is the current plan.
So, two things I need to find out, would switching from benazepril to enalapril make a difference in the UPC.
Anything at all about dog reaction on kidney protein loss using Losartan in addition to benazepril
got to run back to work.
hugs all
Sharlene -- I've done some research on using ARBs in conjunction with ACE inhibitors. I came across one article that seems to answer some aspects of your questions -- caveat is that it is very, very technical, having been written by and for vets. Here is the link for the article:
http://veterinarymedicine.dvm360.com...ric-drugs-dogs
What I can glean from this 2013 article is that the preferred ACE inhibitor is enalapril and that losartan can be used with it if the enalapril does not lower levels on its own. I would need to spend some more time reading the article to discern why the enalapril is preferred.
I'll do some more research on enalapril vs. benazepril and will let you know what I find.
I know the UPC numbers were not what you were hoping for but it does sound like a difficult issue to treat. A big hug for Molly and you!
Thanks Judi. I read that one and a couple others. Enalapril is the choice drug in the USA while benazepril is the choice drug in Canada. There is no difference really in how they will affect the UPC. Those are the top 2 choices.
Now dang if I didn't find another article about Losartan raising potassium in when used in conjuncture with an ACE inhibitor like banazepril. Well, that's not good, as on her renal profile last week, this is her potassium level currently:
6.0 mmol range 3.6 - 6.0 mmol dang it.
Because there is a risk of the banazepril raising the potassium too. In fact she is right at the highest end already, so how can I add something that will maybe help with the protein loss but raise her into dangerous levels of potassium.
This just seems impossible sometimes, the more I read!
I just don't really know what to do at this point.
We'll try to get the cortisol down lower and hope that helps I guess. Then I'll have to talk to the IMS about that potassium issue too.
If you find anything, holler. I'm game to read anything at this point. Though I admit my head hurts from all of it. LOL
I looked at some more articles about losartan and several of them referred to losartan as "losartan potassium"!
That doesn't sound very promising does it. Grrrr.
Thanks. I'm going to look up that phrase tomorrow.
Hey Sharlene,
When I get home I will search and see what I can find, I thought :confused::eek: that one of the difference between the two is how they are metabolized/excreted, one is by the liver and the other through the kidneys.
From what I read Lori I think that is one of the differences.
I'll have to see f I can find the article that talked about it. I know the first was human patients given both had increased potassium. The other article talked about two different arb that ended up increasing potassium in dogs.
This is interesting. Last slide a bit scary
http://www.canwestconference.ca/PDF/...ria_Slides.pdf
Great find! According to that the side effects of ARB and ACEi are the same. It's good to know that if the ACEi does not reduce the Proteinuria than Losartan can be used along with the ACEi.
The issue is going to be the potassium. If it causes potassium to raise I don't think we will be able to use it.
Hi Sharlene,
I am not sure if this is helpful but my boys are both on enalapril and their kidney values became elevated, not terribly elevated but over the normal range.
We had their US yesterday for their tumors and heart disease and blood work to check their kidneys etc and will have the results later today and will let you know if their potassium and kidney values if this will help you.
Thanks Vicki! I appreciate that!
So how is our little diva?
Molly is...you know..molly. :)
She is doing okay. Loves that the weather is nice. I have to really watch her with the luxating patella though, as she can lose her balance easily. The other day she just went over and rolled onto her back (she was on the grass and playing with a fur friend) and she just lay there legs in the air with a what the heck look on her face. I picked her up, set her to rights, brushed her off and she didn't miss a beat, off to play some more, but this time on the sidewalk, where she has more stability. That girl!! She has a spirit that just won't quit.
I'll be signing the release tomorrow for the pharmacy I am switching too and around the third week of april I hope to have things in place to increase her dosage and start the cycle of testing all over again. We have to get her to a good place so the other things are easier to control.
I'm still fighting sinus problems left over from the whole bronchitis thing in February. Now on some different meds. Man this thing sucks, it's not in my lungs any more, just my head. (well they always say it's just in your head right. hahahahah)
We're swamped literally with wedding and family stuff. Family starts arriving this friday and the wedding isn't till the 11th, so I know I've been scarce around here, but bear with me awhile longer.
Work too takes a lot of time and energy as things have changed and I've picked up even more daily jobs, which just leaves me wanting a nap most days. I crash when I am home. LOL Not as young as I use to be obviously. Not even sure when that happened.
LOL
hugs all!
hi Sharlene,
Seems you are having as hectic a time as we...
I hope all goes well w Molly. Seems like she is a little trooper.
Your energy and optimism is refreshing and strengthening . I wish I could be as so.
No ,matter what tomorrow brings for us, I wish you both good outcomes and more happy times.
Sorry to hear you're feeling under the weather, especially with everything that you have going on. Fingers crossed that everything goes well for Miss Molly when you increase the dose - I'll be thinking of her even if I don't get a chance to drop by.
Well the wedding is over and I am trying to get back into the swing of normal after wedding life again. :) At least until the honeymoon in a couple weeks when we'll be taking care of two cats. LOL
The wedding was beautiful, bride gorgeous and groom handsome, it all went off perfectly, but oh my gosh, exhausting! I think we all slept our way through sunday evening and monday, as much as possible at least between ferrying people to the airport at various times.
Molly is home, yay! I hate when she is away but as much as we loved the wedding, she would have hated it. It took her awhile to get settled this time when she got home. She would be up and down, and not really rest for quite a while, moving from spot to spot. She wouldn't let me out of her sight either, just wanted to be where ever I was. Not her normal thing after being boarded, and I wonder if maybe it is that so many of the staff have changed and not as many of her normal regular people any more. She is much more comfortable it now seems going to the vet hospital where her specialist are and seeing the regular vet techs there. Even though it is huge and she shakes on the way and when we first get there, she always comes out happy as a clam and settled with her regular vet techs who take care of her and do the blood draws and blood pressure. She loves those people. Normally that is how she is after boarding but not this time.
We'll be raising her trilostane dose soon. I have them already from the new pharmacy I'm using.
Well back to sleep. I am trying to catch up on the forum as much as possible. I'm sorry for those I have missed, as I am sure there must be more than a few.
hugs all
Molly will be going back to the specialist for ACTH/UPC this thursday. We increased the dosage of trilostane to 15mg tuesday, 2 weeks ago so it's time to check again.
I've noticed a couple things lately. Eye sight, even though the vet said she her cataracts remain small, she had a couple more retinal bleeds that have now likely scared over as she has real difficulties at night seeing or in low light and shadows become threats and make her very skittish for night walks. She also hasn't walked around the pool outside once since we opened it this year. She just seems to not feel comfortable exploring all the way around. Hopefully as she is out more, she will get more comfortable with her territory and feel safe to explore and enjoy her yard again.
Kidneys, I'm noticing that she has to go out more lately. No accidents, but definitely wants out more often, and gets the tremors in the morning until she can get outside. So we are trying to get her out earlier now. I don't know if that is a sign of the protein loss and kidney issues or not or if she has something else going on. She will have a urinalyis when they do the UPC Thursday so if something is going on, I hope it shows up so we can address it.
Luxating patellas are definitely worse. She wants to walk on the grass but sometimes it is almost impossible for her to remain stable. She doesn't appear to be in any pain, but I keep the halter tight enough that if she loses balance I can support her till she gets back on the sidewalk. The hardest thing is that today, we have a cushy mat in front of the kitchen sink and I saw her hind quarters just drop when she was walking on it at one point this evening. I think it was the leg, but definitely a symptom of worsening, and I hope it isn't anything else. I haven't seen her do it since, so don't think it is a return of the back issue.
It is hard to see their bodies failing them and try to remain positive. Some days it's harder than others I guess.
Over all though, she is still happy, I think. Wants attention, not really playing with her toys as much but sometimes, that comes and goes. She will lay on her back and kick and play with us when we tickle or kiss her tummy. She is always available for treats. :)
hugs all
Sharlene--sure do hope Molly's cortisol and UPC numbers come down! Curious how often you are checking her potassium levels ...
We hadn't done them for awhile prior to the increase in the benazepril and then we did a full renal panel.
So I don't check them every time, but if I see something trending upwards, then I tend to start checking it more often.
I agree. It is very hard to watch their little bodies get more frail. I'm experiencing that with my Molly. Cuddling is fine. It's other activities that are difficult. Some days are better than others. I know there will come a day when we need to decide how her quality of life is. I dread the day. She will be 14 in September. The IMS commented on Thursday how cute they are in the kennel together. She said Kaibo was wrapped right around Molly as if to be protecting her and comforting her. Ummm. Excuse me!? I said I need a picture of that! Then, as if on cue, as I put them both down on the floor, Molly barked at him and told him right off. Omg.
So for the first time in forever, molly's cortisol levels are controlled.
7 May, 2015
pre 44nmol (1.59ug)
post 103nmol (3.8ug)
This is after an increase to 15mg trilostane from 11mg trilostane. 2 weeks, so I expect it will go down more, but hopefully not too much. She will be retested the end of june to make sure. I can't do anything sooner as I can't miss work, we are all on no time off orders starting beginning of june to mid june. It did drop over 200 points though, so I will watch her closely.
Her kidney levels are all within range and she is concentrating urine still
Even potassium is down to 5.1, and within range.
Her UPC remains at 2.7 and we're just going to monitor that.
Her ALT is raised to 224 from 163 in Sept, 2014
Her ALKP is raised 1742 from 1400 in Sept, 2014
I don't have the ranges as I got this all over the phone from the IMS and she'll be emailing me copies of the reports later.
Ultrasound shows no major changes. Adrenals still bilaterally enlarged, no change in the nodule, liver shows normal expectations of high cortisol.
So, it's a good report. I just have to watch for any adverse reactions that might indicate she has gone too low on the trilostane. If she does we'll have to back off to 14mg.
hugs
Fabulous report!! :D Keep up the good work, Sharlene & Molly!!
Sounds like a good report, Sharlene! You deserve a pat on the back at the very least (maybe it's lobster time now? ya know, as in someone drives you to the lobster and cooks it and cleans up after? :D ).
Could be lobster for lunch and dinner time!!!!!! Great news...
Yes, terrific well-deserved news indeed!:p
good news for you and molly!
I am thinking about this and need to decide today.
Before we keep molly at 15mg, maybe I should have another test in 2 weeks to see if she has dropped further or too much.
Looking at this history, I have some concerns:
on 8mg trilostane
ACTH Oct 17, 2014
Pre 74 nmol 2.68ug
1hr 858 nmol 31.09ug
2hr 1024 nmol 37.11ug
ACTH Nov 07, 2014
Pre 102 nmol 3.69ug
1hr 582 nmol 21.09ug
2 hr 608 nmol 22.03ug
01/18/2015
Pre - 89
1 hr post - 378
2 hr post - 499
increased to 11mg
20/22/2015 (2 weeks ago)
pre - 166
1 hr post - 339
2 hr post - 389
03/18/2015
pre (?)
1 hr post - 326
2 hr post - 356
increased to 15mg -2 weeks ago
05/07/2015
Pre 44
Post 103
Any thoughts? I'm wondering if maybe she will continue to drop too much on the 15mg and needs to be a 14mg or 13mg instead.
I just don't know, but since I can't get off for a test till later in June, I don't want to take any risks..arghh
My IMS said she would order in 40pills of 15mg for monday. So, I'd have to send an email saying not to place that order today.
What a drop in that post number! which is good!
She was increased to the 15 mg after that March stim test? If so that I think the 15 mg should be fine. You could always get the Trilo compounded in a few 2 mg and 10 mg capsules if you decide to decrease her 15 mg dose, although that would probably be a pain in the butt.
How does she seem to be feeling?
We didn't increase the dosage until 2 weeks ago as I didn't want to have an increase during the whole wedding stuff going on. So she stayed on 11 mg until 2 weeks ago when we increased to 15 mg It scares me that she dropped that much that fast.
I think she is okay at this level. It is going lower that worries me.
Sharlene -- I'm trying to follow the numbers you posted but am confused. Why are there three numbers for all the tests except for the 5/7 test rather than just pre & post numbers?
In canada we used the same stimulating agent uses in the UK Australia Europe. That company was sold and it is no longer available to be used for "pets". This last test was done using the same stimulating agent used in the US and follows its protocol of only doing one post draw.