Tipper - adrenal tumor/breathing issues

Hi and thanks for posting the stim test results. Are you sure the extra blood draw was done for a full blood chemistry or was it to check the electrolytes, which should be done with every acth stim test? If it was done for a full blood chemistry, in my opinion, it's premature and a waste of money. It makes more sense to get Tipper's cortisol within the therapeutic range of 1.4 to 5.5, or as high 9.1 if all symptoms have resolved, before doing another full blood pane. Since Tipper's post stimulated cortisol is too high, you would have to expect that some, if not all, blood abnormalities are still abnormal. Did your vet mention what the next step is to get Tipper's cortisol to an acceptable level?

With reference to the tremoring, I think I mentioned previously that we've had a lot of members who report that their dogs developed tremors after starting Vetoryl treatment. The majority reported that tremors were noticed at rest or during sleep. I don't recall that any of these dogs were experiencing joint pain during sleep and not during waking moments. Does Tipper act arthritic during the day? i.e. any struggling or apparent pain in trying to stand from laying or sitting position? Any noticable stiffness while walking? If no to these questions, I believe that it is highly unlikely that the tremors you are seeing being caused by joint pain. Has your vet done xrays and/or manipulated Tipper to confirm or rule out arthritis?

Glynda

Glynda:
I am confused- the Vet told me her cortisol is at a good level now. The test says anywhere between 6-18 is normal. What am I goofing up here on? Tipper does have some slight displaysia in her hips as of years ago. Since she is 11 she could have arthritis. I don't think they really know what causes these tremors, and they are guessing at best. Thanks for your help in advance, as you really have me going about this cortisol now. The reason he does the Early Detection Profile is to see if there are any problems with her liver, kidneys etc. so it would be caught early. He also does urine testing at the same time.

Quote:

---

...the Vet told me her cortisol is at a good level now. The test says anywhere between 6-18 is normal.

---

This is something we see often, unfortunately - vets who don't learn how to read these tests and therefore base doses on incorrect info. That range, 6-18, is normal for an UNTREATED dog - a dog that does not have Cushing's and/or is not on treatment. Once diagnosed and treatment is started, that range changes depending on which drug is being used.

The post range for a Trilo pup has to be between those values Glynda gave. If the post is higher than 5.5, the dose is probably not right. IF all signs are controlled, the post can go up to 9.1 - but no higher.

Hope that helps you understand a bit better.

Hugs,
Leslie and the gang

Leslie:
Not knowing what to do, I called Dechra, and they said that Tipper is where she should be for now. They said she has steadily been coming down, and they don't want to rush it. They told me since her clinical symptoms have mostly disappeared that is what we need to pay attention to now. They told me they do not want her to get to the lower end of those numbers, as then she can have problems going too low. They said just hang in there and see if her number continues to drop on it's own. If she has no more symptoms, and she is at 11 and Glynda says 9 is ok she is not too far away. Does everyone agree with this or not?? I would appreciate everyones input, and Glynda especially what do you think? I don't want to rock the boat and make her worse off than she is. She has been doing well like this. Please tell me what you think as this makes me nervous. Thank you Leslie for explaining this to me I did not know all this and I appreciate it. I hope to God I am doing the right thing here. Thank you all for you help.

Hi Patti,

I was unable to find any prior acth stim tests so I had nothing to compare this latest stim to. Tipper has been on 10mg am and pm since August 25 so it is possible that her cortisol could continue to drop. We've seen some dogs whose cortisol continued to drop well into the 60 day mark and a few into the first 90 days of treatment. If Tipper is doing well and all of her symptoms have resolved, then I would agree to leave her where she is and see where cortisol levels are in 30 days. You'll find that a lot of members believe that treating the symptoms are preferrable to treating the numbers; however, I'm not one of them. I believe therepeutic ranges are established for a reason. It is when pre and post stimulated cortisol levels are within this range that one can expect full resolution of symptoms as well as continued normalization of blood and urine abnormalities.

Tipper is early on in treatment so if she were mine, I'd do exactly as Dechra has recommended. FYI, their recommendation is contrary to their published monitoring protocol which reflects that a dosing increase is recommended if any post stimulated cortisol in excess of 9.1 ug/dl, regardless of symptoms. If you are confused, you're a perfectly normal cushdog parent. It's all overwhelming at times and not everything makes sense until you have all the pieces of the puzzle. Trust me when I tell you that if you make a concerted effort to educate yourself, you'll wake up one day and realize you have all the pieces to the puzzle and that somewhere along the way, you became an excellent advocate for Tipper. You are well on your way, Patti.

Glynda

Glynda:
Thank you so much for you help. I wanted to give you Tipper's other results :
8-1 Pre-6.4 Post- 27.9
8-24 Pre- 7.6 Post- 4 hr1.3 Post 8 hr 1.0
9-12 Pre- 9.6 Post- 15.2
10-10 Pre 4.6 Post 11.0
Do you still think she is on the right track?? I sure hope so. It seems Dechra does give conflicting information at times- look at the different things they told me about the tremors! In her blood panel she also has her electrolytes checked- I forgot that on the last post. You guys are all sure amazing, as my head feels like it will burst from all the Cushings information. I am so glad for you all this again, is a blessing to be able to get your help. Hope all the babies have a good day.

Glynda:
Please look at my thread I posted Tipper's stim results and want your opinion if I am still doing the right thing with her.
Thanks in advance, you are a life saver.

Hi. I'm looking at the results and they did come down from Sept to October and I can see why they might think that staying the course is the thing to do for now if the numbers continue to come down.
I'd go with symptoms and how they are doing and then retest in November, staying at this dosage unless any symptoms get worse.
If I understand correctly, while on treatment you are looking for the second number (the post) to come down to below 9.0. It's moved from 15.2 to 11. in a month. You don't want a fast downward spiral as often cortisol levels continue to drop (but because they can always start heading north, we do the testing). We aren't seeing that here though. So, I think you are fine for now.
Lets see what November looks like and how Tipper's symptoms are.

hugs,
Sharlene

Sharlene:
Thank you so much for looking at Tipper's numbers. I second guess, third guess, and fourth guess everyhting I do!! I am a novice at this and really appreciate the help. I hope she keeps going well, and staying on course. God Bless you and all the babies on here. Hope all the babies have a good day>

Hi Patti.

Sorry for missing your post yesterday but see Sharlene had the bases covered. The opinion I expressed in my prior post included consideration for Tipper's last post stim of 11 ug/dl. As long as Tipper's symptoms have resolved completely, then I'd stay the course for another 30 days.

Glynda