Tess, radiation therapy (Tessie has passed)

Admin note from Terry (Mytil): The following message was sent to us via Forum Feedback and I have started this new thread for "Sammie"/ Dottie and Tess.

Admin note Alison (AlisonandMia) on 07/10/09): I have changed things so this thread now belongs to Dottie (username: Sammie)


On the first day of Vetoryl which was given at 7:00 a.m. on a full stomach,Tess front legs started to shake really bad. That had never happen before, only the back legs. She was just staring at the wall in bed. She sleeps with me. She is taking at once two tablets at once 30mg each tablet, so 60mg of Vetoryl. She is 22 to 25 pounds. The second morning again at 7:00 A.M. two more tablets. Around 5:00 P.M. notice she did not want to go for a walk with the other dogs. Not drinking any water. This is 4th of July night. Got her to walk down the street and a firework went off. She freaked. I called the vet at his house. While I was on the phone with him she vomited. Forgot the first night she would not stop shaking, breathing really hard. back to second night. She is now weak, cant walk, and has vomited 6 times though out the night. The last one was pure stomach acid. Yellow smelled like acid. Its sunday July 5th 2009 and I am trying not to call the vet. I found soaking her in a wet towel helped, she is still shacking and her tong keeps coming out of her month licking at the air. I have a medicine dropper and I am giving her water with it. I pinched her skin and it does come back. Her gums are a pale pale pink/white. She had a chusing test and it was positive. So she is dehydrated from vomiting, Not giving her to much water. I don't want her to vomit again. Its the very hot body and shaking of the stomach that I am worried about. I can't find anything on it. Vet said she has something else going with her and that Vetoryl should not of made her sick. Help me fast please.

Dottie

Hi Dottie,

Stop the Vetoryl. You should never give it to a sick dog. It does seem to be too much of a coincidence that she has been ill as soon as you started the Vetoryl.

If Sammy is not improving you need to get her to the vet for maybe a steroid injection and some prednisone to combat the drug.

What tests did you have done to confirm cushings? How old it Sammy?

Please come back and tell us how things are going.

Jenny

Hi Dottie,

I hope you received my email with the link to this thread.

I agree completely with Jen here, stop the Vetoryl until her condition improves. Is she taking any other medication that may have interacted with the Vetoryl?

Here is a link for you on Vetoryl - http://www.k9cushings.com/forum/showthread.php?t=185. Take a look especially at this link Treatment and Monitoring Flowchart. From this it sounds as 60mgs is too high of a dose with the weight you have given.

Terry

The best advise I can give you, is to bring her to a vet asap. Pale gums are always a reason to see a vet asap. Could be the Vetoryl, could be something else but she needs to see a vet.

The air "licking" probably is a sign she is nauseous. But not giving her the amount of water she needs because you're afraid she'll vomit again, is not the way to go. If she is dehydrated, as you say, but also you mention her skin is popping back...she needs fluids and not just a few drops through a medicine dropper. There is just one way to handle this and that is taking her to a vet, as soon as you can. And to not give her any more Vetoryl till she has seen a vet...

Good luck,

Saskia and Yunah.

Hi Dottie,

I agree with the others. Stop the Vetoryl and see your vet. We used vetoryl here. After only 2 doses my little girl started vomiting too. The dose was to high for her. We stopped it for a couple of weeks and then started back on a lower dose and she was fine with it after that. Good luck and let us know how things are going.

Hi Dottie,

PLEASE stop the Trilo and call the vet asap! Your baby is in crisis and needs medical attention. If you have prednisone give it now, call your vet to let them know what you have done and insist that they see Sammy now.

Dottie, this is not something to "wait and see" what happens. This could be the result of the meds, a misdiagnosis, pancreatitis, and many other things.

I hope we hear from you soon as I am worried about Tess. You did really good in reaching out to Terry for help. :)

Hugs,
Leslie and the girls

Hi Dottie,

I hope you have received Terry's email and been able to follow the link and read these posts. I, too, agree that Tess is in need of a vet or an ER visit right away and please, do stop the Vetoryl. It should not be given to a dog who is vomiting and ill.

The following is information from Dechra re Vetoryl.

Quote:

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ADVERSE REACTIONS:
The most common adverse reactions reported are poor/reduced appetite, vomiting, lethargy/dullness, diarrhea, and weakness.

and

Owners should be instructed to stop therapy and contact their veterinarian immediately in the event of adverse reactions or unusual developments

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The cushings diagnosis and treatment can be discussed later. We'll all be here for you to help. Right now the #1 priority is to get Tess to the vet for help.

Louise

(Who is Sammie?) :D

Hi Sammie is my user name, but Tessie is the name of one of my dogs and she is very sick. Last night at 2:00 A.M. I took her out to pee. She did, she was so hot I put another wet towel on her. I feel asleep and woke up to Tes wanting to be sick again. I helped her do that. Turned on the light to get some more water. I saw that her eye's were going back and fourth very fast. At 4:20 A.M. I rushed her to the emergency Vet. Her blood was took thick to draw and run a test, so they got fluid's in her. About 20 or so minuet later, they got blood and every thing was out of whack. The vet said she now has Addison's disease, which is the opposite of chusings disease. We were there tell 8:00 A.M. and we transfered her to my Vet for the day. She is home on the couch for the night. She is doing better, but she has not come back from this yet. I have to Vets now with two different opinions. I have been with my vet for 11 years and trust him. He thinks after two days on Vetoryl that it could not get to Addison's. He did say because of the eye's going back and forth it could be another disease, I will post the name of that disease tomorrow. I forgot the name. He said it was just bad timing for that disease to pop up while we were starting the Vetoryl. My Vet still feels she has chusings.

LADYMOMS6: You are the only post I have seen after two days of searching that had the same thing happen to them. I could not find any thing except for what was on Vetoryl web sit that you have all kindly posted for me. I was at my wits in. I had called my Vet on Saturday at home, But from 5:30 P.M. Saturday to 24 hours later she really went down hill. I will never wait that long again. I have a total of 5 dogs.

My Vet said he might want to start her when she is better on Lysodren Mitotane. Tessie was not on any other medication before she started Vetoryl. She has been given a steroid injection and a injection for nauseous.

I just want to thank you all and am watching over Tessie all night and she will go back to My Vets at 6:30 A.M. California time. I had been up for two days straight, except for that hour last night. Thank god Tess got me up and I got her to the Emergence Vet. Next time there will be know waiting. My vet said if she was still walking around and not lethargy that she might be ok. That is why I waited so long. Thank you all again and I will let you know how it goes.

I am sorry I called Tessie the wrong name.:o
I am glad you got her to the vet because it sounded like she was in real trouble. If she has gone addisons it must have been the vetoryl and makes me wonder about the testing that confirmed cushings. Sometimes getting a correct diagnosis of cushings in all it's forms is hard to do. Once the Vetoryl wears off and the injection should speed things up you should see a great improvement. I would not be starting Lysodren or Vetoryl again until you get some more testing done. If Tessie stays addison then you will have to medicate her for that.

Jenny

Just cared Tessie out to the lawn and she held her own weight and peed. She is still really weak.:)

Please tell us what tests were done to confirm your dogs diagnosis for Cushings. With the way your dog reacted to the few trilostane treatments makes me wonder if your dog has cushings for sure. We have seen it happen here a number of times. Diagnosing Cushings can be difficult sometimes and some vets not familiar with treating cushings have even misinterpret test results.
I am glad your dog is doing better, do you have the test results from when you took your pup in to the vets? When you say all the results were out of wack, please post them, normally with an addisons crisis the Potassium and sodium do get out of the normal range, that is why it is so important to get your dog to the vets asap when that happens.
You will want to be sure you get copies of all the test results your dog has, it is a good idea to keep the copies in a file at home, you never know when you will need it and it is a great reference. I think most of us keep copies, as well sometimes it is hard to remember when the vet talks to us so we have the results.
Please continue to watch your dog, did the vet give you prednisone in case your dog got sick again?
Sharon

I am so relieved that you posted an update as I was horribly worried about Tessie! I am sure that you saved your dog's life going to the ER vet. Thank God you did. Good job.

Please continue to post as this group has seen alot of similar cases over the years and we can help but we need to know as much as possible about Tess, the doses etc.

First off as Mytil said earlier it appears that the dose you were on was significantly too high for your dog's size. Its too late to undo that but Addisons can result from too much vetoryl/trilostane. And if the dose is too high it can certainly happen in just two days. Sometimes it is permanent and sometimes it is not. The symptoms you described we have seen many times here and they are of overdose. Has your vet done any testing to see what the cortisol levels are? He/she can't say if it is addisons or whether its something else without testing.

I assume that in addition to the steroid shot that your vet has given you prednisone to give Tess to help restore her current LACK of cortisol? Also were the electrolytes checked? This is important. Typically after an episode like this it takes treatment with IVs for a day or so for the dog to get stable. Did your dog stay overnight at the ER vet's?

Please get copies of the testing done and we can help you decipher what it all means.

You mentioned another vet saying you should try lysodren/mitotane. Please do NOT give this drug yet. First off you have to be sure the dog is not addisonian. If your dog has Addisons and you give her lysodren the result could very well be fatal. Even if your dog still has cushings you must wait for all of the vetoryl to be out of the system and for the cortisol level to RISE before giving lysodren.

I'm not sure which vet is saying what but one of them is clearly not aware of how to treat cushings dogs. That is why we need to know more. Tell us all you can - we are here to help.

We all found this forum the same way and were scared. Cushings is often misdiagnosed and mistreated - but it isn't bad if you know about it. We'll help you with that part.

Again thanks for getting back to us. We were worried about you and Tess. Please - no more vetoryl or lysodren until we find out what Tess's cortisol level is ok? Hang in there!

Kim

Quote:

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Originally Posted by BestBuddy

I am sorry I called Tessie the wrong name.:o
I am glad you got her to the vet because it sounded like she was in real trouble. If she has gone addisons it must have been the vetoryl and makes me wonder about the testing that confirmed cushings. Sometimes getting a correct diagnosis of cushings in all it's forms is hard to do. Once the Vetoryl wears off and the injection should speed things up you should see a great improvement. I would not be starting Lysodren or Vetoryl again until you get some more testing done. If Tessie stays addison then you will have to medicate her for that.

Jenny

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I agree 100%. I wanted to do the 8 hour test for Chusings, but My Vet said that the two hour test was fine to do and normally this is enough. I said this to him today about the test. I will be having the 8 hour test. I don't want to start her on Lysodren ever. I too think the does was to high. Just by going to there web site I could tell from that chart. Thank you for posting that. I had been there before all of this. I did a lot of research before her first test. All signs point to chusings. They still point that way. Addison's would be easier to have for her. Only from what I have read. Can any one tell me from experience how is it with a dog with Addison"s? TY again you guys are great.

Hi,

I'm so glad you took Tessie to the ER and that she is more stable. The Vetoryl Treatment and Flowchart states the following:

Quote:

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PRECAUTIONS:
Hypoadrenocorticism can develop at any dose of VETORYL Capsules. In some cases, it may take months for adrenal function to return and some dogs never regain adequate adrenal function.

---

Hypoadrenocorticism is the opposite of Cushings and is what the ER vets said happened to Tessie. Many of us have had vets we trusted and had been with who were not knowledgeable about Cushings disease nor followed protocol for treatment. I was one of those people and my dog suffered as he was not sufficiently tested and was incorrectly diagnosed w/Cushings and given Trilostane. It was a nightmare for him and me.

What tests did your vet do to diganose cushings? Also it would be very helpful if you actually get copies of those lab results and post the results for us.

I will be interested in finding out the name of the other disease your vet is referring to. Tessie needs to recover from this. If it is Addison's disease you would not want to give her any Lysodren. If she is ill with some underlying disease the whole Cushings diagnosis could be skewed.

We're here to help so hope you will continue to post and give us updates on Tessie.

Louise

Quote:

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Originally Posted by ventilate

Please tell us what tests were done to confirm your dogs diagnosis for Cushings. With the way your dog reacted to the few trilostane treatments makes me wonder if your dog has cushings for sure. We have seen it happen here a number of times. Diagnosing Cushings can be difficult sometimes and some vets not familiar with treating cushings have even misinterpret test results.
I am glad your dog is doing better, do you have the test results from when you took your pup in to the vets? When you say all the results were out of wack, please post them, normally with an addisons crisis the Potassium and sodium do get out of the normal range, that is why it is so important to get your dog to the vets asap when that happens.
You will want to be sure you get copies of all the test results your dog has, it is a good idea to keep the copies in a file at home, you never know when you will need it and it is a great reference. I think most of us keep copies, as well sometimes it is hard to remember when the vet talks to us so we have the results.
Please continue to watch your dog, did the vet give you prednisone in case your dog got sick again?
Sharon

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Hi I left my copies of the lab test with my Vet I will get them back and post them. Yes the Potassium and sodium were to high. The Potassium is down. Can't remember the one that is to high right now. I know I should remember more, but my other dog (Bunny) had a 7 min seizure and they are getting worse. She had this yesterday evening while I was caring for Tes. Then coming back from My Vet Bunny gets bit from my Lab (Lindie) in the neck. Not bad, but back to the Vet's for a shot and Med's. All of this with know sleep.

Yes I will start a file. Your right it might come in handy. TY Dottie
Forgot my Vet has 5 or dogs right now with Cushings. I have know problem switching vets. There are specialist in Orange Counting I can go to

Hi Dottie,
I hope that Tessie is still doing okay. Sending out healing thoughts and prayers for her. And also for little Bunny. It sounds like you have your hands full. They say when it rains it pours, and we need real rain here in So. Cal, but don't need to pour more problems for you.

I do have a huge concern about your vet prescribing such a small 20 lb pup such a large dose of trilostane and then saying that it could not cause addisons. Each dog reacts differently to any drug, but it seems in particular to trilostane. We've had large dogs on minscule amounts and small dogs on comparatively large amounts and vice versa. But the one thing that we have discovered, is start with the lowest possible dose and work your way up.

Before you attempt to start the medication again, be sure to have her thoroughly tested for cushings. You said that your vet currently has five cushings dogs. I truly hope that they are doing better than poor Tessie. Did he/she ever mention the University of Tenn Adrenal Panel. It will tell you if Tessie has Atypical Cushings, which is NOT treated with trilostane, but instead with melatonin and flax seed. I am not familiar with the dosing, etc., but there are several here that are having great success. And others that are thriving on the correct doses of trilostane or lysodren. It is so important to get the testing done. And you are so right to insist on additional testing.

I hope that you are able to get the ACTH test results and post them. There are several here that can help you interpet most of the lab results.

Continued prayers.
~ Mary Ann

Thank goodness you got Tess to the emergency hospital. When I read your post it was obvious that Tess was in an Addisonian crisis so I am not surprised that the ER vet was able to make this determination. At 20 pounds, Tess should not have been prescribed any more than 30mg once daily so she was getting twice the recommended dose. I must respectfully disagree with your vet and tell you that we have seen this time and time again. Dogs are extremely sensitive to Trilostane in the first few days so with Tess getting almost double the recommended dose, her cortisol and obviously the aldosterone dropped like a rock. Your vet is probably assuming that because Tess' eyes were darting back and forth, it isn't Addison's but peripheral vestibular syndrome and it was a mere coincidence. If the ER diagnosed Addison's then they checked the electrolytes and quite possibly they ran an ACTH stimulation test which would have shown that Tess' cortisol was not registering at all. It is extremely important that Tess continue receiving prednisone or florinef.

It sounds as though Tess had a severe crisis and I am very concerned that she is already home. Most dogs in her shape are extremely dehydrated and in order to correct the electrolye imbalance, the dog is on intravenous fluids for 24 to 48 hours and until the dog is eating and drinking on its own without vomiting. A dog also getting injections of florinef as there is inadequate reserve of cortisol. Once off of the IV and the dog is eating, the injections of florinef can be switched to an oral medication and this must be continued until the adrenal glands can start working on their own. How long was Tess on an IV and was she sent home with Prednisone or Florinef?

I have two cushdogs, both of which treated with Trilostane and while I am not a medical professional, I know the drug like the back of my hand. I was so distraught when my dogs were diagnosed, I became obsessed with learning everything I could about the drug. UC Davis did their own clinical trials and found that there is a great disparity in the dosing by weight recommended by the manufacture of Vetoryl aka Trilostane. They had many dogs that went into Addison crises at these recommended dosing and as a result, their own dosing protocol is much more conservative. Based on their protocol, Tess would have been started on 20mg once daily. 60mg is huge in comparison and I really think that every horrible thing you saw Tess going through was a direct result of her being overdosed.

My dogs treated with the same vet for 10 years and I trusted him implicitly. Unfortunately, I didn't know back then that a good number of gp vets don't have much experience with cushing's and they are a cushdog's worst nightmare. I found out that our bad experience wasn't so rare as many members had alread walked in my shoes. The fact that your vet doesn't realize that the dose he prescribed is too much and that dogs are extremely sensitive to the drug in the first few days is an indication that he isn't that experienced with the drug and perhaps not the disease. GP vets can be the absolute best vet in the whole world when it involves nonadrenal disease; however, when it comes to cushing's or any other endocrine disorder, many haven't had the extensive training, education and vast experience that an internal medicine specialist has. It wasn't until I found a wonderful internal medicine specialist that my dog was correctly diagnosed and stabilized. To this day, I resent and am so terribly disappointed in my old gp vet for letting my Lulu suffer for so long. We can place blind faith in our vets to do what is right by our dog for a lot of things but cushing's isn't one of them. Addison's is a very, very serious condition and I highly recommend that you consider consulting with an IMS in your area.

It sounds like you are in Southern California so I have no problem recommending excellent specialists in Los Angeles and Orange County. If you are in Orange County, I highly recommend that you consider VCA All Care Referral Center in Fountain Valley. I live in Rancho Cucamonga and don't mind the hour to hour and half drive there. My dogs treat with the Director of Internal Medicine, Dr. Michael Moore. If you are closer to L.A., I highly recommend Dr. David Bruyette, Medical Director at VCA West Los Angeles Animal Hospital. Both of these specialists are excellent and I don't know if you have noticed but we have a video of Dr. Bruyette discussing Trilostane in our Resources Forum.

VCA All Care Referral
http://www.acarc.com/

VCA West Los Angeles
http://www.vcawla.com/

I too will be looking forward to hearing more about the tests that were done to diagnose Tess as well as tests done by the ER vet to diagnose Addison's.

I am so sorry that you and Tess have been through such a horrific ordeal but I am glad that you found us. The collective experience and knowledge base here is amazing and you will find no better handholders anywhere.

I will be thinking positive thoughts for Tess. Please keep us posted.

Glynda

Hi Dottie,

I cannot tell you how relieved I am that you got Tessie to the ER. You done good, mom! :):cool::):cool: I really was worried about coming on today and finding bad news on your thread. :(

You have been through a very rough few days here lately and I am worried about you, too. I have four babies and it seems something is always going on with at least one of them so I can understand the strain you are feeling right now. You must take care of yourself, too, Dottie. Sleep whenever you get a chance, do something to help you relax a bit from time to time, and know you are not alone...we are here with you all the way.

You mentioned you didn't want to use Lyso for Tess "ever" and I want you to understand something. What you have just been through on Trilo is exactly what people fear with Lyso. They are often told that Trilo is much safer than Lyso with no "side effects" like Lyso can produce. You have just experienced those exact same "side effects" with Trilo...the "safer" drug for Cushing's. The "side effects" of either of these drugs is usually the result of misdiagnosis, incorrect dosing and monitoring, and lack of educating the parents on the part of the vet and/or lack of diligence on the parents part. You carried your part quite well with the limited information and tools you were given by your vet. IMHO your vet failed miserably on his part. :( My point here is that you have nothing to fear from the Lyso now as you have already been through an Addisonian crisis produced by the Trilo. You now know the worst. The danger isn't in the drugs themselves - the dangers lie with a vet that isn't as cush savvy as they need to be.

That doesn't mean you have to give up on your vet, tho. If they are willing to listen to you and work with you as a team, then this is a BIG plus in their favor. This is where your cushing's education come in. Your vet has the years of experience and training in general animal care to bring to the table; as you learn more about Cushing's, you will bring that specific knowledge to the table along with all of our experience and first-hand knowledge. In this manner, together you will make a formidable team working for Tess. :cool:

I am so proud of you for insisting on further testing! :D This decision alone may prove to be the very thing that saves Tess' life now and gives her many more years of quality days ahead with you. Way to go, mom! :cool::cool::cool: But don't rush the testing. She is in physiological stress right now and that will skew any Cushing's testing, plus those for Addison's. So let her recover from this crisis, if she does, then look into further testing. I HIGHLY recommend that she have the UTK panel done first, then an ultrasound done on a high resolution machine. These two tests will give you more information and a more solid idea of whether you are dealing with Cushing's or not, and which kind if she is cushinoid.

We continue to send healing thought and prayers your way,
Hugs,
Leslie and the girls

Ok I am not sure how to get this info to you all to help me. The lab results aren't any that I understand. So Here goes.

The first one is from the Emergence doctor.
JUNE 6 2009 4:34 A.M

ALB 2.8 2.5-4.4 G/DL
ALP>2400% 20-150 U/L
ALT 377% 10-118 U/L
AMY 907 200-1200 U/L
TBIL 0.3 0.1-0.6 MG/DL
BUN 50% 7-25 MG/DL
CA++ 11.9% 8.6-11.8 MG/DL
PHOS 6.8% 2.9-6.6
CRE 4.2% 0.3-1.4 MG/DL
GLU 85 60-110 MG/DL
NA+ 149 138-160 MMOI/L
K+ 7.2% 3.7-5.8 MMOI/L
TP 6.0 5.4-8.2 G/DL
GLOB 3.2 2.3-5.2 G/DL
QC OK
HEM 0, LIP2+, ICT 0

NA:K=20.7 This is hand written in a separate box by the doctor
PCV/TS- Also hand written in same box
44%/4 g/dl also hand written in same box
Colloids/unit 0.20
Notes from emergence doctor.

S:Lethargic. Has vomited bile approximately eight times in the past 48 hours. Tessie was still walking around 4 hours ago but then became very lethargic. The owner also noticed that Tessie's eyes were rolling around in her head. Trilcstane 60 mg PO SID was started Friday. Tessie received the last does of Medication Saturday at 7 am.

O: EENT: Horizontal nystagmus with fast phase to the right, prolonged CRT with tacky gums, severe dental calculus: integ: full coat, small SQ masses, normal skin turgor. PLNS: WNL; M/S:
recumbent/nonambulatory, cool extremities; N/S lethargic; cardio: NSR, normal pulses, resp: increased bronchovesicular sounds; abdornen: slightly tense; U/G: F/S

A:Vomiting, lethargy- R/O adverse drug reaction to Trilostane +/- iatrogenic hypoadrenocorticism (most likely) old dog vestbular disease, HGE, pancreatitis, ect.
Horizontal nystagmus-R/O secondary to electrolyte imbalances, neurologic signs seconary to cushings, old dog vestibular disease ect.
Poor perfusion-R/O hypovolemic shock

P: Adised owner of guarded prognosis. Placed IVC. Unable to obtain i-Stat to assess electrolytes on presentation because Tessie's blood was too thick and clotted in the cartridge. Administered 250 ml bolus normosol-R IV. Unable to obtain a blood pressure, and extremities were still cool. Tessie began to have frank blood in her stool in addition to dark brown diarrhea. Drew blood again following intial bolus: VetScan- ALP>2400 U/L, ALT 377 U/L, BUN 50 mg/dl, CA++ 11.9 mg/dl, PHOS 6.8 mg/dl, CRE 4.2 mg/dl, K+ 7.2 minol/L, PCV/TS- 44%/4g/dl. R/O Addisonian crisis. Repeated fluid boius and administered 0.15 mg/kg dex sp IV. Administered 75 ml hetastarch IV for oncotic suuport. Transfer to RDVM.

Breed Yorkshire Terrier/ Shitzu
Age 12
Weight 23.20 LBS

My Doctor:
JUNE 1 2007 This is when my doctor ran the Cushings test.

ACTH STIMULATION RESULTS
PRE-ACTH CORTISOL 5.1 UG/DL
POST-ACTH CORTISOL 41.5 UG/DL

CANINE:
2-6 PRE-ACTH (resting) cortisol
6-18 Post- ACTH cortisol
18-22 Equivocal post-ACTH cortisol
>22 Post-ACTH cortisol consistent with hyperadrenocorticism
<2 Post-ACTH cortisol consistent with hypoadrenc corticism
1-5 desired pre- and post-ACTH cortisol on lysodren therapy

Notes from lab:
ACTH response test is only clearly positive (>22) in 30% of dogs with hyperadrenocorticisn (HAC); equivocally positive in another 30% of dogs with HAC, and normal in 40% of dogs with HAC.

If the ACTH response test is normal and HAC is still suspected, proceed with a low-dose dexamethasone suppression test.

Dogs with iatrogenic Cushings disease will have flatline response test results in the low end or below the normal reference range.

I don't have the yesterdays ( 7/6/09) or today (7/7/09) blood work from my doctor. Will get them tomorrow 7/08/09.
Dottie

The name of that underline disease that I could not remember is called
NYSTAGMUS. I have never heard of this. Will now be looking that up
Tessie is home tonight, will go back tomorrow for more IV. She is doing much better. She hate a little chicken. My vet said it was ok. She is drinking water and walking around slowly. She just tried to poop and a little diearea came out, but she has not eaten sense Friday morning, so i think that would be normal. She is sleeping here on the couch. My vet does not have 24 hour care so that is why she is home with me. PS. Tessie was to be on the DBL dose for ten days only, then she was to be dropped down to one dose a day or a week . I can't remember right now. The idea was to bombard the system, get a blood test in a week and then lower it or higher it. We all know now it was to much for her. Dottie

These test results clearly indicate that Tess suffered from a critical Addisonian crisis. The results that indicate this are the elevated potassium, the decreased sodium/potassium ratio is even a bigger indicator. In a normal pup, this ratio should be between 27:1 to 40:1. This is a pretty severe decrease which is a clear indication of an Addisonian crisis meaning that the adrenal glands, besides not secreting enough cortisol at this point, are also not secreting enough aldosterone. Aldosterone is a very important hormone as it controls the sodium & potassium levels in the body. Serious imbalances in these 2 (electrolytes) can be life-threatening.

As Glynda mentioned last night, I am also very concerned that Tess is already home. Is she receiving some type of steroid, along with a florinef injection? The bloody diarrhea is another clear indication that Tess really needs to be at the vet's on IV fluid, where she can be closely monitored with regular labwork to monitor her electrolytes. The other thing that disturbs me on the labs you have posted are the elevated BUN & creatinine results. These are the 2 major tests that monitor kidney function. With these elevated results, there is apparently some impairment of kidney function, but it's hard to tell if this has also been brought on by the Addisonian crisis.

Please, please ask your vet for a referral to an IMS, & get Tess there ASAP as I'm very fearful that she is not out of the woods just yet.

Debbie

Hi and a belated welcome from me too.

I'm wondering if you've been given any tablets for Tess to take now. Prednisone is what is usually used. Or maybe the emergency vet has given her some sort of steroid shot? This is quite likely if she was vomiting and unable to keep pills down. It would be good if you can find out the name of any medications they are giving her.

Nystagmus is rapid eye movements caused by a disturbance to the balance mechanism in the inner ear. The balance mechanism is called the vestibular system and when it is affected this way it is called Vestibular Syndrome (http://www.vetinfo.com/dencyclopedia/devestib.html). No one really knows what causes it in most cases and it seems to be something that happens more often in older dogs than younger ones. Sometimes it is caused by an ear infection and I'm sure the emergency vet checked out this possibility. It isn't a symptom of low cortisol as such but we have seen a couple of dogs that seemed have it come on when their cortisol went too low so maybe it can be triggered by low cortisol in a susceptible dog. Other symptoms of Vestibular Syndrome can be lack of balance, circling, head tilt and nausea and vomiting (but not diarrhea as far as I know unless anxiety caused by the balance problems triggers diarrhea in a particular dog.)

It does sound like her biggest problem is that she is Addisonian at the moment as a result of the Vetoryl and that the vets are working to manage both problems - the Vestibular Syndrome and the Addisonian state.

Good luck - it sounds like you have all been through a rough few days - and keep us posted.

Alison

Hi the test labs I posted was when she was in crises. My vet said today that almost all her lab work was back to normal. She is going to have more IV tomorrow and a x-ray of her Kidneys, lungs, and stomach. Her whites of her eyes are really blood shot and that is new. I had that in another dog. She went blind in one eye. Blood shot eyes was the first signs of the retina going bad. Tessie is at the vets from 8:00 a.m. to 5:00 P.M. on a IV he does not have 24 hour care so I have to bring her home to watch over her. I think it was all brought on by the Addison's. He would of told me today if she had a kidney problem. I will ask him tomorrow.

Can you please post any repeat labwork that was done today & over the next several days? Also, Alison has asked a very important question, did the ER clinic either send you home with medication for Tess, & do you know the name of it? Did the ER clinic give her any type of steroid injection such as dexamethasone, and/or florinef?

Debbie

PS- I do realize that the results you have posted were from yesterday when Tess was so very ill. Just to let you know, I'm a medical lab tech with 29 years experience, so I am very used to looking & interpreting these types of results. The kidney values from yesterday do clearly indicate a kidney issue that you need to question your vet about.

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Tessie was to be on the DBL dose for ten days only, then she was to be dropped down to one dose a day or a week . I can't remember right now. The idea was to bombard the system, get a blood test in a week and then lower it or higher it. We all know now it was to much for her

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From what you have said above, it appears that your vet may have attempted to do what is called a "loading" with Trilostane. If this is the case, this is absolutely inappropriate dosing for this medication. Loading is only done with lysodren. As several of the more experienced members who have used Trilo have pointed out, dogs are extremely sensitive to this drug, & need to be started on a low dose, working up to a higher dose as needed. From all of the information you have posted as to how your vet has managed the use of Trilostane for Tess, if I were in your position, I would be asking the vet some serious questions about his/her experience with using Trilostane. I'm not coming down on you, you did the best you could with the information you were given. You got Tess the help she needed as soon as you could. Your vet appears to have a serious lack of experience with using Trilostane at a minimum, if not treating Cushing's, & unfortunately, Tess has paid the price.

Debbie

Hi the rapid eye movements has stopped. It stooped yesterday. My vet said the same thing and it was just dum luck that it was brought on at the same time she was given Vetoryl. Again the lab results I posted was when Tes was in crises and she is doing better, but she is still not out of it. It will take awhile. She is 12 years and soon to be on 7/29 13 years. She is safe a warm, she had her favorite food chicken. She is on the couch snoring and I am rubbing her tummy. With what ever we find out, cushings, Addison's, Kidney, or tumor you have all been a big help. Tess has had the best life. More Love from me and my husband. Lots of room to play in. Plenty of mom and me time. She was are first born, meaning are first dog. My husband didn't even want a dog. Tessie was his christmas gift 12 years ago. Now we have 5 dogs. She has been on lots of trips to the river, beach and chased lots of birds and possums. With all my love I will help her to get what she needs, but in the end she is a old dog with a young sprit that will need me to help her to doggie heaven when ever that comes. Thank you all for giving so much Dottie

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Originally Posted by StarDeb55

Can you please post any repeat labwork that was done today & over the next several days? Also, Alison has asked a very important question, did the ER clinic either send you home with medication for Tess, & do you know the name of it? Did the ER clinic give her any type of steroid injection such as dexamethasone, and/or florinef?

Debbie

PS- I do realize that the results you have posted were from yesterday when Tess was so very ill. Just to let you know, I'm a medical lab tech with 29 years experience, so I am very used to looking & interpreting these types of results. The kidney values from yesterday do clearly indicate a kidney issue that you need to question your vet about.

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Hi yes the E-Vet did give Tes a steroid injection then we took Tes over to my doctor. I don't have the lab test from Doctor yet. I will have then 7/8/09 for you. I think that is why my doctor wants to have a x-ray done tomorrow 7/8 on Tes. I think he is thinking Kidney. I said to him when he said to me he want ed to x-rays. I said to rule out kidneys or tumors. He just looked at me. It took him by surprise. Thank you for reading the labs. I have know clue what they were saying. Ok tell tomorrow. Dottie

Dottie, please do keep us posted as to how Tess is getting along. She has a lot of people worried about her & pulling for her. Yes, she is a senior, but once this emergency is straightened out, she very well could have several more years with a good quality of life. My Harley is a 14 yr. old Shih Tzu, who has been treated for a little over a year & is doing pretty well, so don't throw in the towel just yet.

Debbie

Hi Dottie,
I certainly hope you have lots more "good times" left with Tessie. You did the right thing by getting her to the emergency vet. From what I know addisons can come on as a crisis and resolve after a few days of treatment or Tessie may be permanently addison. She has made some good progress so hopefully that will continue. There are a few members whose dogs have permanent addisons and it can be managed.
Jenny

Dottie,
There is always hope. My dear Buddy who passed away earlier this year had an addison crisis after a few months of treating with trilostane. He was also diabetic and after the steroid injection he pulled through and we were lucky his body responded and we didn't have to treat for addisons or cushings for the next two years of his life. The addison crisis happened to him at age 13 and he was with us until 15 1\2.
Jenny

Hi Dottie,

Just wanted to let you know my heart goes out to you with everything that you and Tessie have been through.

You both will be in my thoughts and prayers tonight.

Lori

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Originally Posted by StarDeb55

From what you have said above, it appears that your vet may have attempted to do what is called a "loading" with Trilostane. If this is the case, this is absolutely inappropriate dosing for this medication. Loading is only done with lysodren. As several of the more experienced members who have used Trilo have pointed out, dogs are extremely sensitive to this drug, & need to be started on a low dose, working up to a higher dose as needed. From all of the information you have posted as to how your vet has managed the use of Trilostane for Tess, if I were in your position, I would be asking the vet some serious questions about his/her experience with using Trilostane. I'm not coming down on you, you did the best you could with the information you were given. You got Tess the help she needed as soon as you could. Your vet appears to have a serious lack of experience with using Trilostane at a minimum, if not treating Cushing's, & unfortunately, Tess has paid the price.

Debbie

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Hi Debbie I don't know how he did the test. All I know is that he asked to have tes for two hours. I said don't you need her for 8 hours. He said two would be fine. Unless I really needed to know if it was pituitary or adrenal which he thought was a waste because 95% of the dogs he has seen has always come out adrenal. So I believed him. He got the results back and it was cushings. I started Tes Friday morning at 7:00 am on her first dose, by mid-night I was hiding the drug so my husband would not give it to her in the morning because I would be sleeping. Then I changed my mind, because I stated up all night look for any thing that about Vetoryl. The first day on Vetoryl all that I could see is that now her front legs were shaking and she looked like she did not feel good. The next day she ate her breakfast and drank water, she did not seem bad, but I could tell she did not seem right. It was the look on her face, but I still gave her the medicine. By 5:30 on Saturday she was vomiting and ever two or so hours tell I took her to the E-Vet Monday morning. She vomited a total of 8 times between Saturday night to Monday morning. All day sunday she was still waking around, going out side to pee, drinking a little water. I regret waiting so long to get her to the E-Vet. That won't happen again. I asked my Vet today when i took her home if i needed any medication for her, he said know. Ok enough of my store, thank you all again Dottie

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Originally Posted by BestBuddy

Dottie,
There is always hope. My dear Buddy who passed away earlier this year had an addison crisis after a few months of treating with trilostane. He was also diabetic and after the steroid injection he pulled through and we were lucky his body responded and we didn't have to treat for addisons or cushings for the next two years of his life. The addison crisis happened to him at age 13 and he was with us until 15 1\2.
Jenny

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NOW THAT IS A GREAT STORE. TY for that Dottie

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Originally Posted by StarDeb55

Dottie, please do keep us posted as to how Tess is getting along. She has a lot of people worried about her & pulling for her. Yes, she is a senior, but once this emergency is straightened out, she very well could have several more years with a good quality of life. My Harley is a 14 yr. old Shih Tzu, who has been treated for a little over a year & is doing pretty well, so don't throw in the towel just yet.

Debbie

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TY Debbie will never throw in the towel. My husband is worried I will spend his retirement money on this LOL He is kidding kinda, LOL but it would be very hard for me to give up

I've already spent my retirement money. Harley is my 2nd Cushpup, my first boy, also, developed lymphoma, & went through chemo. He crossed the bridge almost 3 years ago at the age of 15. I did want to tell you that my 1st boy was successfully treated with lysodren for nearly 8 years with a good quality of life. So with the right treatment, & a good vet, this dratted disease can be controlled. Now, my 2nd boy, Chewbacca, is going for skin testing in the morning for major allergy issues. As you can see, this is why I've spent my vacation since 7/2, here at home, can't afford to go anywhere.

I think you may haven't gotten what the vet told you about what type of Cushing's backwards, 85% of pups have pituitary Cushing's, only 15% have adrenal. The only reason to determine what type is that there is a possibility of surgery to remove the adrenal tumor which would offer the hope of a permanent cure.


Debbie

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Originally Posted by Sammie

He said two would be fine. Unless I really needed to know if it was pituitary or adrenal which he thought was a waste because 95% of the dogs he has seen has always come out adrenal. So I believed him.

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You were correct in asking for the eight hour Low Dose Dex test. The ACTH (2 hour) test was used for diagnosing in the past, but now is used mainly for monitoring the cortisol levels while on treatment. I am hoping that you just misunderstood his comment about 95% of dogs having adrenal cushings, because mostly we find they have pituitary cushings.

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The first day on Vetoryl all that I could see is that now her front legs were shaking and she looked like she did not feel good. The next day she ate her breakfast and drank water, she did not seem bad, but I could tell she did not seem right. It was the look on her face, but I still gave her the medicine. By 5:30 on Saturday she was vomiting and ever two or so hours tell I took her to the E-Vet Monday morning. She vomited a total of 8 times between Saturday night to Monday morning.

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Your vet should have advised you to look for signs that Tess was not tolerating the drug. Especially since he was giving her over twice the recommended dose. God probably couldn't have helped her if he had done that to her with lysodren. I have no idea where he came up with this protocol of giving a double dose for ten days. I have never heard of such a thing. There is no loading phase for trilostane. Lysodren does have a loading phase, and the worst instruction ever given by a vet is to "give for ten days".

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I regret waiting so long to get her to the E-Vet. That won't happen again.

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Dottie, we all have regrets of some sort, but don't beat yourself up. You were following directions of a trusted vet. Then you searched for help and found us. We are not vets. Debbie and Sharon do have medical knowledge and are a tremendous help in sorting out labwork, tests, etc. The rest of us are only a bunch of puppy lovers that have experienced many of the highs and lows of cushings treatment and are willing to share and guide you the best we can. That way, you will be able to help and share with the next person that comes along.

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I asked my Vet today when i took her home if i needed any medication for her, he said no.

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I know that you are doing a good job of watching her for any signs that she isn't doing well and hopefully she will not need any medication. But I am surprised that he would not have at least sent you home with a few pred tablets in case she got stressed. Then again, maybe I should not be surprised.

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will never throw in the towel. My husband is worried I will spend his retirement money on this

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This really warmed my heart. Tell hubby to join the club. There is no retirement!!!!! :D

Be sure to keep us posted.
Sending healing thoughts and prayers for little Tessie. And haven't forgotten precious Bunny.
~ Mary Ann

Dottie, I must apologize, again, for coming across so harshly. Let me emphasize I was not angry with you by any means. I was angry for the needless suffering that Tess has been put through.

There is one other very important thing that you need to know for Tess' safety & continued treatment. It will probably be a good idea that once she is stabilized, & has had no prednisone for 24 hours to have an ACTH done, so you can see just exactly how low her cortisol is. If she does require further steroid medication, it would probably be a good idea to use dexamethasone, instead of prednisone, because dex will not interfere with an ACTH's that might need to be done. Pred will read like cortisol on the test, giving a falsely elevated value. If Pred has been given, any testing will have to wait for a minimum of 24 hours.

Please keep us posted on how Tess is doing, & please, please ask for that referral to an internal medicine specialist.

Debbie

Hi again Dottie,

You have received so much input and information and I am so very glad you found us. Your Tessie is a very lucky girl and like you said, she is not out of the woods yet, it will take some time with the type of crisis she has had.

Please continue to keep us posted on Tessie.
((hugs))
Terry

Hi Dottie,

Honey, it broke my heart to hear you talk about Tessie as if the end were in sight. :( I don't know how you were even able to write the words. They made me cry just to read them. Probably because there have been times in my Squirt's life when I, too, thought that day was very close and that is more than I can bear to think about. It hurts my soul to think you are feeling that way about your Tessie. :( But our babies need us to be strong and positive, they need us to keep to the routines they know, they need to feel we are still fighting for them. So even during those times when I feared the worst, I did my best not to let Squirt know. She knew I was worried, tho, because I hovered over her 24/7 til she was ready for me to take a long trip alone somewhere! :p

Tessie is still fighting and making progress so that is good! It may take some time for her to get her feet back under her but she is giving her all to make that happen. With you by her side, she has the best chance to do just that. You have done an amazing job considering the horrific start you and Tess have had. So don't you be beating yourself up about what happened to her! It was not your fault!!!!! This statement below is proof of that beyond doubt -

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Tessie was to be on the DBL dose for ten days only, then she was to be dropped down to one dose a day or a week . I can't remember right now. The idea was to bombard the system, get a blood test in a week and then lower it or higher it. We all know now it was to much for her. Dottie

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As Debbie said, this is just WRONG! Trilo is not to be administered in that manner at all - this is the protocol for Lysodren, NOT Trilo. You did what we all have done in the beginning...trusted the professionals to know what they were doing. They are the ones with the education, training and experience so of course we trust them!....until they have proven that trust was misplaced when dealing with Cushing's. YOU have done nothing wrong. All you have done is love Tessie and try to help her when you knew something was wrong. So just let all that guilt fall away...you don't deserve it. Besides, I am the Queen of Self-flagellation and I don't want any competition! :p

Hugs,
Leslie and the girls