Our Silver Belle Labrador~Athena has crossed the Rainbow Bridge

Hello
SO grateful to have found this site. We just received news today of the results of our Lab's test for Cushings. She has been officially diagnosed with Cushings ( Pituitary dependent). We are so sad but trying to be hopeful for her. Let me give you some basic info and such.

Our Lab is a Silver Lab. Her name is Athena. She's precious, smart, protective, loyal and the happiest dog you will ever meet despite what she's going through. You couldn't ask for a better friend in her except her brothers and sisters ( We have 3 other doggies that she adores).

Athena is 4 1/2 years old

She started to show signs of being thirsty all the time, extremely hungry all the time, her coat was thinking but only in certain areas like along her back and part of her tail. She has little black spots on her belly/skin. In addition to this she has this barrel like belly and when standing she shifts her weight between her two back legs. She's overweight and we have tried everything under the sun to decrease her weight and nothing has worked. That is when we became very concerned and took her to the Vet. All our dog go to the vet for all their yearly appointments/shots, etc. They miss nothing and are well cared for. We thought maybe diabetes but it wasn't that.

We had the Cushings test on Friday. She was there all day. After we picked her up and came home. She couldn't drink enough water. We picked up the bowls so she wouldn't get sick but she did. She vomited everywhere twice. She was pacing back and forth and was so hot you could feel the heat come off her. We thought she was having a reaction to the Low Dex injection. Our vet uses an emergency service after hours. We call. They said to watch her close, to give her only a few ice chips hourly (which we did and we were up all night with her) and not let her drink freely from the water bowls. We had to move those to another part of the house for our other dogs.

She refused food which she never does. We tried a few times to feed her a little something because she's on tramadol but nothing.

The emergency vet said if she wasn't better by morning ( when we called it was around 8pm) to bring her in. The next morning she stopped the wanting of so much water. She started to slow down. She was walking a few steps then would sit down. She then just slept. She went out to potty and it was bright orange ( I'm thinking dehydration or the injection) but eventually she was willing to eat a small bowl of food but all day Saturday she slept and we just let her rest. We put her water bowl back out and she would drink a little then lay down.

Today is Monday. I was able to talk to our regular Vet when she called with the results but I had already called her in the morning to report what happened over the weekend. She said Athena did great at the office when she had her test but that she felt the stress of being there all day long and noise of other dogs could have just stressed her. She's used to just us and our other dogs and it's peaceful and fun here for her.

So the report today was as follows:

Her baseline was 4.8
the 4 hour test draw was 3.5
the 8 hour test draw was 10.0

She's a big lab, big boned lab and her weight is 115

Our vet is real good and explained everything. She wanted to start her on 120mgs of Vetoryl. She explained she felt that was safe. She told us we had to watch for diarrhea, vomiting, gastro upset and if that happens call her asap and bring her in.

She said if no side effects then she wants to see her in two weeks for a blood draw to check ACTH and Electrolytes. We have to be careful with the drug as to not give her an Addisons crisis.

We are very worried. Athena has proven to be sensitive about thing. She has fought 3 bacterial infections with no source known since we had her as a puppy. Not sure if this is a result of her compromised immune system due to this Cushings or what.

She tolerates her other meds well as in Tramadol for her sore hind legs. She always tolerated anitibiotics fairly well.

I asked if we could start her on 90mgs vs 120mg. I know she's the Vet but I'm anxious about this drug and the amount and wondered if it was better to start her at a lower amount initially and if she tolerates it well to up the dose. Any thoughts? I'm a Nurse (RN) and at home I always start with small doses for things and increase as needed vs a big whopping dose of something.

We are beside ourselves tonight because there is a minefield of info on the web and I'm cross eyed from reading and not sure what to believe about this drug. I know just as with humans everyone responds a certain way to a certain drug.

All our dogs are our life. We have no kids. Our dogs are the kiddos. Athena in particular has been a great source of love and healing for my Marine who was injured in combat a few years back in Afghanistan. She has been a wonderful member of our family and we want to do what is best for her.

This has been alot to take in as we have a 14 year old and 9 year old pitbull who are the picture of health even at those ages and our youngest is a 2 year old blue nose pitty. We are meticulous in how we care for them and give them plenty of love, play time, trip to the beach and mountains and where we go...they go..if they can't go..we don't go. They have never been boarded or anything.

Is there any other information I can give you to help? If so, please just ask away. Sorry to be long winded. Just very concerned. Depending on what you read and who you talk to you get a different story and finding this site I saw that it appears to be a rock solid place of good info and great people.

Does anyone have experience with the drug Vetoryl? Side effects? Effectiveness?

Are there any other treatment options out there? Anything else we can do to help her?

Thanks for your time...:o

Hi and welcome to you and Athena!

First, I understand how frightful you are but I want you to know that Cushing's is not a death sentence for a dog, with proper treatment a dog can have a good quality of life and there is every reason to believe that they can live out their normal life span.

Thank you for the detailed information about your sweet girl, that helps us to provide our best feedback. But, of course, I still have a few more questions ;) Did Athena have a CBC/chemistry blood panel performed, and if so, could you post those values that are marked abnormal (H or L) with the normal reference ranges....as an example.....ALP 150 U/L (5-75)...thanks! Was an urinalysis done to rule out an UTI, and does Athena have diluted urine with a low specific gravity? Does Athena have an underlying illness that she is taking any herbs/supplements/medications for?

Those test results you posted are from a low-dose dexamethasone suppression (LDDS) test and do point to Cushing's, but to my knowledge are not indicative to the pituitary type of Cushing's. The criteria used to interpret the LDDS test:

Quote:

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Test interpretation. When interpreting LDDS test results, first evaluate the eight-hour post-dexamethasone administration cortisol concentration. If it is above the reference range, the dog probably has hyperadrenocorticism (false positive results may occur in dogs with nonadrenal illness). I

If the eight-hour post-dexamethasone administration cortisol concentration is above the reference range, then evaluate the baseline and four-hour postdexamethasone administration cortisol concentrations to see whether cortisol suppression occurred during the eight hours. If at least 50% cortisol concentration suppression is present at the four- or eight-hour time points, the definitive diagnosis is PDH and additional adrenal function tests are not needed.

---

http://veterinarymedicine.dvm360.com...n-test-results

I am sorry that Athena had such a bad reaction to the dexamethasone, although not real common it can happen, sounds like this may have been a gut issue for Athena and I am glad to hear she is feeling more like herself.

The starting dose of Vetoryl that is recommended is 1 mg per pound of a dog's weight, so for Athena's weight of 115, that 120 mg is reasonable; however, seeing that she can be sensitive to certain medications I would opt to start her at a lower dose, maybe at 60 mg. Over a period of time larger dogs do seem to need smaller doses of Vetoryl to control their Cushing's.

Did the vet mention that the Vetoryl has to be given with a meal to be properly absorbed? And the timing of those monitoring ACTH stimulation tests are crucial ~ Dechra recommends that the ACTH stim tests be performed 4-6 hours after the Vetoryl is given. We have information regarding Vetoryl/Trilostane in our Resource Forum which I'll post a handy link to:http://www.k9cushings.com/forum/showthread.php?t=185

Athena, her brothers and sisters sure hit the jackpot with such loving pet parents as you are, they are a lucky bunch!

Cushing's sure can be a scary but when knowledge of the disease grows it does become less frightening, we are some of the best hand holders and are here for you, so lean on us, ok ;) If you have any questions please do ask them.

Hugs, Lori

Hello and welcome. This is a wonderful site and you will get lots of helpful information. I am new and can only say that it has helped me tremendously with my precious Lena and her diagnosis. I have gained a lot of information and so much support. I went nuts searching for information after we were told that Lena had Cushing's and I was panic stricken until I stumbled on this forum...they are all wonderful.

Joan

Hi Lori

Hello Lori. Thanks so much! Yes, it's very overwhelming but trying to stay level headed although it's hard.

Quick?? Are you saying after the first dose they should draw her blood within hours? The Vet said she wanted to draw in 2 weeks from the first dose. Is that normal or waiting too long? I will be speaking with the Vet tomorrow so any info will help.

Here are the lab values of the bloodwork done two weeks prior to her cushings test and I will be able to post the actual numbers to her Cushings results tomorrow when I pick them up at the Vet with her meds.

The only things on her initial labwork that were out of range were the following


EOS Range 0.06-1.23 and her result was 1.45
ALKP Range 23-212 and her result was 459
TT4 Range 1.0-4.0 and her result was 1.3

as a RN I saw some of her values on the low side but they weren't marked as being bad because they were within range but I felt they were on the low side such as the following

BUN Range 7-27 Her result was 11
CGT Range 0-11 Her result was just 0 ( Vet didn't say anything about it)


I felt her T4 was of course within the range BUT it's what I think they call "Euthyroid Sick".

They didn't say a U/A was done but I will know when I pick up results in the morning but they have never done any U/A on her. Is that normal?


Athena takes Tramadol in the morning and at night ( 1 tablet) because she has soreness in her hind legs whether it's from this Cushings or what she limps and when she stands her legs shift alot. Her Xrays and MRI showed no damage as in an injury so they felt that her weight could be contributing to her being sore in her hind legs and put her on Tramadol and it seems to help her rest and do better.

They did mention that she must eat with her med and to give it in the morning.
They wanted her on 120mgs but I asked to start smaller. Just due to her being sensitive and what she just went through with the Cushings test.

There are no words that I could say that would ever properly explain how thankful I am for your posting and this site. THANKS!!!

We are both exhausted and worried about her.

Thank you Joan. So grateful for your words and kindness.

I am still learning about this disease, but I don't need to learn how it feels...I already know, and it breaks my heart each time I hear that someone else is going through it too.

Welcome to the forum. We all came here terrified for our furry kids, so your in good company. I agree with Lori that I would mention starting a bit lower than the 120 just because of her reaction so maybe until you see how she does on the medication lower would be better for all of you.

14 (corrected from 24 UGH) days is the recommended time frame for the first five low up test which is an ACTH. On the test day you give the meds with her breakfast and 4-6 hours later she goes in for the test. I go st about 4.5 hours. They do a first draw. Baseline and then an hour after that they do the second blood draw after giving an injection that basically makes the adrenal glands dump the excess cortisol. The post tests how much excess the glands are making.
You are looking for a post ACTH result of under 5.0 ug it can be as high as 9.0 ug if symptoms are controlled.
Normally you don't want to withhold water in general as they need the water to stay hydrated because the kidneys work over time. I do understand the reasoning though as she was throwing up from drinking too fast and probably having an upset stomach too.
The high cortisol tends to cause ligaments and tendons to weaken and rear leg weakness is common in Cushing's dogs. The wreight probably doesn't help with that so maybe try supplementing when she is hungry with something low cal but filling like cooked green beans etc.
Another thought is to try water therapy to strenghen them.
We do see a lot of lower thyroid results in initially diagnosed Cushing's dogs so that might straighten up as the cortisol comes down.
They often go a UA to rule out a UTI and to see how she is concentrating her urine.
You will be surprised how fast you pick up the Cushing's info. It tends to become second nature almost.

This is a link to info on Cushing's and vetroyl from the manufacturer Dechra. I find the flow chart to be a very handy guide for ns I gating through what to do when.

http://www.dechra.us/Admin/Public/Do...US-046-TEC.pdf

Again. Welcome.

Welcome!

It is a fact that some dogs over 100 pounds will achieve ideal control taking trilostane at an initial dose of 60 mg. It upsets me that the vet didn't hear your concern to start Athena at 90. Have you purchased the vetoryl yet? If not, you can ask her if starting at 60 mg BID could be an option. This will not only reduce the risk of over suppression but also keep her cortisol levels balanced evenly throughout the day since vetoryl has a short half life of 8-10 hours.

My dog also had trouble with his hind legs because of his weight. He weighed 83 pounds when diagnosed. He's been on vetoryl for 7 months now and has lost a total of 14 pounds which has helped him significantly. It took him 9 days post treatment for the PU/PD to resolve and about a month before his energy levels increased. I honestly thought he was just old and didn't want to walk or play as much. I can barely keep up with him now. This drug saved my dog. Athena is quite young. It's rare but this disease can occur in younger dogs. I truly hope you see improvements in symptoms soon. Keep in mind that response time is different for each dog. It can take anywhere from a few days to a month or two.

The link below is to help guide you with the timing of the ACT tests after a dog begins treatment with vetoryl.

http://www.dechra-us.com/therapy-areas/companion-animal/endocrinology/canine-hyperadrenocorticism/monitoring-cushings

~Katherine

Welcome from me, too!

I see that you've already gotten excellent advice, so I only have a couple of comments to add. First, I think that Sharlene's auto-spell might have run amok in her answer above :p, because I'm sure what she meant to say is that the "first followup" ACTH test should be run 10-14 days after you start giving the trilostane (not "24" days). So your vet's testing recommendation conforms with the recommended protocol.

Secondly, if you decided to dose twice daily rather than 90 mg. once daily, I would recommend giving 60 mg. in the morning and 30 mg. at night (if you are using brand name Vetoryl capsules). I would not exceed 90 mg. as the daily total, and might even start as low as 30 mg. twice daily. This is because studies have shown that dogs dosed twice daily often actually end up needing less total daily dosage than do dogs dosed only once daily. As Katherine says, I imagine this is because cortisol levels never elevate quite as highly at any time during the day when the med is given at twelve hour intervals.

Some specialists do indeed prefer twice daily dosing in order to keep cortisol suppressed more consistently throughout the day. However, many dogs seem to do fine in terms of overt symptom resolution on only once daily dosing, and here is a quote from noted endocrinologist, Dr. David Bruyette, who tells us that dogs being dosed twice daily actually may need to be monitored even more closely for the development of low cortisol or electrolyte imbalances.

Quote:

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With regards to once vs twice a day dosing if we look at all the studies throughout the world you will see that about 80% of dogs do well with once daily dosing. One huge advantage of once daily dosing is owner compliance which goes up substantially when owners only have to dose once a day. While twice a day dosing may result in a lower amount of trilostane being used pre 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.

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Marianne

I also want to add one more note to stress what Lori has said above: Athena's LDDS results can be consistent with either the pituitary or adrenal form of Cushing's. So unless your vet has performed an ultrasound or other secondary diagnostic test to differentiate between the two forms of the disease, it remains a question mark. The reason why this is significant is because in the situation of an adrenal tumor, complete surgical cure is a possibility. Adrenal surgery is very expensive and also risky, so it is not a viable option for all owners. But given Athena's young age, I just want you to know that the option may exist for her, depending upon the outcome of additional diagnostics.

Marianne

I'm fairly new here and first of all welcome, you are in the best possible place for cushings and other things. You said your baby was sensitive and I can relate to that , my baby was started to high on the Vetoryl and it had a very bad effect on him. I stopped the Vetoryl immediately and called the vet, it was the information from this site that told me they started him to high so what I did is started him at the lowest dose possible and we worked our way up as he tolerated it. My vet told me my baby has a sensitive system.
I hope all goes well with your baby.

Hi and welcome to you and Athena.

I am sorry the reasons that brought you here and I'm glad you found us. The symptoms you list are certainly those associated with cushing's but with Athena's young age and so few lab abnormalities, I am wondering why your vet did not recommend an abdominal ultrasound to determine which form of the disease Athena has. My first cushdog was only three years old at diagnosis. She had every symptom in the proverbial book and her specialist was beyond comprehensive in confirming a cushing's diagnosis. She had an LDDS, ACTH stimulation test, abdominal ultrasound. which confirmed pituitary based disease, and because she was a nordic breed prone to sex hormone imbalances, she even had a full adrenal panel done by the University of Tennessee Knoxville. If my Lulu had an adrenal tumor, which is a lot more serious than PDH, I most certainly would have opted for surgery. While the minority of dogs with cushing's have an adrenal tumor, a lot of credible resources state that larger breeds seem to be more affected than smaller breeds and females are more affected than males. My own experience in following a lot of case studies over the years would support that statement which is why I am concerned that your vet has not done adequate testing.
Labrador Retrievers are also a breed listed as being more affected with pheochromocytomas than other breeds and symptoms for this specific adrenal tumor does have overlapping symptoms with cushing's. It is rare but some dogs actually have both types of tumors. The symptoms you describe seeing after Athena had the LDDS are symptoms associated with pheochromocytomas. There are recorded cases where humans with pheochromocytomas have gone into crisis after receiving dexamethasone but I believe at higher doses but because there have been no formal studies done, who knows how a dog with a pheo could be affected by a low dose of dexamethasone?

Pheochromocytoma crisis induced by glucocorticoids: a report of four cases and review of the literature
http://www.eje-online.org/content/158/3/423.full

If Athena were my dog, I would not start treatment without knowing for sure that she does not have an adrenal tumor of any kind. Dogs with pituitary dependent disease can live out their normal lifespan, with a very good quality of life, but the prognosis for a dog with a functional adrenal tumor that is not surgically addressed, is very guarded. My intent is not to scare you but to provide you with as much information as possible before starting treatment so that you are making an educated decision for Athena. If Athena has already had an abdominal ultrasound, I apologize for making you read all of this. If so, can you please share the radiologist's interpretation?

Adrenal gland tumours. Different clinical presentations
in three dogs: a case report
http://vri.cz/docs/vetmed/58-7-377.pdf

Glynda

I wanted to post this info real quick to help answer some questions folks may have and this evening I'm going to go over each posting here and read everything and respond because it's very important to us to read everything you have all written and respond. You have all be so kind in giving us our time, guidance and reassurance and it's a priceless gift to us all just being hit with all this. Thank you. I'm sure people think I'm crazy but Ive been sick about this since it all went down. In tears but I don't show that to Athena. She's very sensitive if she see's anyone upset. She's such a jewel. Always the friend, listener, protector and caretaker. We want the best for her and we are so grateful we came across this site. No way could we do this without all of you. Thanks with all of our hearts.

Here is the info from what went down today so far.


Hello to all. Thank you so much for all the input and responses. We are beyond grateful to each and everyone of you. It's as if I don't even have to try and explain how we feel. Each of you truly "gets it". Thank you for that.

We started Athena on her medication today. The Vet agreed to the scale back. She offered to do 90mgs vs 120 and I asked if we could do 60. So that's what we will do but they had already filled the 90 ( which was a box of 60 and a box of 30mgs) so we have both. I'll keep the 30's on hand to maybe increase later.

I made Athena a little med flow sheet where I can write the time she was given her meal, meds and anything that we notice. I want to keep track and take it to her next appt in two weeks.

She ate her meal just fine and we gave her the meds. I won't lie. My heart was beating just giving her this med. How crazy right? :( I'm an RN and have been in emergency nursing forever but when it comes to our dogs I'm just a regular person trying to do the best for our dogs. I can handle just about any human emergency but with my dogs it's different. I can't stand for them to be sick or have to suffer in anyway. I honestly feel it. Sounds crazy but I'm sure the awesome people here totally get it.

So she took the med and nothing so far and it's been 6 hours. She has not been showing any signs of feeling sick. She was a bit hot but she's been that way since she got home from her Cushings test. Just that her head is so warm. Not sure if that is the steroid in her still or what that is. Vet said its nothing to be concerned about. :confused:

Meds were very $ but I'd pay whatever it costs to help our girl. I just didn't expect it to be that pricey. For both boxes it was $254.00. Is that the normal cost of this medication? I don't care what I have to do but we will always find a way to cover whatever our dogs need.

I also was given a copy of her Cushings Low Dex Test and this is how it reads:

Baseline Cort 4.8ug/dl
4 hour post low dose dex 3.5 ug.dl
8 hour post low dose dex >10.0 ug/dl

This is the info under these lab values. Will type just as it reads

Both 4 and 8 hour <1ug/dl- Normal

Both 4 and 8 hour =1-1.5 ug/dl - Inconclusive consider repeat test 8 weeks

Both 4 and 8 hour >1.5 ug/dl and 50% of baseline= Consistent with Cushings Syndrome; consider HDDST to rule out adrenal tumor

4 hour < 1.5 ug.dl or <50% of baseline and 8 hour> 1.5 ug.dl and 50% of baseline is consistent with PDH

4 hour < 1.5 ug/dl or <50% of baseline and 8 hour >1.5 ug/dl and <50% of baseline is consistent with PDH

4 hour > 1.5 ug/dl or >50% of baseline and 8 hour > 1.5 ug/dl and <50% of baseline is consistent with PDH

Tests were done by IDEXX Labratories


Thank you and will post again this evening. May you each have a beautiful day. ;)

Oh, we all know how you feel! I give Lena her pill at least an hour and a half before I go to work, just in case. And my hands still shake when I take it out of the case. And I still hesitate, wondering if this is the right thing to do. And then I watch....I hate leaving her and going to work. I wish I was able to just stay home and take care of her. The days drag.......

The minute I get to my front door, the first thing I do is look through the window to make sure she is there, and then I can really breath for the first time all day.

So, you are not alone....

Joan

You take all the time you need to read and process the info we've offered to you. We all understand only too well how overwhelming this diagnosis may feel as you are starting out.

I just want to reassure you about one thing, however. You can definitely purchase the Vetoryl for a much less expensive price. I quickly scanned a couple of reputable internet pharmacies and found a range of $120-140 for both boxes in total. Perhaps your own vet will be willing to price match. But if not, we can tell you how to search for credentialed pharmacies from whom to buy veterinary Rx's.

Marianne

I've been purchasing from California Pet Pharmacy for the last 2 years. Never had an issue, except when first switching, they had some trouble coordinating with my vet, but it's been smooth sailing since then. It's about half the price. :) And, free shipping!

There are several good online pharmacies to order from, they just need the prescription from your vet and they will ship to you. Most of our members, use something of this sort to keep prices in check.

I have been using California Pet Pharmacy as well. Used them for over a year and a half without any issues. I get Vetoryl at almost half what it would normally cost me at the vet's office. Very convenient and saved me a lot of money.

Quote:

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Baseline Cort 4.8ug/dl
4 hour post low dose dex 3.5 ug.dl
8 hour post low dose dex >10.0 ug/dl

This is the info under these lab values. Will type just as it reads.

Both 4 and 8 hour >1.5 ug/dl and 50% of baseline= Consistent with Cushings Syndrome; consider HDDST to rule out adrenal tumor

---

Just wanted to stop back to highlight the lab's interpretation that fits Athena's LDDS results. Her 8 hour result was greater than 1.5, and both her 4 and 8-hour results were greater than 50% of baseline. Therefore, an adrenal tumor, rather than PDH, is a possibility. Personally, though, I would put my money towards an ultrasound rather than a HDDST test. With an ultrasound, not only do you get important info about the adrenals, but also about other internal organs, as well. And if an adrenal tumor is present, the imaging will give specific info as to size and location.

Has the vet said anything at all about further diagnostics? I think Glynda's speculation about the possibility of a pheo is very interesting, given Athena's very odd response to the LDDS test.

Marianne

I just want to say if your crazy we are all crazy, I cried almost everyday last week because my precious little furbaby wouldn't eat.
When Bandit had a bad reaction to the Vetoryl the first time I didn't give my vet much choice in lowering the dose after I had gotten the information from this site. I always listen to what she has to say and then give her my opinion and what I think would work for him, after all I am the one that lives with him and knows him. I really like my vet she does take the time to listen to me even tho I am hysterical sometimes. Your just like everyone here, just wanting whats best for your loved one.

Quote:

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Originally Posted by Joan2517

Oh, we all know how you feel! I give Lena her pill at least an hour and a half before I go to work, just in case. And my hands still shake when I take it out of the case. And I still hesitate, wondering if this is the right thing to do. And then I watch....I hate leaving her and going to work. I wish I was able to just stay home and take care of her. The days drag.......

The minute I get to my front door, the first thing I do is look through the window to make sure she is there, and then I can really breath for the first time all day.

So, you are not alone....

Joan

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Oh Joan.. You would like me with how I feel giving her this medication. Thankfully we can be home with her. My other half retired recently from the Marine Corps after being injured in combat ( which we have had a long few years with that as well) on top of that I was diagnosed with MS. So you can imagine....thankfully we both have level heads and are able to face everything thrown at us head on but when it comes to our dogs it's so different. We feel it's because they are just our world, they ask for so little, and they give so much and we have come across some cruddy people along the way that just made us so jaded when it comes to humans and the only bright light of the day are these beautiful dogs we've been blessed with. They have been lifesavers. It's so true when they say "who rescued who".

I just wanted you to know I appreciate your words. you have a good heart. I can tell and I would do the same thing if I had to give meds and leave. I'm an RN as well but I too, am home now but I'm taking care of alot here with my Marine and everything else. When I give her the meds ( it's day 2) we won't go anywhere. We stay put with her. About to post an update on that as well
Have a great day. Is that your little bandit in the pic? Sooooo cute!!

Day 2 of Medication

Hello all. I intended on writing last night. I'm so sorry. I just crashed on the bed and couldn't do much more. I think the stress of all this and worry just got to me.

Athena is on day 2 of her medication. I'm so nervous giving to her. So strange considering I've been an RN for so many years and administered big drugs on doctors orders which all have risks but nothing ever made me nervous like this. Isn't that crazy. :confused:

We give her the medication after she eats. We actually wait about 15 mins or so for her food to settle. Then we give it to her. We don't leave the house at all. We stay close by just in case. So far day 2 and she has had nothing really happen. She seems her happy self again. We do notice one thing and not sure if this is related to this medication but she sleeps alot more than she used too. She will actually go off in the dog room where we have a queen size bed ( mattress and box spring but no frame so they don't have to jump) and she will get up there with all the soft blankets and just lay down and sleep. We notice she does that alot more. Not sure if the meds are making her sleepy. Before the med she would sleep but she was always up here and there. She's a lab that is always on alert for lack of better words. She is protective and the true guardian of this home.

However I wonder if the extra sleep is just because she was so stressed during that test, the reaction she had and the 2 days it took her to get over it all. Maybe she feels like I do... wiped out.


I'm reading and re-reading everything heere. So much to take in but with that I'm beyond grateful, we both are, for this priceless gift of everyones kind words, information and such compassion. I feel like I found this little dog family that "gets it".

As you know we started her on 60mgs vs the 120 they wanted us to give her. They gave me a box of 60 and 30 because they thought I may go for the 90mgs vs 120 but I'm not comfortable with that. Started her on 60 and if she does good for awhile I don't mind adding the 30 mgs. Not sure I ever want to do 120 but we'll see. Any thoughts on that?

I did call the vet about the possibily of adrenal tumor but she assured me there was nothing that indicated it could be that, or that Athena should be tested for that unless I really wanted to go that route but she didn't see the signs for that with Athena. Does that sound right? I love our Vet. She's cared for all our dogs and Athena since she was a puppy but I know vets are not perfect and all sort of have their opinion on things.

She's a hard working vet. She works long hours and I love how she is with the dogs. She's very kind. She's willing to listen to what you say and she's not one of those Vets that push $$$ things on you ever. She's very common sense.

I love all the pictures here of your doggies. So adorable each one and they are so lucky in having such awesome families caring for them :-)

I haven't slept good. I sleep but I'm up every few hours checking on her. I have this fear for some reason that I'll wake up and this med has done her in. I know. Pure paranoia. I promise I"m not crazy:p

Thanks to each of you. This has been so overwhelming....

That is indeed my precious! We have 3 others, a teacup chihuahua, a puggle and a lab mix. I love them all, but there is always that one, and that is Lena. I hardly sleep anymore as I am listening to her breathing, moving, anything.

I watch her so closely that the poor girl avoids eye contact most of the time and when she sees me with the camera she either closes her eyes or looks the other way. She knows what I'm doing...

I am dreading the day that she dies or I have to make that decision. I know she's going to be 15, she's had a great life and it's not fair that she got sick like this. She has never been sick, ever. Up until a few months ago she was a happy little girl, even though she had a lot of the symptoms, but they were subtle and just seemed to go with old age. Then it was like BOOM! And our lives changed...I cry all the time now.

And the only place where I can say all this is here, with people who understand and feel the same way about their furbabies. So, nothing you say sounds strange to anyone in this forum.

With all due respect to your vet -- you have nothing to lose by definitely ruling out (or ruling in) an adrenal tumor. I'm confused about why she would insist you not pursue finding out, regardless of whether or not she thinks there are definitive symptoms pointing one way or the other. For that matter, if your dog has cushings at all, then an adrenal tumor is always a possibility and there is no way to determine if the cushings is PDH or ADH based on symptoms alone. Given Athena's age, surgery could be a hugely viable option.

Great vets aren't always right. It's sad, but very true, that cushings is a complex disease that most vets just are not familiar with. Or, their education of the disease is outdated.

Hang in there, because you are doing a great job with all of this!! So much new info and so much worry to have to absorb all at once. But I am hopeful that things will start to settle down again soon, and you will be able to feel more peaceful about Athena's progress.

I have one quick comment about meals and administering the Vetoryl. I totally understand why you are thinking it is better to wait for a little while after her meal to give her the capsule. But I do believe that for maximal absorption, it may be better to give her the capsule simultaneously with her food rather than waiting even for just a little while. I could kick myself because I didn't bookmark an article that I recently saw that I think made this statement. But since I can't find it again right now, I've put in a call to Dechra, the manufacturer of Vetoryl, to see what their advice is in this regard. It may be a day or so before I hear back from them, but I'll report on what they tell me

Also, as far as an adrenal tumor...

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I did call the vet about the possibily of adrenal tumor but she assured me there was nothing that indicated it could be that, or that Athena should be tested for that unless I really wanted to go that route but she didn't see the signs for that with Athena. Does that sound right? I love our Vet. She's cared for all our dogs and Athena since she was a puppy but I know vets are not perfect and all sort of have their opinion on things.

She's a hard working vet. She works long hours and I love how she is with the dogs. She's very kind. She's willing to listen to what you say and she's not one of those Vets that push $$$ things on you ever. She's very common sense.

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Your vet sounds as though she's been a wonderful partner for you through the years, but the info she is giving you about the possibility of an adrenal tumor doesn't really sound accurate. In the absence of additional specialized blood testing or actual abdominal imaging, there is no way to know whether or not it is an adrenal tumor or a pituitary tumor that is causing Athena's Cushing's. Frequently, there is nothing different about the symptoms that are produced, or the outward appearance, or the general labwork of the dog.

It is a fact that adrenal surgery on a dog is very expensive and a risky undertaking. And if surgery is not an option, then treatment with Vetoryl is recommended for adrenal Cushing's as well as for pituitary Cushing's. Your vet may be hoping to save you the financial and emotional stress that might accompany further diagnostics, let alone the stress of contemplating surgery itself. In honesty, I don't know whether or not I would opt for adrenal surgery on a dog of my own. A lot of factors would go into that decision. But from what I can tell, there is nothing that we know about Athena's testing that would rule out adrenal Cushing's as a possibility. So if this is something that you want to know more about, I think you will need to push your vet a bit harder for more answers. This is not something you need to do today or tomorrow. But if surgery is something you'd consider, it is better to proceed sooner rather than later so as to remove the tumor before it expands even further and perhaps becomes inoperable. However, if you already know upfront that surgery would not be an option for your family, then your vet is correct and there is no need to stress further about the issue.

As an ER nurse, I'm betting you will agree with this thought: Just because a procedure is available does not mean that it is the "best" choice for every patient. So however you and your husband feel about further diagnostics and the possibility of surgery for Athena, we will understand and support you here.

OK, enough blabbing for now. As I say, I'll report back when I hear from Dechra.

Marianne

Renee/Marianne Thanks. I'm calling her now for a more detailed explanation on her feelings on this. I'm glad you wrote this. Making the call now. Thanks! :-)

** Marianne. Thank you. I was thinking let her food settle and not upset her stomach but you're correct. It's better to do it the way you said. I'll give it to her with the meal. Thanks. I'm so overwhelmed right now with it all but that does make sense. Thanks for checking with Dechra for us. We are so grateful

I just got the call back from Dechra -- they were very prompt! -- and they did confirm that it is best to give the capsule simultaneously with food for maximal absorption.

This disease is very overwhelming, even for 'seasoned' veterans. You are doing amazingly well and being very thoughtful / thorough. :)

When my pug had her LDDS done, it was inconclusive for PDH / ADH. I opted to do a CT scan in the hopes she may have an adrenal tumor that could be surgically removed. Turned out that she has PDH, but I have never regretted finding out for certain which tumor she had and it provides more information to me now in terms of watching and assessing symptoms.

Vetroyl will continue to lower cortisol levels for usually at Least 30 days with no change in dosage.

So I would definitely not introduce the additional 30mg until you see how she is doing after a month on the 60mg. They test usually at 14 days and some vets now don't test till 3 weeks or 4 as long as there are no risk factors. Dechra the manufacturer still recommends the 10 - 14 and 30 day testing regime though.

If you can get an ultrasound at a reasonable price, then I personally think it is worth it and that is just me personally. I hate surprises when it comes to my molly. Not that the little diva doesn't throw a lot of surprises our way but they are usually of the more pleasant sort. LOL

@ Marianne. Thank you!!! So thankful you made that call. How very sweet of you to do that for us. We will make sure it's done together with her food. Thanks again;)

Renee, thanks for prompting me to make that call to the Vet. She called and what I didn't know ( and she may have told me but I was so taken back by the whole thing of Athena having Cushings and such) is that the test she did on Athena is from IDEXX Labs. It tests for both with certain markers. The math turns out that because of Athena's numbers and her baseline being less than 50% that she is not in danger of having an Adrenal Tumor. Had her numbers been matched with her baseline being over 50% then she would have had us bring her in for an ultrasound and further testing.

I'm so sorry. Hope this makes sense. You'd think with my fancy Nursing degree I could get this straight but I'm taking this real hard about our girl Athena. Just so much happening at once which I've always been great handling but not lately :-(

So she said her baseline was 4.8

4 hour was 3.5
8 hour was 10.0


Hope that makes sense. I apologize for being all over the map right now. In a few days I may be able to explain this more clear but the vet said the old test they used to do ended up causing alot of dogs being misdiagnosed or having to go back in but this new test takes longer ( 9 hours) but it tells them whether or not it could be an adrenal tumor. She said she tried not to dump alot at once so she just wanted us to know what it was and how we would treat her and when we see her in two weeks we could go over more info but that there was nothing to be concerned about regarding a tumor in Athena.

I was able to tell her how Athena was doing on the meds so far and she was happy about that. She said in fact that she may do well just staying on 1/2 the original dose she had wanted her to be on. I pushed for the 60mgs vs 120mgs and it Athena's numbers look good in two weeks there is no reason to up the dose but if not we will have to up the dose.

I'm thankful Athena is tolerating the meds. I pray it helps her. We noticed today that she was playing with some of her toys. She hasn't touched those toys in a long time. We thought that was pretty funny. It may have nothing to do with being on this drug for 2 days but it was good to see her playing. Her brother and sisters were laying with her today. Very sweet. They didn't like that she was gone for a whole day. They missed her! We all did.

Thank you to all and thanks to you Renee. I feel better with that info now.

Question: I've been told that Athena is actually pretty young to have this diagnosis and that Cushing is seen in older dogs moreso than young dogs. Is this accurate? Her parents were very healthy and are still alive. No issues. We know the people we got her from as a puppy and her mother/father are both fine. No issues at all. Wonder if this is something heredity in certain bloodlines or just happens. I have MS which is hereditary but not a soul in my family had MS or anything remotely like MS. I guess one never knows.

Usually we do see it in older dogs, but it has been known to happen in younger dogs too. We've had some diagnosed at I want to say 4 years old.
There is nothing so far that has shown that cushings is hereditary, although if the parents had it I'd be inclined to watch for it since there is nothing that says either way. Basically there is no Known proven cause for a cushings tumor for either pituitary or adrenal.

Remember what I said that cortisol will lower for 30 days on the same dose. Unless her cortisol numbers are Very high post ACTH at the mid way mark of 14 days, I probably wouldn't increase till after 30 days.

I just want to add one thing, you aren't at all abnormal in your worry and stress over this. I've been on the this forum for years and can throw out what to do, what things mean, at the drop of a hat and then my Molly has her test, and I become still, a basket case of what should I do, what shouldn't I do, even though I Know. I do know, but emotions just sort of flood you and rational thought goes out the window, either that or I analyse all the possibilities until I become practically inert. Thank god for the other members and the other admins here who have kept me sane and on track for the last 4 years.
So I think you are completely normal in your response to this diagnosis and what to do and what things mean and what questions to ask, etc. It's always harder in our own. Big hugs. I can say, it does it get better, but I couldn't be more thankful for a forum like this when the mind starts rolling.

Sharlene. Thank you so much. Your words mean more than I can say. I appreciate the info on the cortisol and will defintely not make any changes until after 30 days if that. This site is an absolute godsend. I thank my lucky stars I stumbled on it.

After Athena ate tonight she just wanted to go lay down and sleep. That's not what she normally does but she's been more active today and the last 2 days. She used to try and go to everyone else's bowl to see if they left any food. We always have to pick up bowls or she will try to eat everyone's leftovers. The otehrs always have a bit leftover but she never does. The last two days however she will just eat her meal and go lay down until she wants to go outside. She's not looking for more food.

Thanks again for everything Sharlene. I really truly do appreciate it.

Okay that is good. One thing that might be causing the change in sleeping more laying around is that when the cortisol drops, some dogs feel yucky for a bit till they adapt to a lower level. Like taking all that feel good stuff that has been in excess away. We've seen that happen quite often. Normally is this is the cause then she will get back in sync and be better. Also aches and pains they didn't know they had can be uncovered. That she is already having a change in eating behaviour does signify that the cortisol is dropping.

I'm so sorry to be the squeaky wheel that keeps disrupting your peace :o, but I'm really afraid that your vet is misinterpreting the IDEXX test results.

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Renee, thanks for prompting me to make that call to the Vet. She called and what I didn't know ( and she may have told me but I was so taken back by the whole thing of Athena having Cushings and such) is that the test she did on Athena is from IDEXX Labs. It tests for both with certain markers. The math turns out that because of Athena's numbers and her baseline being less than 50% that she is not in danger of having an Adrenal Tumor. Had her numbers been matched with her baseline being over 50% then she would have had us bring her in for an ultrasound and further testing...

So she said her baseline was 4.8

4 hour was 3.5
8 hour was 10.0

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If those are truly Athena's results on IDEXX's LDDS test -- and in that order -- then your vet is interpreting things backwards. You do not check to see whether the baseline is less than 50% of the 8 hour result. You do the reverse, and check to see whether either the 4 or 8 hour results are less than 50% of the baseline. If not (and assuming the 8 hour result is greater than 1.5 which Athena's is), then this test result does not show whether the Cushing's is caused from a pituitary tumor or an adrenal tumor.

Here is a link to a pdf that gives you charts for all of IDEXX's Cushing's related tests. The LDDS is on Page 3 of the pdf, and Athena's results are consistent with the result "silo" that is the third from the left: the one in which both the 4 and 8 hour results are greater than 1.5, and both are also greater than 50% of the baseline. As you will see, that test result is consistent with Cushing's, but further testing is needed to determine which type of tumor is the cause.

https://www.idexx.com/resource-libra...g-guide-en.pdf

As I say, I am so sorry to be harping on this. But when you have the time to take a look at this chart, I think you will see how IDEXX would interpret Athena's result. And at that point, you can even print the chart out and once again talk this over with your vet if you choose to do so.

Marianne

Yikes, I was just typing up a response quite similar to Marianne's.

It's a lot of absorb at once, so hopefully you aren't getting overwhelmed by us.

Even if she does not have an adrenal tumor, there are many uses from doing high quality imaging. I opted not to do an ultrasound and went straight for a CT scan. Would you believe we have referred back to that scan numerous times the past 2 years for a number of reasons? Point is, you'll not only get to rule in or rule out ADH, but you'll get a good view of the surrounding organs and any other information the imaging can provide.

There is a lot of good advice on this thread. I just want to emphasize what others have said...to not increase the dose on the 14th day. Vetoryl can continue to lower cortisol for 30 days and it is recommended that any increases be made on the 30th day if necessary. I'm thrilled to hear the vet has heard your concern to start at a lower dose.

The first week my dog started taking vetoryl, I was a wreck. I didn't leave the house at all. Nothing you say can sound crazy to any of us :D Also, I remember my dog being tired in the very beginning of treatment and looking back I believe it was due to his cortisol dropping quickly. His post ACTH number went from 25 to 7 ug/dL in under 2 weeks. He got his energy back around the one month point and it was more energy then I have seen from him in a couple of years. I felt horrible when I realized this disease took so much out of him.


http://www.idexx.nl/pdf/en_ie/smalla...monitoring.pdf

~Katherine

I wish I had known about the 30 days before I let my vet increase Lena's dose from 10 to 20 to 30. Next week is 30 days on 30mg...if I had found this forum first I would have fought it.

Quote:

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Originally Posted by molly muffin

I just want to add one thing, you aren't at all abnormal in your worry and stress over this. I've been on the this forum for years and can throw out what to do, what things mean, at the drop of a hat and then my Molly has her test, and I become still, a basket case of what should I do, what shouldn't I do, even though I Know. I do know, but emotions just sort of flood you and rational thought goes out the window, either that or I analyse all the possibilities until I become practically inert. Thank god for the other members and the other admins here who have kept me sane and on track for the last 4 years.
So I think you are completely normal in your response to this diagnosis and what to do and what things mean and what questions to ask, etc. It's always harder in our own. Big hugs. I can say, it does it get better, but I couldn't be more thankful for a forum like this when the mind starts rolling.

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Oh how I can relate! It's been 7 months and I have yet to find that perfect balance of sanity.