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Thread: Possible Cushing's, 8.5 y/o male Boxer (Sweet Jordan has passed)

  1. #111
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    Default Re: Possible Cushing's, need advice on next steps (Jordan) 8.5 y/o male Boxer

    Also? At this point you don't really feel like a 'total stranger' anymore, so...I take that back. And if you're ever in Germany, I'll happily pay you in really good beer and pretzels!!

  2. #112
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    Default Re: Possible Cushing's, need advice on next steps (Jordan) 8.5 y/o male Boxer

    Hey, All...I'm back again.

    You're gonna love this. We had to take Jordan in to the ER vet yesterday, and since fell out with the one near home, we had to go to the only other one we know, which is our very first, original vet that we had here in Heidelberg...the only vet in the county that we've not seen for Jordan's Cushing's symptoms.

    We had to do a follow-up appointment today with the main Dr. there, so when he asked what the problem was (Yesterday, he kept squatting to pee but nothing came out. By the time we got to the vet...he peed just fine. He likes to take a trip to the ER about every six months, just to flirt with the ladies, so far as I can figure...) I gave Dr. Mauer a very brief history of the past six months, ending with the fact that he has been confirmed not to have Cushing's and that the last Dr. (an IM specialist)told us less than two weeks ago that, "He looks fine to me."

    The next thing out of the good Dr.'s mouth? "But he looks exactly like a Cushing's dog." I swear...you just can't make this stuff up. So then I had to give him a more detailed explanation of everything we've done so far, including that the IM basically told me there's no such thing as Atypical Cushing's, to which, he responded, "There most certainly is such a thing." He was well-informed on the topic, and referenced a 'famous' US Dr. - I want to say, Feldman, maybe? Anyway, since the urinating problem seems to have come and gone, he asked that we table today's appointment so that he can collect all of the test results from the three vets we have seen, and decide from there what to do. Can you believe this?? After all we've been through, I hadn't even bothered to take his previous test results with me today. I had consciously considered and rejected the idea, deciding that they wouldn't listen to me anyway, so why bother? Go figure. He actually said to me, on his way out of the office, "Internal medicine is my hobby." Of all the dumb, dumb luck.

    We go back on Thursday, and depending on what he sees in all of the previous test results, in addition to the full blood panel we had done today, we'll decide our next steps. It sounded like he will probably want to do a full hormone panel, as he was mentioning one of the secondary hormones, specifically...I forget the name, but it has the number 17 in it. He mentioned Vetoryl, which is why I am back here today. From the reading I've done, it was my understanding that Vetoryl only helps if cortisol is the issue, and that it can actually worsen symptoms if they're caused by secondary hormones? Can anyone confirm, deny, or otherwise enlighten?

    So. Sorry...but that was a long-winded way of asking, "Can Vetoryl be used to treat atypical Cushing's?"

    As always, thanks for your help. I'll do some searching around on here, too, to see what I can find on my own. I just wanted to update Jordan's case and see if anyone had anything to offer.

    Best,
    Jenn

  3. #113
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    Default Re: Possible Cushing's, need advice on next steps (Jordan) 8.5 y/o male Boxer

    Hi Jenn,

    I am one who would not use Trilo (Vetoryl) on a pup of mine who had elevated intermediate hormones, which is what Atypical is. There is much debate on this subject but I choose to follow the recommendations of those who are the pioneers in this area - University of Tennessee in Knoxville (UTK). Here is what they have to say about the use of Trilo in Atypical pups -

    Trilostane. Now available in the U.S. as VetorylTM from Dechra Veterinay Products. NOTE: Trilostane always increases 17-hydroxyprogesterone (some cross-reactivity with pregnenolones in assays??), and frequently increases estradiol and androstenedione as well. LysodrenTM may be preferred for Atypical Cushing’s cases. FURTHER NOTE: Care should be used in switching from trilostane to LysodrenTM. Allow adequate time for either drug’s effects on the adrenals to subside before switching treatments. (E.g., one month off drug; normal or increased stim-cortisol levels).
    Several here feel differently and have no problem using Trilo in their Atypical pups. For me, I don't understand the use of a drug that will elevate the very things I want lowered. My Squirt is Atypical and we are a Lyso household.

    Hugs,
    Leslie and the gang
    "May you know that absence is full of tender presence and that nothing is ever lost or forgotten." John O'Donahue, "Eternal Echoes"

    Death is not a changing of worlds as most imagine, as much as the walls of this world infinitely expanding.

  4. #114
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    Default Re: Possible Cushing's, need advice on next steps (Jordan) 8.5 y/o male Boxer

    Thanks, Leslie! From the reading I've done this afternoon, I find myself firmly on the same page with you, so at least now I'm going in fairly informed for our visit on Thursday. He can convince me (or not) why I should change my mind. Meanwhile, I think we can probably get access to Lysodren via the US medical system, so if he's open to that, we can discuss it. In the meanwhile, I'm just glad somebody is finally taking us seriously.

    I'll keep you posted. Thanks again!!
    Jenn

  5. #115
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    Default Re: Possible Cushing's, need advice on next steps (Jordan) 8.5 y/o male Boxer

    Hey, Everyone...

    I hope all is well with you and yours. I just wanted to check in with a minor update. Yesterday's vet visit turned into just a consult, much to everyone's frustration, I think, except my little man, who was thrilled to get treats and flirt with the ladies without having to pay the usual needle toll.

    The good news is that all of his Tuesday blood work came back normal except for very slightly elevated alkaline phosphatase. It was 303, with an upper limit of 212. The doc gave us 3 options: an ACTH stim test for the 17HPO hormone, which is the only other hormone his lab tests for adrenal illness; a Vetoryl trial; or a Lysodren trial.

    He was pushing me to do something, and even got a little short with me when I kept asking questions and posing 'what-if' scenarios, asking me if I wasn't prepared to do something, then why did I come to him for this? I had to remind him that I didn't, in fact, come to him for this but for an unrelated(?) issue.

    I am not prepared to put Jordan through another ACTH stim, benign as it may seem (death by a thousand needle punctures doesn't seem so benign to him, I'd bet) to test for just the one hormone, because the only thing those results can do is rule out or leave open the option of Vetoryl, and there's no way I'm using Vetoryl on a dog whose cortisol levels are normal, regardless of what his other hormones are doing. Can someone please confirm or refute my logic here? I'd appreciate it.

    As for trying Lysodren, I'm open to that, but he's only been on the flax/melatonin combo for about two months now, and much of what I've read says you have to give it more time than that. Since his appetite has become manageable (it's 0812 now and he hasn't yet asked for breakfast...absolutely unheard of two months ago) and his blood work was for the most part normal, it seems to me that the conservative (and kind, I hope?) approach is to do nothing further until we give the requisite four months of melatonin/flax protocol time to do its thing. Again...I'd appreciate anybody's thoughts on that.

    I am going to look into milk thistle (thanks Laura) as a liver supplement in the meanwhile. I would appreciate any feedback y'all have to offer on the matter. I'm so tired right now....I need some help here, to see clearly and make sure I'm doing the best I can by my sweet baby boy.

    Thanks muchly, as always,
    Jenn
    Last edited by Somesie; 06-29-2012 at 02:19 AM.

  6. #116
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    Default Re: Possible Cushing's, need advice on next steps (Jordan) 8.5 y/o male Boxer

    Jenn, aside from his appetite, how are his other Cushings symptoms at the moment?
    If you feel that these are moderate, I'd think that allowing yourself the rest of the summer to keep going with the melatonin / flax combi would work, and just keeping an eye that he doesn't suddenly become overt in his symptoms. Are you keeping a month on month photo record? great stuff if so, if not I'd recommend it as a way of keeping track (although I hated doing it and deleted it off my laptop earlier today).
    Then all being well, at the end of the Summer schedule a general health check, considering an acth as an option then.
    As far as supplements go, I think the flax will also be helping skin and fur too but you might also want to add some fish oil or cod liver oil. If you don't already give glucosamine I'd do so as cortisol masked Saoirse's arthritis, I think Jordan being of a similar size and similarly bouncy nature he could be a candidate for it further down the line. Have some cranberry extract to hand and if he has signs of urinary tract irritation, add some of that to his food for a few days.
    Oh and don't forget some St John's Wort. Not for Jordan, for you before your next trip to the vet!!!
    Love to you all,
    Laura x

  7. #117
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    Default Re: Possible Cushing's, need advice on next steps (Jordan) 8.5 y/o male Boxer

    Hi Jenn,

    When Squirt was first diagnosed, I was very hesitant to start either of the drugs used to treat. We were lucky to have a vet who was very thorough in the testing phase, who supported my desire to be even more thorough, and who was very cautious in her treatment approach. That caution gave me time to learn about this disease and the treatments available.

    Squirt started on Anipryl, then we went to the lignans and melatonin. The Anipryl helped her for about 9 months - 6 months longer than it typically does. The lignans and melatonin helped her and continue to help her...when I have run out of either, I can tell the difference in her behavior so I know they help.

    I worried that her cortisol would start to rise and I wouldn't notice it happening...that I would continue to use the "milder" approach to her detriment. HOWEVER...let me tell you that when, if, Jordan's cortisol starts to rise, you will know it! Squirt's started rising last summer and it was obvious...even tho I did miss the more subtle signs like her hair and body shape changing - my niece pointed those out. Within a few days of that sudden awakening, she was in full blown cush mode....drinking like crazy, peeing all the time, and her appetite was heart-wrenching to see. She would finish her meal then look up at me with the saddest eyes, begging for food as she knew, absolutely knew, she was starving where she stood. We started the maintenance dose of Lyso then and she is doing very well today with the Lyso, lignans, melatonin, herbs, diet and supplements she gets daily.

    I think you are being wise not to rush into treatment right now. As long as Jordan's signs remain mild, I would continue the path you are on now...but that's just me.

    Hugs,
    Leslie and the gang
    "May you know that absence is full of tender presence and that nothing is ever lost or forgotten." John O'Donahue, "Eternal Echoes"

    Death is not a changing of worlds as most imagine, as much as the walls of this world infinitely expanding.

  8. #118
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    Default Re: Possible Cushing's, need advice on next steps (Jordan) 8.5 y/o male Boxer

    Hey Everyone!

    Well, after telling him just yesterday that we were not going to pursue further treatment yet, I just sent the following email to the vet:

    Can you please see that Dr. M gets this message? I know I just told you yesterday that we would be holding off on further treatment for now, but I have since done a lot of reading about Anipryl (L-Deprenyl), and wonder if you might be willing to prescribe it for Jordan? I understand that it has a lower efficacy rate than trilostane or mitotane, and may not work for him, but given our circumstances I would like to try it, for the following reasons:

    1) Fewer, less severe side effects
    2) Requires no further ACTH testing (He’s been through a lot in the past months, which is why I changed my mind about the ACTH stim test last week).
    3) The worst of his symptoms have abated and I feel that Lyso or Vetoryl might be an overreaction to his current level of sickness. However, he is certainly not his old self, and if there’s a chance that Anipryl can bring back some of his personality and make him feel like the happy, healthy pup that he was at this time last year, I would like to take that chance, even if it only helps him temporarily.

    We will be out of town for the weekend, but if you are willing to prescribe Anipryl for him (he’s at 38 kilos right now), I would love to pick up a few weeks’ worth on Monday when we return. I’m sorry to be so indecisive on this – I am just trying to be the best advocate that I can for him, and that has taken a considerable amount of research and thoughtfulness, so I haven’t always been able to make a decision right there at the office…I hope you understand.

    Please let me know your thoughts, either via email or phone.


    I know...it's like I actually want them to think I'm crazy, what with all the back-and-forth and hemming and hawing. And the Germans...they don't have a lot of tolerance for such things, I assure you. But, having had some discussion with Leslie (thank you!) and reading until the wee hours last night, I want to give this a try. I can't imagine the doc will have a lot of trouble with the plan, except for maybe the fact that I'm the one who thought of it instead of him, so hopefully we will be able to grab some up on Monday and see if it helps bring back some of his spirit.

    As far as his current symptoms, he really seems to have good and bad days with the appetite, but even on the bad days, it's not quite as bad as it was a few months ago. His drinking does not seem to have improved much, if at all. That's hard to track, since he shares a bowl with sissy Barkley. His coat is slightly improved since the flax/melatonin...it's softer, but still quite thin. I understand that will take the longest to see improvement, though, naturally.

    Couple of questions -

    1) I am using ground flax seed, that I grind myself. I read a bunch last night about lignan pills v pressed hulls, and now I'm wondering...does he have to get this in some type of pill or liquid form in order for it to be effective? Am I not doing the right thing by using the real deal, ground up? This concerns me gravely, so I'd love to hear somebody's thoughts on the matter.

    2) Ah, crap. I forgot my two. Ummm...hold, please. (Getting old s*cks!)

    Oh! I know...supplements! As mentioned, his most recent blood work came back looking pretty good, other than mildly elevated alkaline phosphotase. Laura...I got yours, so thanks. What does St. John's Wort do? For me or him? Leslie...if you have a few minutes to share what you're currently using and why, that'd be great, as it seems Jordan and Squirt have some things in common. I finished reading all 45 pages of your thread this morning, so I know some stuff, but not necessarily why. Any help that anybody can offer in this regard is most appreciated.

    Hey. This is somewhat unrelated...but he's doing it right now so it's top of mind. He cries sometimes, when he's laying down. Right now, he's practically asleep, but he's doing it. "Cry" might be a little strong...it's more of a quiet little whine. It's so pitiful! Any ideas? He's not one to complain about pain, so I don't think that's it, but I could be wrong. It used to be that this was his precursor to an all-out barkfest, where he wants to get our attention for playtime or some other vital demand, but now he just lays there and whimpers ever so slightly. GAHHHH!!! I want my boy back!!!

    A'ight. Sorry for the dissertation. I'm tired. And that's Leslie's fault, for having such an entertaining and informative thread that I was up until ridiculous hours.

    As always, thanks & sloppy Boxer smooches,
    Holla!!
    Jenn

  9. #119
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    Default Re: Possible Cushing's, need advice on next steps (Jordan) 8.5 y/o male Boxer

    St John's Wort is a herbal antidepressant! Never used it on animals although I know it can be used but it has lots of contraindications with other meds so I'd only use it under expert guidance!
    I've taken it myself though when facing tough times, it works although it induces a slight mania and restlessness which is at odds with my slothful nature!
    Lxx

  10. #120
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    Default Re: Possible Cushing's, need advice on next steps (Jordan) 8.5 y/o male Boxer

    Anyone...??
    Quote Originally Posted by Somesie View Post

    Couple of questions -

    1) I am using ground flax seed, that I grind myself. I read a bunch last night about lignan pills v pressed hulls, and now I'm wondering...does he have to get this in some type of pill or liquid form in order for it to be effective? Am I not doing the right thing by using the real deal, ground up? This concerns me gravely, so I'd love to hear somebody's thoughts on the matter.

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