Daisy Mae - our sweet Daisy has crossed The Bridge

[doxiesrock912]

Hello everyone,


Daisy Mae "monster" is a 9 yr. old, 14 lb, miniature, smooth, black and tan Dachshund.

I've suspected that Daisy may have Cushing's for almost a year now since she never fully recovered from a severe reaction to Blue Buffalo Wellness dry dog food 2 years ago, but her vet insisted that it was IBD because she had chronic diahrrea. We have since changed vets to Dr. Toby Kimm of Ragged Mountain in Plainville, CT.

Aside from the diarhhea, she has a markedly increased appetite. I've had to add water to her Royal Canin Dachshund formula to make her eat slower and avoid choking. Now she's drinking a lot of water, recovering well from her first ever bacterial skin infection, and at times seems indifferent toward me. She had luxating patella surgery in 2005 and has arthritis in that rear leg now which responds well to glucosamine chondroitin MMS? (I think those are beneficial omega 3 fatty acids.)

She's just begun 20mg, once a day of Trilostane and the vet suggests that we do some imaging because she's starting to get the pot belly.

Here are the results of her LDDS test and followed by what the vet had to say in response to my email asking for clarification.

CORTISOL SERIAL 3 (OEX)
Time 1 Pre
Time 2 Post
Time 3 Post
Cortisol Sample 1 8.8
ResuIt verified .

Cortisol Sample 2 Dex - 3.7
Result verified .

Cortisol Sample 3 Dex
Result verified . 4.5

Low-dose dexamethasone suppression test: Normal: Cortisol level less than 1.4 ug/dl 8hrs post-dex.
Hyperadrenocorticism: Cortisol level greater than 1.4 ug/dl 8hrs
post-dex.

If the 8hr post dex. cortisol level is greater than 1.4 ug/dl, the following can be used to difierentiate pituitary dependent hyperadrenocorticism (PDH) from an adrenal tumor : 1. Cortisol level less than 1.4 ug/dl 4hrs post-dex is consistent with PDH .
2. Cortisol level less than half the baseline level at either 4 or 8 hours post-dex is consistent with PDH.
(Samples taken at 2 or 6hrs are interpreted the same way as a 4hr
sample)

If neither of these criteria is met, further testing is needed to differentiate PDH from adrenal tumor Cushings.

NOTE: Approx. 5% of dogs with PDH have normal results. False positives

Vets Response to my email asking for clarification of the results:

Hi Valerie, In response to your questions, we did a dexamethosone suppression test, low dose, as opposed to an ACTH response test. The better test changes about every 4 years, and now the dex suppression test is better, according to both meetings I went to last year on Cushings. From the results, there is no doubt that Daisy has pituitary dependent hyperplasia, as a more than 50% reduction at either 4 or 8 hours from the baseline indicates PDH. As for the bloating, it is along with PU and PD, a clinical sign of the disease. That being said, an ultrasound of the abdomen is always a good idea with any Cushings suspected cases. We can also take new abdominal xrays, as we have been updated to a digital system since your last visit and the contrast is much better. I am still using Trilostane at once daily dosing, as I believe the twice daily is more prone to overdose. I have had three cases in the past month where we had to go to every other day dosing as we were causing signs of Addisons Disease (weakness, megaesophagus collapsing) on the daily dose. I will scan the bloodwork in following. - Toby Kim

What else can you tell me about the results? Is she in the beginning stages of Cushing's? The pharmacy said that the 20mg daily dose was on the low end of the spectrum.

Also, is anyone familiar with the Cornell University Veterinary Hospital in Stamford, CT? Going there is an option too.

New surgery options?

There is so much information on the internet that it became overwhelming.

Thank you in advance for your help.

Valerie

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♂∞❤∞♂ ♂ ∞❤∞♂
Gracie Daisy

[Harley PoMMom]

Hi Valerie,

Welcome to you and Daisy, so sorry for the circumstances that brought you here but so glad you found us.

By the description of Daisy's clinical symptoms plus the positive results from the LDDS test it sure seems that Daisy does have Cushing's resulting from a tumor on the pituitary gland. Just to confirm the diagnosis of Cushing's an ACTH stim test or an ultrasound should be performed because not one test is 100% accurate at diagnosing Cushing's disease.

Although I am not a vet, with Daisy weighing 14lbs I would of liked to see her starting dose begin at 10mg instead of 20mg. Does your vet follow the proper protocols when monitoring with an ACTH stim test, such as having an ACTH stim test conducted in 10-14 days after treatment has begun? And the ACTH stim test has to be performed 4-6 hours after the dose of Vetoryl is given. Also did your vet mentioned that Vetoryl has to be given with food to be properly absorbed?

Was a chemistry/cbc blood panel done and if so could you post any abnormalities that are listed along with the reference ranges and units of measurements. Was diabetes and any thyroid problem ruled out? Is Daisy taking any other herbs/supplements/medicines? So sorry for all of these questions but the more we know about your sweet girl the better our feedback can be, ok?

Here is a handy link with info about Trilostane/Vetoryl: Trilostane/Vetoryl Information and Resources

Please know we will help in any way we can so do not hesitate to ask any and all questions.

Love and hugs,
Lori

[doxiesrock912]

Lori,

I just emailed the vet asking for the other test results that were performed the first day that I brought Daisy in. We did the LDDS on the second visit.

She seems more active already and it's only been the second day on Trilostane. Still "pigging out" and drinking a lot. I'm hoping that we caught this early.

Unless I'm told otherwise, I give Daisy all medications and supplements with her breakfast and then we go outside.

This is the most recent reply from the vet.

Valerie,
If you mean imaging, I think $350 covers an abdominal ultrasound. Abdominal radiographs are $220. We have omega 3 fatty acids or you may order them on line and i will fax a prescription. As for the food question from before, I am not sure. I like to do an ACTH response test two months into therapy as a monitor on success of therapy.


Ask away, I'm new at this and want to learn as much as I can to make informed decisions about her treatment.

Valerie

[Simba's Mom]

Hello and welcome from Simba and me! Simba is a mini Doxie, on the heavy side but every pound is loved he will be 11 years old on April 9, he has been on trilostane since Aug of last year. They started him at 20mg and is now on 25 mg. This forum has been awesome, knowledge is power and the encouragement is a blessed bonus. Take care, we are here for you!

[doxiesrock912]

Thank you Letti!

I read many of the threads before Daisy was diagnosed because I had suspicions.

Has Simba ever had a salivary mucuole? If so, what did the vet do for that?
Daisy has one, but because it isn't bothering her or interfering with eating, breathing, etc the vet prefers to watch it.

Did you suspect that Simba had Cushing's before vet confirmation?

Valerie

[Simba's Mom]

No, sorry I don't know what that is, what else can these poor pups have right? I actually changed vets because my old vet was saying Simba was just fat, but I knew it was more by his symptoms... He was drinking like crazy and he had some hair loss besides his pot belly....
I love the name Daisy Mae, and quick question for you, does she do well on the dashound royal canin food, and is it low fat?

[Harley PoMMom]

Lori,

I just emailed the vet asking for the other test results that were performed the first day that I brought Daisy in. We did the LDDS on the second visit.

We will definitely be looking forward to the results of those tests.

She seems more active already and it's only been the second day on Trilostane. Still "pigging out" and drinking a lot. I'm hoping that we caught this early.

Cushing's is a slow progressing disease, many elder dogs can go undiagnosed for years and when treatment begins some clinical symptoms begin to abate within 2 weeks.

Unless I'm told otherwise, I give Daisy all medications and supplements with her breakfast and then we go outside.

This is the most recent reply from the vet.

Valerie,
If you mean imaging, I think $350 covers an abdominal ultrasound. Abdominal radiographs are $220. We have omega 3 fatty acids or you may order them on line and i will fax a prescription. As for the food question from before, I am not sure. I like to do an ACTH response test two months into therapy as a monitor on success of therapy.


Ask away, I'm new at this and want to learn as much as I can to make informed decisions about her treatment.

Valerie

IMO, 2 months is too long to go for an initial monitoring ACTH stim test. If a dog is doing really well in the beginning of treatment, a month is the longest that I would wait to have an initial ACTH stim test performed.

Many vets want a dog to be fasted for an ACTH stim test but a dog that is being treated with Vetoryl/Trilostane has to have some food with the dose of Vetoryl/Trilostane, even when an ACTH test is scheduled.

Please read the articles at this link: Trilostane/Vetoryl Information and Resources

If this were me, I would have the abdominal ultrasound done because it can give you a lot of helpful information about all of Daisy May's major organs.

Love and hugs,
Lori

[doxiesrock912]

Daisy hasn't had a single issue with Royal Canin and I'm still beating myself up for changing that one time which literally almost killed her. She was vomiting and bleeding from her rear end within a week of being on Blue Buffalo Wellness formula. BB insisted that nothing was wrong with their product and despite sending them ALL of the vet documentation, they refused to reimburse me.

I also give Daisy frozen carrots (not many because carrots contain a lot of sugar), cauliflower, green beans, and broccoli every few days in addition to the Royal Canin. She also tried Hills R/D when a previous vet thought that she had IBD.

I'll never change her food again.

She's had periodic weight issues mostly because grandpa likes to give her treats or too much food, but a week of exercise brings her right back to normal. Now she appears fat, but that is obviously only because of the recent pot belly.

Valerie

[doxiesrock912]

Thanks Lori,

Daisy has had chronic diarrhea since the incident with BB Wellness food despite being changed to Hills R/D at one point which had a minimal affect (the vet who assumed that she had IBD).

Ironically, the new vet prescribed Baytril 22.7mg to treat the bacterial skin infection and all episodes of diarrhea ceased almost immediately. I mentioned this to Dr. Kim on the second visit and the light bulb came on because according to him, if she had IBD the Baytril would've had no affect at all on the diahrrea. He said that she may have had a systemic infection all of this time from the bad dog food. I told him that the only thing ever mentioned to me before now were higher than normal liver enzymes and none of the other vets ordered more tests.

As of now, Daisy is almost done with the prescription of Baytril 22.7mg, almost done with the EFA 2N (formerly A2N) Omega 3 & 6 antioxidents (prescribed by a former vet who missed the Cushings), Osteo Pet Glucosamine Chondroitin MSM, and the Trilostane 20mg.

Dr. Kimm (current vet) said the continue all of them until they're gone. I sent an email to him asking to verify if he really meant two months or maybe should've said 2 weeks.

I'm not sure how much of the improvement in the past two days is due to the Trilostane or the Baytril.

I'll let you know the other test results and what the response is to me questioning the timeline of the ACTH stim test.

I'm unemployed and he's conservative with treatment according to my good friend Lamont who recommended Dr. Kimm. My friend did say that Dr. Kimm is honest and if he really feels that something needs to happen, he'll let me know.

Lamont has used Dr. Kimm for years, he has dogs, cats, and birds.
So far, he's done well by Daisy Mae (thank you for complimenting her name, it fits).

I never had kids, am recently engaged, so Daisy and Gracie (long haired gray cat) are my children <3

Valerie

[Harley PoMMom]

Hi Valerie,

The ACTH stim test is an expensive test because of the stimulating agent, cortrosyn. Vets will usually use a whole vial (.25 mg (250 mcg)) of cortrosyn but studies have shown that only 5 mcg per kg of weight is necessary for an accurate result. I am providing a link to an article with info on how to split, reconsititute and store cortrosyn for future use. This article is written by a renown cushing's expert, Dr Peterson: How to Extend Your Supply of Cortrosyn and Lower the Cost of ACTH Stimulation Testing

I urge you to print this out and give it to your vet as it can save you a ton of money.

Love and hugs,
Lori