New To Forum - Keesh has crossed over

[Trixie]

We started the same medication in April. It took almost 4 weeks before I saw a decrease in symptoms for my dog Trixie. In fact her drinking got even worse the first few weeks of treating. Some days she drank 50oz of water and peed all day. I wasn't good about being patient but that's what it takes.
Finally it began to decrease, but it did take time. More time than I expected. We did increase her dose very gradually since then. There is constant tweaking. Drinking was our main symptom too so it's my gauge to see how Trixie is doing. We got down to normal and then it started to increase a bit again so we are again increasing and tweaking the dose, this week there was improvement.
You'll probably soon see some changes over the next few weeks if not sooner.
Barbara

[lulusmom]

I just checked out the labwork you posted and they are very difficult to read. I tried magnifying but that just enlarged what was already unreadable. Can you give me the date of the test for each document. Looks like two blood chemistries and one UCCR. Document 1 looks like all was normal with the exception of ALP which was only mildly elevated and ALT which was also mildly elevated. The numbers look like ALP 183 and ALT 145 but I can't read the normal reference ranges for either.

The UCCR, which looks like it was done on the same date as the doc 1 blood chemistry looks like result is 22 x 10-6 which according to the interpretation is abnormal (high) but this can happen in the face of stress or nonadrenal illness. I'm mentioning nonadrenal illness because the second blood chemistry (doc 3) shows ALKP normal with much higher elevation of ALT. Albumin is also elevated a bit which is usually due to mild dehydration, especially if fasted for the tests. There is a section on doc 3 at the bottom that says "Endocrinology". I can't read it at all so it would be helpful if you could type those three rows out for me. I've looked at a whole bunch of bloodwork over the years for my three cushdogs and about hundred members and from what I see so far, cushing's would not be my first suspect but will wait until you post the endocrinology part of the test. If doc 3 is the most recent bloodwork, I'd be more concerned that there is something else is going on that is assaulting the liver. With PU/PD (excessive drinking and peeing) being the only symptom and with blood abnormalities (ones I can read) not being the usual we see with cushing's, the cushing's diagnosis is suspect.

Do you have the results of a urine analysis? I would be interested in seeing the urine specific gravity. I am hoping that the endocrinology results include an acth stim test but it doesn't look like it to me. The first line looks like T4 which is thyroid and the other two lines I can't make out. If those other lines aren't the results for an ACTH stim test that is consistent with cushing's, I personally would stop dosing until either an acth stim test and/or a low dose dex (LDDS) test can be done. Actually based on the bloodwork, I'd be looking for something other than cushing's.

Looking forward to your next post.

[spdd]

I'm going to forward you the email with the PDF they sent. I was told the ACTH test was done. I asked for the reports and this is what they sent. I will try to get the urine report from them. Thanks for your input.... now I wonder if they are just trying to get more money from me. They have been his vet since he was a puppy so I trusted their judgement, but what do I know.

[lulusmom]

Okay. I'll check the email. It could very well be that the part of the endocrinology results I couldn't read are the acth stim test. I'll be right back after I have a chance to take a look at your email attachments.

[lulusmom]

Okay, just took a look and yes, I could read those much better but now I'm very worried because there is no acth stimulation test or low dose dex test results. Also the latest bloodwork is not consistent with cushing's and for that matter, neither was the first blood chemistry. If your vet didn't do one or both of these and Keesh were my dog, I'd stop dosing immediately.

Can you please see if you can get a copy of the acth stim test from your vet? If Keesh does have cushing's, it is impossible to determine which form of the disease Keesh has without doing an abdominal ultrasound. Did your vet tell you if Keesh had pituitary or adrenal disease?

Glynda

P.S. The endocrinology section of the test result was a thyroid panel and T4, Free T4 and TSH are all within normal range.

[spdd]

Okay, just took a look and yes, I could read those much better but now I'm very worried because there is no acth stimulation test or low dose dex test results. Also the latest bloodwork is not consistent with cushing's and for that matter, neither was the first blood chemistry. If your vet didn't do one or both of these and Keesh were my dog, I'd stop dosing immediately.

Can you please see if you can get a copy of the acth stim test from your vet? If Keesh does have cushing's, it is impossible to determine which form of the disease Keesh has without doing an abdominal ultrasound. Did your vet tell you if Keesh had pituitary or adrenal disease?


Glynda

P.S. The endocrinology section of the test result was a thyroid panel and T4, Free T4 and TSH are all within normal range.

They told me they took an acth test and I thought those were the results that I sent, obviously not, but I told them about this forum and I wanted their current test results . I will get a copy of those results from them next week as it is a holiday weekend here in Canada and they won't be open until Tuesday. I'll send it when I get it. The vet does not know if it's pituitary or adrenal, but said the Trilostane is good for both. No ultrasound was taken, but they did x-rays and all organs looked good. I can't remember if they offered to do an ultrasound. This getting up every 2 hours in the night has been going on now for a month. I hate to admit it, but the vet said to get men's depends for him as he will dribble at times when asleep.
Oh, how we love our dogs. Is the acth test done over a period of hours? They took him in and did blood work, then administered a drug, then took blood every couple of hours. This was the better part of a day. It that the acth test? That is the same one they want to do on July 11th. I am supposed to give him the Trilostane at 8:00 a.m. then bring him to the vet at 1:00 p.m. They said he would be there for a couple of hours.

[molly muffin]

The ACTH test, you give him the trilostane (always with a bit of food for better absorption), and then you take him in and they test within 4 - 6 hours. Because you are here in Canada, they typically do use a compound agent for the test and do two draws instead of just the normal one draw that they use in the US.
Your results will be in nmol I am guessing.

You mentioned there was an infection in the urinalysis? This can cause excess drinking and peeing too and can also cause the ACTH to be a false positive. Were you given meds for an infection? Sorry you might have said and I missed that part.

Sharlene and Molly Muffin

[lulusmom]

It sounds like your vet did a low dose dexamethasone suppression test (LDDS). It's an eight hour test. The ACTH stimulation test takes a bit more than an hour. I was hoping that they did an ACTH Stimulation test as it is less likely to yield a false positive result. No matter what, I'll be looking forward to seeing the results.

Glynda

[Budsters Mom]

Just popping in to check on you and Keesh. This is all very overwhelming at first and I just want to make sure you're doing okay.
Big hugs,
Kathy

[spdd]

Thank you again for your concerns. Nothing has changed, matter of fact I think he is actually drinking a bit more. There has been absolutely no improvement since starting Trilostane 13 days ago. They did not give me any medication for a suspected infection found in his urine. They only said how diluted it was, which of course would be with all the water intake. He's happy, eating, no diarrhea but becoming very stubborn and I find at times he's just not as obedient as he used to be. Guess we all get a little stubborn in our old age.