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Thread: New Diagnosis and 7 day update

  1. #1
    Join Date
    Mar 2018
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    Default New Diagnosis and 7 day update

    Hello and before I begin, let me say "thanks" to the administrators and all that contribute to this site. While I assume many if not all are not doctors, the information and observations provided are extremely valuable as we, the mom's and dad's of our four legged friends are most in tune with them.

    Macie, our soon to be 10 yr old female Shih Tzu has been remarkably healthy her entire life. Just recently, she had been showing signs of weakness in her back legs (not able to jump up on chairs, etc.) as well as a few other things such as thinning hair, panting, increased water intake and a more robust, aggressive appetite. These symptoms began about 2 months ago. Fast forward to February 24 when the vet did her annual senior blood work and suspected Cushings. After a STIM test was conducted, Cushings was confirmed. While not conclusive to be pituitary dependent, the vet was fairly confident it was in fact pituitary. I will be inquiring about having an ultrasound performed to rule out adrenal dependent. I immediately went into research mode and I found this site. In the last three weeks, I have learned a great deal from this site among many others. I ask a lot of questions and have no hesitation in questioning any diagnosis and treatment protocol. Fortunately, we have a vet that encourages this relationship and she has been wonderful in answering questions.

    Macie was started on Vetoryl 7 days ago and will have her 2 week follow up on the 4th of April. She takes 15 mg in the morning. Her weight is just shy of 12 lbs. Just in these 7 days, we have noticed a decrease in water intake, less demonstrative about food and maybe slight improvement in hind leg strength/mobility. She still seems to be a bit lethargic, but I am not sure it is any more than pre-Cushings diagnosis. Her "normal" behavior (say 6 months ago) was very frisky, almost puppy like in many ways, although being a senior she does sleep a bit more. We are hoping for a return to that puppy-like condition and are fully committed to her treatment and follow up.

    I am providing the results of her blood work and STIM test and would welcome anyone's insight and feedback.

    Platelet - 591, 143-448
    ALT - 185, 18-121
    ALP - 501, 5-150
    GGT - 17, 0-13
    Cholesterol - 401, 131-345
    Total T4 - .8, 1-4

    STIM Test:
    Baseline was >10, 1 hour post was >30. Vet is aiming for Baseline 2-5 and 1 hour post 4-7

    Crazy thing is she had the senior blood panel done in Jan 2017 and all values were great, in the "normal" range. I guess things can change quickly.

    From a diet perspective, on the recommendation of our vet, we have not changed anything except in the morning with the medication she is getting a very small amount of Freshpet Vital Grain Free Beef and Bison Adult Dog Food with her dry kibble (Nutro Small Bites Lamb and Rice). No signs of problems with food or Vetoryl tolerance. She has no diarrhea, vomiting or anything else, however we are hearing some burping or gas since all this started.

    Thanks again for taking the time to read ad if you chose to comment, it is sincerely appreciated.
    Last edited by my2sons; 03-28-2018 at 03:05 PM.

  2. #2
    Join Date
    Apr 2009
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    Georgia
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    Default Re: New Diagnosis and 7 day update

    Hello, and welcome to you and Macie — we’re really glad you’ve joined us! You are correct in guessing that none of us are vets, but instead we are dedicated pet parents ;-). But the truth is that, over the years that this forum has existed, we’ve encountered more Cushpups than many vets see in a lifetime. So that’s certainly not to say that we share the same medical expertise as a vet, but we’ve witnessed many, many treatment journeys that guide our suggestions and feedback. Above all, we offer our support!

    Turning to little Macie, she certainly exhibits a number of laboratory and behavioral abnormalities that are consistent with Cushing’s, and we’ll surely be hoping that you’ll see continued improvement with the Vetoryl. Everything about your treatment protocol sounds very reasonable to me, with one small exception. As you’ve probably seen us write elsewhere, the most widely recommended starting formula for trilostane dosing is 1 mg. per pound. So with a weight of less than 12 pounds and a daily dose of 15 mg., you guys are rounding “up,” if you will, as opposed to rounding “down.” Given the available Vetoryl capsule strengths, my personal preference would have been to start at 10 mg. and work up as needed over time, rather than vice versa. But she’ll soon be having her monitoring testing, and you’ll have a better idea as to the appropriateness of that dose. It’s clear that you are watching her very closely, and will notice any issues that might arise beforehand.

    So all in all, we’ll be hoping for smooth sailing for your little girl, and we’ll remain anxious for further updates. And once again, welcome!

    Marianne

  3. #3
    Join Date
    Mar 2018
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    Default Re: New Diagnosis and 7 day update

    Thank you Marianne. In your opinion, how did the blood work and other numbers look to you? Our vet thinks we caught this early and we are hoping that the Vetoryl will be effective given the early stage of Cushings and her overall excellent health otherwise. Regarding the dosage, I too thought that 10 mg would be a better starting point, but we are now in day 9 so I figured let's let it go the full course before the next ACTH test and see what we get. She has been tolerating the medicine and is showing small signs of improvement such as decreased water intake, decreased urination and is less aggressive regarding food. Again, thank you.

  4. #4
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    Georgia
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    Default Re: New Diagnosis and 7 day update

    Hello again! Macie’s labwork abnormalities are pretty classic in terms of Cushing’s: significantly elevated ALP; mild or moderate elevations in other liver markers, cholesterol, and platelets; decreased thyroid. And yup, that ACTH result is also consistent with a “positive” Cushing’s diagnosis. So taken in conjunction with her overt symptoms, I’m on board re: your treatment plan. The 15 mg. Vetoryl dose may end up being perfect for Macie, and I don’t want to worry you unduly with my comments about that since she’s taking only a little bit more than I’d normally suggest. For the benefit of all our readers, we just tend to harp on that 1 mg. per pound initial dosing formula. In earlier years, dosing ranges were much higher and we do encounter vets who persist in starting off with some whopping big doses.

    I’m so glad Macie is doing well at this point, and we’ll be rooting for even more improvement in the coming days!

    Marianne

  5. #5
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    Mar 2018
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    Default Re: New Diagnosis and 7 day update

    Hello again. One additional observation I would appreciate some insight on. Not sure this is Vetoryl related, but about an hour after giving her the medicine, she appears very lethargic, but not totally unresponsive. About an hour or two later, she appears to be back to normal. What makes this difficult to connect with the Vetoryl is she usually takes a good nap around this time of day, but she just seems to be a little more "sleepy" than usual. Her eyes may be open but she doesn't really follow your hand movement. I have a call into the vet and am waiting a response. It may be nothing, but I want to be sure.

    Thanks

  6. #6
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    Georgia
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    Default Re: New Diagnosis and 7 day update

    It may be the case that Macie is responding to what may be a pretty dramatic drop in cortisol for her. The manufacturer of Vetoryl tells us that the medication reaches maximal level in the bloodstream by about 1.5 hours after administration, so that would correlate fairly well with the timing you’re noticing. If this is the cause, the reaction may just be temporary as her body adjusts to the med. But if it persists, it might justify lowering her dose for at least a few days in order to allow for a more gradual transition to a consistently lower cortisol level.

    Marianne

  7. #7
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    Mar 2018
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    Default Re: New Diagnosis and 7 day update

    Thank you - I read that same thing about the 1.5 hr maximum level. Vet just got back with me and she said basically the same thing, so all is well so far. Have a great Easter!

    Keith
    Last edited by my2sons; 03-30-2018 at 04:33 PM.

  8. #8
    Join Date
    Jun 2012
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    Canada
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    Default Re: New Diagnosis and 7 day update

    Hello and welcome from me too. So, the 4th has passed, i assume you did the follow up blood work. Where did her cortisol numbers come in at? How is she doing, does she still have that very sleep time about 1.5 hours in?
    Sharlene and the late great diva - Molly muffin (always missed and never forgotten)

  9. #9
    Join Date
    Mar 2018
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    Default Re: New Diagnosis and 7 day update

    Hello, thank you for the note and apologies for my delay in responding. Macie had her 14 day follow up and the Dr. said all her numbers looked great. I will get a copy and post the numbers this week. Overall, she seems to be doing really well. Energy level is up, drinking is down although appetite still seems stronger than usual . We have not changed her food but are watching her daily food intake and have added green beans to her evening meal. She loves them and it seems to satisfy evening hunger. Her energy level seems to have smoothed out a bit, even after taking the Vetoryl. We are back to going on walks which is really encouraging. She has continued to lose some hair but I have read that will taper off with regrowth in about 6-9 months.

    She will have another ACTH test in about a week and we are hoping she continues to do well. Thank you again for your message and I will continue to provide updates as we work through this.

  10. #10
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    Default Re: New Diagnosis and 7 day update

    Quote Originally Posted by my2sons View Post
    Hello, thank you for the note and apologies for my delay in responding. Macie had her 14 day follow up and the Dr. said all her numbers looked great. I will get a copy and post the numbers this week.
    Are those numbers coming from a Chemistry blood panel or an ACTH stim test?

    Quote Originally Posted by my2sons View Post
    Overall, she seems to be doing really well. Energy level is up, drinking is down although appetite still seems stronger than usual . We have not changed her food but are watching her daily food intake and have added green beans to her evening meal. She loves them and it seems to satisfy evening hunger. Her energy level seems to have smoothed out a bit, even after taking the Vetoryl. We are back to going on walks which is really encouraging. She has continued to lose some hair but I have read that will taper off with regrowth in about 6-9 months.

    She will have another ACTH test in about a week and we are hoping she continues to do well. Thank you again for your message and I will continue to provide updates as we work through this.
    Glad to hear that Macie is improving with treatment, it's a happy time when one starts to see their dog return to their "ole self" please do keep us updated!

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