Dachshund diagnosed and needs advice/thoughts

[Harley PoMMom]

Could you post his recent ACTH stimulation test results for us? Some dogs do have a reaction to the stimulating agent, members have reported that their dog became restless and/or hyperactive. Since the stimulating agent has had a positive effect on Tucker I'm wondering if he needs a daily dose of a supplemental steroid such as prednisone.

[TheDude]

Last night he turned around and was a lot better. He actually slept good through out the night too. This morning he has more energy and more like himself. Actually seems a little restless, but he's definitely happy today.
The last results were 0.7 and 1.4 (unchanged).
Maybe his numbers are finally coming up or he has big variations through out the day. With all of the neurological symptoms he has he has to have a decent size tumor on his brain.

[Harley PoMMom]

I do recommend starting him on a daily dose of prednisone especially since his numbers are still too low, and the added benefit is that if pituitary tumor has gotten larger than the prednsione could reduce the inflammation caused by the tumor.

[Budsters Mom]

I am with Lori on this one. Tucker's numbers remain dangerously low. Prednisone helped his neurological symptoms tremendously when my little Buddy has a probable pituitary macro tumor. It helps to reduce swelling around the tumor. Talk with your vet about a daily dose for Tucker, at least for now. The dosage will most likely need to be adjusted as time goes by and the tumor grows. I realize that money is an issue. It is for many of us. Thankfully prednisone is pretty cheap as far as meds go.

I would not restart Vetroyl in any dosage while Tucker's numbers remain so low.

[TheDude]

Isn't it dangerous to start steroids without seeing if his numbers come up on their own? Last night he had to go out to pee now than usual and his water consumption is up already. He's also begging even more for food. Other then fatigue at times he's not showing signs of addisons.
Even vetoryl says post 1.5 is ok. Yes I agree its to low, but they also say to stop meds and retest after 7 days. I think I'd rather test then see if he needs the steroids then risk driving him up if his numbers are already starting to go back up.

[Harley PoMMom]

Increased drinking and urinating are signs of Addison's too. Dr. Mark Peterson, who is a renown Cushing's expert, states that when treating Cushing's with Trilostane a post of less than 2.0 ug/dl is too low:

When using trilostane, it has become increasing clear that we do not want the cortisol values to drop too low, because that may indicate early or mild adrenal necrosis (1,11,12). In contrast to the protocol used in this reported study, I recommend stopping the drug in all dogs that develop a ACTH-stimulated cortisol values less than 2.0 μg/dl, and repeating the ACTH stimulation test in 1- to 2-weeks in those dogs. Some of these dogs will require that the drug be restarted at a lower dosage, but others will maintain low to normal serum cortisol concentrations for prolonged periods of time. And a subset of these dogs, presumably because of mild adrenal necrosis, will never need any further trilostane treatment to control the signs of Cushing's syndrome.

https://endocrinevet.blogspot.com/20...rilostane.html

[labblab]

Last night he turned around and was a lot better. He actually slept good through out the night too. This morning he has more energy and more like himself. Actually seems a little restless, but he's definitely happy today.
The last results were 0.7 and 1.4 (unchanged).
Maybe his numbers are finally coming up or he has big variations through out the day. With all of the neurological symptoms he has he has to have a decent size tumor on his brain.

I definitely understand Lori’s and Kathy’s concerns, and the decision as to what to do is perplexing. But if Tucker continues to show improvement as far as energy level and overall demeanor, I think I’d be reluctant to start the steroid now, too. If he’s just now showing the excessive thirst/urination, I’d be guessing it’s due to a rising cortisol level rather than a lowering one. If it was low cortisol that was the culprit, I’d have expected to see those issues back when he was tested at the end of August and his cortisol was known to be low. So if he remains perky and energetic, I’d probably continue to track him for another week or so and then retest again, too. Of course, all bets are off if he backslides and becomes lethargic or visibly ill. If that happens, steroid supplementation may indeed be warranted and genuinely needed.

Marianne

[TheDude]

You're not kidding with what to do is perplexing. He seems to have a very stubborn case of cushings. One day he seems fine then the next he's lethargic. I dont know whats related to cortisol levels, his brain/tumor and whats related to a possible other underlying issues. He does have the lump on his leg that could be cancer and he does have back issues/pain so its hard to tell whats what. The interesting thing is even on the meds and as low as he was he never lost his appetite. His poop is normal, hes not vomiting, etc..
He drinks normal water during the day. Night time seems to be when its more increased. I dont know if his cortisol is bouncing around a lot or what.
He actually snuck on the sofa earlier. Jumped up himself. I dont allow it, but he sneaks it. He just hasnt been able to do it for quite sometime because of the hip issues he had.
This morning he climbed on me in bed like he always does and was wagging his tail then after awhile he's weak again. I am going to have him retested before anything else is done. If his levels are still as low then I'll have the vet give me steroids. I wonder if I'm one of the cases where the meds caused necrosis that he wont have to be put on the meds again. That or he now has atypical.
The last 5 days I took him off of the meds he starting panting easily outside and was weak. This time he painted the 3rd day, but that was it.
I am hopefully going to be able to get an ultrasound done soon. I set up donations. Not many are coming in, but I'll at least have some towards it. Vet doesnt see a need for it, but I want to see his adrenals size and if theres any kind of mass on his liver and what not especially since he does have the lump on his leg.


My other dog heard something outside in the back yard, barked and Tucker perked up and ran out. He's walking around sniffing as usual at the moment.

[TheDude]

Ok so after 7 days I had his resting cortisol ran to see if his levels were still way too low. It came back normal at 2.5. So no steroids. He was also acting very normal yesterday. Lots of energy, happy, etc. Today back to lethargic. His cortisol levels must be bouncing like crazy. Now I'm wondering if he's one where the trilostane isn't going to help him.
I am keeping him off of the meds for the moment until more symptoms appear. I am also calling around getting prices on ultrasounds. So far $425 without a specialist visit is the cheapest in the area.
Vet also ran a basic blood panel that didn't show anything different. Still has low bun, low amy, high alp and elevated triglycerides.

He also has a new lump on the back of his right leg.