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Thread: New to Cushings

  1. #181
    Join Date
    Apr 2009
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    Default Re: New to Cushings

    Hi Karen,

    Being pretty OCD myself ;-), I surely understand your search for some definitive answers. However, I'm afraid that Cushing's is about as far as you can get from being a cookie-cutter type of disorder. It's labeled as being a "syndrome," meaning there's a whole big basket of *possible* symptoms or complications. But as far as predicting the actual road map for any individual dog -- that's pretty much impossible.

    In my own personal opinion, probably the most difficult possibilities are these. First, for dogs suffering from pituitary tumors, I think the possibility of enlargement into macrotumors is one of the most unwanted outcomes. If the tumors enlarge enough, they can invade brain tissue and create neurological changes that can seriously jeopardize quality of life and even become life-threatening. As you probably know, that's what happened to my own Cushpup, Barkis. So I'm especially sensitive re: that risk. However, it's a minority of pituitary tumors that enlarge to that extent.

    The development of the skin disorder, Calcinosis cutis, can also seriously affect quality of life. A couple of the other most serious complications from Cushing's would include high blood pressure (with the associated risk to vision, kidney function, etc.), and also an increased risk of creating/throwing blood clots. The article that I linked to in my previous reply noted that therapeutic trilostane treatment does appear to help lower liver enzymes and cholesterol levels, reduce proteinuria, normalize specific gravity of the urine, and ease calcinosis cutis. However, apparently it does not necessarily lower blood pressure or reduce the risk of clots. Whether or not Lysodren treatment is more successful in this regard, I do not know. But I'm thinking the general take-away is that some aspects of Cushing's indeed benefit from treatment, but some risks do remain since the disease is not actually curable. However, it is highly variable as to exactly how problematic those risks become for any given dog.

    So I'm afraid I can't provide the specific roadmap that you're seeking. From my experience here throughout the years, every dog's path is different. Some take dramatic twists as did my Barkis. But for other dogs, Cushing's proceeds as more of a back-burner type of issue. Once the overt symptoms come under control, life goes on pretty much as normal and it may be some other unrelated health condition, or just old age, that ends up being the over-arching issue. In Annie's case, for instance, it may be the diabetes that provides more challenges than the Cushing's. So in honesty, I don't think there's any way to prepare in advance for what a new day may bring. The best any of us can do, whether dealing with Cushing's or not, is to rejoice in the good days, and then on the not-so-good days, bring any worrisome changes to the attention of our vets.

    If you're born to worry -- like you and me -- Cushing's is just one more thing to worry about! I don't say that to be flip, but I've actually had just as much to worry about with my non-Cush dogs as I did with Barkis, and no better ability to predict what the next challenge was going to be. I would love to tell you what you can and cannot ignore, but in reality, worriers like us will never be able to ignore *anything.* The trick, I think, is just to go ahead and ask about anything that is bothering you, rather than fretting all alone and letting your worry overtake you.

    I'm sure this was not the answer you were hoping for...but I'm trying to be as honest as I can. That's what we're here for, and we intend to stay right by your side ;-).

    Marianne

  2. #182
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    Default Re: New to Cushings

    Hi Karen! Just stopping by again to say “hi” and hoping that things are still going OK for you girls. Do let us know when you get the chance.

    Marianne

  3. #183
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    Feb 2019
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    Spring Valley, Il
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    Default Re: New to Cushings

    IiHi Everyone….and a special thanks to Marianne for checking in on us. To begin, so no one has to worry, Annie is doing GREAT!!!! I was the one who was out of action last week with some bug. To make it worse, the hubby was in North Dakota on a fishing trip…I know, I know…who leaves a sick wife home alone with a “sick pup”? Well, all I can say is he needed to get away and now we have two “pay back Mom” trips in the works.

    But first and foremost,…our little Annie. I’m almost afraid to say the words, but here I go once again…she is doing great! She had been scheduled for cataract surgery way back in February, then all heck broke loose with her Cushings..then her gallbladder surgery in April. Anyway, on Monday of this week, we made the two hour trek to her ophthalmologist to have her cataracts re-checked and evaluated. Well low and behold, the universe was smiling on our little baby and her eyes have actually improved as far as her dry eye condition and the doc also said her cataracts had not gotten worse. Her recommendation was that we just stay on her eye meds and re-check in three months. She also said that her little body is probably still healing from the surgery not to mention her “new and improved self” is still readjusting to life with Cushings and diabetes to boot.

    When we checked in for her eye check, it was like a moment from the past. When we were in the exam room, the staff that I have talked to over the past months came in to greet Annie and they even took her in to the back, wherever that was to say HI to everyone back there. Jerry and I were dumbfounded because we had only seen this eye doc once before and she just couldn’t believe how well Annie was doing. Of course, like any proud pup mom, I had to whip out my phone and show off her latest healthy poop. The clouds of laughter are still probably hanging over her office. I know I’m just rambling but hang with me.

    Now I want to update you on our plans. Tomorrow I’m going to make an appointment with her regular doc for her semi-annual senior check-up and set up some kind of schedule for complete blood work, the next stim test and whatever else needs to be done.

    Jerry and I love to fish, and Annie has been with us on several fishing trips in her younger years to Northern Minnesota with her “angel sisters”. If doc gives us the ok, we are going to take her fishing with us, probably for the last time, in late July. We went to Petsmart yesterday and bought her a new life jacket. Needless to say, she did not appreciate me trying several sizes on her. But, in the end, she ended up with not only a new life jacket, but also a new toy.

    When I was under the weather last week, I did spend a lot of time reading through the threads and tried to get caught up on what I could.
    I have nothing else to add at this point so I offer my Blessings to all of you and your pups. Karen
    Last edited by Katy1; 07-02-2019 at 02:38 AM.

  4. #184
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    Feb 2019
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    Default Re: New to Cushings

    Hi everyone,

    I just wanted to touch base before things get more crazy then they already are. Annie had her semi-annual senior check up last Friday. Doc still can’t believe that she’s still alive let alone the fact that she has transformed herself into a little “super pup” complete with a big bark fest when doc walked in——I couldn’t believe it either. She has found her voice and is using it!

    I grilled him about any bloodwork or stim test that might need to be done and basically he told me to quit worrying—which will never happen, and just to take a good look at her behavior. At this point, she acts like a normal pup. We had such a good report from her eye doc and regular doc that we are going to take her on what will probably be her last big road trip this month. The hubby an I love to fish in northern Minnesota for walleye and got the green light that she could go with us.

    We will take three days to get up there so we can keep Annie on her schedule as a dual diagnosis pup. I know I’ve already posted our outing to get her a new life vest so I ‘m sorry if this is a repeat.

    We have all her papers in case we decide to travel in to Canada for a day. She is such a good traveler but we will take no chances. I’ve already made a list of every vet clinic on our route between here and International Fallls, Mn. After that it gets a little “iffy” so if she does get sick, we may have at least an hour drive or more to the nearest care.

    Well, I’ll sign off for now. I wish you all a happy and healthy 4th for your families and your pups. Blessings, Karen
    Last edited by Katy1; 07-01-2019 at 09:18 PM.

  5. #185
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    Mar 2009
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    rural central ARK
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    Default Re: New to Cushings

    I hope you are enjoying your trip! Fishing or doing anything in a northern clime sounds WONDERFUL to me down here in Arkansas! I swear I am a misplaced Siberian citizen. LOL Be careful and let us know how things went when you get back home.

    Hugs,
    Leslie
    "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.

  6. #186
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    Feb 2019
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    Spring Valley, Il
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    Default Re: New to Cushings

    Oh, man what a day! I knew when I posted that Annie was doing great that I probably shouldn’t have done that.

    Forward a week. We woke up this morning to our normal routine, but no such luck. Annie did not want to eat! She has always been my little chow hound and if she turns her nose up to food, something is wrong.

    The cst is now 8:10 and she is asking to go outside, so I throw on a robe and follow her. We had a torrential thunderous night last night, so while Annie was strolling amidst the ruins, I was picking up lawn furniture, etc…..then I noted her classic poop walk. I was sitting on the deck letting her do her thing and she pooped, checked her poop and it was totally normal looking so we went inside. She still had NO interest in food so I called the clinic.

    Our favorite tech was on duty and said Doc would not be in the office until 11:30….. I said we would be there. A brief digression, the hubby had made plans weeks ago to play golf with out of town buddies for this morning so he is out of the picture at this point. I’m on my own.

    Annie had a normal poop at 8:30am cst but she still did not want to eat. 15 minutes later she wanted out again, so I followed her and she had the runs. I called the clinic again.

    Our appointment was for 11:30, so of course, we are there at 11:15. In the meantime, Annie had the runs again outside the clinic, so someone went out and gathered a sample.

    Finally, Doc is here and is poking and prodding all over Annie. I told him that since she was totally fasted, it might be a good idea to do whatever he wanted to do with her diagnostically. He said he would run a complete blood panel.

    These are the critical numbers we are looking at right now:
    In May, 4 weeks post gallbladder surgery:
    ALP…852
    ALT….87
    Today:
    ALP: 1336
    ALT: 420

    Everything else was in normal range. Doc said these increases indicated something going on with her liver so he put her on Amoxicillin, Ursodiol and Denamarin. They gave her first dose of Ammox. and denamarin in the office plus some sub-q fluids. The time now is 1:00cst

    Now Annie is snoozing on the couch and after an hour, I decided to leave my watch post and go to the kitchen to unload the dishwasher. After the first few dishes, I hear the classic sounds of pup puking and I see my poor baby puking up bile on the couch. Thankfully, it was covered with a sheet. Another call to the vet, another drive to the vet, another wait at the vet. He thought it may have been a reaction to the meds they gave her on an empty stomach. He gave her a shot of Cerenea and another load of sub-q H20 and we were home by 4:45. Annie slept until about 9:00 and then was giving me the hungry look.

    Well, I thought what the heck, if she’s hungry, she’s hungry……even though doc said to fast her for 24 hrs…..not happening on my watch. I fed her the usual amount and she gulped it down. I also gave her the night dose of Amoxicillin and waited for an hour to make sure everything maintained it’s proper place. Then I gave the rest of her insulin dosage for the day.

    Today was also supposed to be her Lysodren day so my question is how long do I wait for the next dose?

    I wasn’t even thinking about that when I was in doc’s office this afternoon. He told me to wait until tomorrow, but she is now on so many other drugs, I’m wondering if I can just wait until our next scheduled dose which will be on Saturday. I want her little tummy to get used to all the new stuff.

    People often wonder why I worry so much………I rest my case.
    I’m so tired at this point. Blessing to you all and a happy and safe 4th tomorrow. Karen

  7. #187
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    Default Re: New to Cushings

    I'm glad the vet was in and you were able to get Annie in to see him! As for the Lyso dose, the first thing I would do is some serious research on drug interactions with the meds, and class of meds, the vet has already given her. It may be that is the reason he said to wait a bit - to give the meds time to get out of her body to lessen the chances of a bad reaction. Here is a link that will get you started:

    https://www.drugs.com/drug-interacti...,lysodren.html

    Generally, we say never give Lyso or Trilo to a dog who is sick with something else. Let the other acute condition improve then start back on the treatment. So if I were you I would definitely wait at least 1 day if not a day or two more depending on how Annie is then. So Sat sounds pretty good to me. If she is still having digestive upsets I would talk to her vet about how long you can wait. We don't want to reload but neither do we want to put too much on her system if we can help it.

    I fully understand the worrying part! My new little rescue girl, Tilly, had what seems to be a seizure late yesterday afternoon and we can't get in to see a vet until Mon morn due to the holiday. She hasn't had another episode of whatever that was but if she does we will be driving to the next town over for a veterinary ER! So as you worry about Annie know another twitcher mom is worrying with you.

    Hugs,
    Leslie
    "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. #188
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    Default Re: New to Cushings

    Gosh Karen, I’m so sorry about this setback and I’m really hoping that Annie is feeling much better this morning! I also can’t argue against delaying her Lysodren until her tummy is settled, although on the flip side, we really don’t know whether delaying is a good or not-so-good thing to do in terms of her cortisol level. Since we don’t have a monitoring reading, I think you’ll have to trust your “mom instinct” on this one.

    As you know, diarrhea and vomiting can be symptoms of a cortisol level that’s gone too low. But if Annie’s potassium and sodium levels were normal on the chemistry panel, that makes overdosing far less likely. On the other hand, elevated ALP and ALT are classic symptoms of elevated cortisol, so it’s possible that she’s losing ground in terms of cortisol control. Have her glucose levels been more consistent lately, or have they remained higher than you’d like?

    Of course, this episode may have nothing to do with Cushing’s at all. However, I remain puzzled by your vet’s reluctance to monitor Annie’s cortisol. If Annie otherwise was not going in to the vet regularly and having blood drawn, I might more easily understand his decision to not stress you guys with added testing. But you do go in regularly, and it seems as though there are several occasions now when he could easily have performed an ACTH, especially since the time of day that the test is run does not matter for dogs taking Lysodren. Outward appearance tells you some things, but far from everything. It’s not uncommon for a Cushpup under treatment to “look” fine up until the moment when they don’t — when they start barfing or having diarrhea, for instance. It seems to me that it would be better to check the internal lab status so that medication adjustments can be made in order to avoid behavioral disturbance or abnormality.

    Right in the middle of an acute episode that is not Cushing’s related is not the best time to monitor cortisol because cortisol is likely to be elevated at least temporarily by whatever else is going on. So if your vet is convinced this has nothing to do with Cushing’s, I guess I would hold off until she’s recovered. And I really, really hope you guys are still able to take your trip. But as soon as you return and at a time when she’s stable, if it were me, I’d really want that ACTH to finally be performed, especially in light of the new elevations in Annie’s liver enzymes. Just sayin’...

    Marianne
    Last edited by labblab; 07-05-2019 at 09:54 AM. Reason: To add.

  9. #189
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    Default Re: New to Cushings

    Oh! I have completely missed that she is not being monitored!!! That is extremely risky on either of these drugs so I do not at all understand her vet's stance UNLESS the vet does not understand the drug that they prescribed to Annie or Cushing's. If that is the case I would RUN and find another vet asap. These drugs are very very powerful and should not be given unless the dog is monitored regularly. I do realize it is more difficult with a dual diagnosis pup but doing an ACTH simply cannot be put on a shelf when a pup is on Lysodren (or Vetoryl). Please, for Annie's sake, insist that her vet run the ACTH asap.

    Hugs,
    Leslie
    "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.

  10. #190
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    Feb 2019
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    Spring Valley, Il
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    159

    Default Re: New to Cushings

    Ok, everyone just take a deep breath. Annie is doing so much better and if anyone wants to rant on her vet, you need to rant on me first because i’m her first line of defense.

    The amoxicillin and ursodiol seems to be making a positive difference. Last night I gave Annie a Cerenia tablet because today was her scheduled Lysodren day. I’m happy to report that all food and meds stayed in place.

    When she is fully recovered we will be doing further testing on everything. Blessings to you all. Karen

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