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Thread: Our Silver Belle Labrador~Athena has crossed the Rainbow Bridge

  1. #1
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    Default Athena - Athena. Vestibular Crisis. Our Cushings Diabetes Lab. Diabetes Meds?

    Hello
    SO grateful to have found this site. We just received news today of the results of our Lab's test for Cushings. She has been officially diagnosed with Cushings ( Pituitary dependent). We are so sad but trying to be hopeful for her. Let me give you some basic info and such.

    Our Lab is a Silver Lab. Her name is Athena. She's precious, smart, protective, loyal and the happiest dog you will ever meet despite what she's going through. You couldn't ask for a better friend in her except her brothers and sisters ( We have 3 other doggies that she adores).

    Athena is 4 1/2 years old

    She started to show signs of being thirsty all the time, extremely hungry all the time, her coat was thinking but only in certain areas like along her back and part of her tail. She has little black spots on her belly/skin. In addition to this she has this barrel like belly and when standing she shifts her weight between her two back legs. She's overweight and we have tried everything under the sun to decrease her weight and nothing has worked. That is when we became very concerned and took her to the Vet. All our dog go to the vet for all their yearly appointments/shots, etc. They miss nothing and are well cared for. We thought maybe diabetes but it wasn't that.

    We had the Cushings test on Friday. She was there all day. After we picked her up and came home. She couldn't drink enough water. We picked up the bowls so she wouldn't get sick but she did. She vomited everywhere twice. She was pacing back and forth and was so hot you could feel the heat come off her. We thought she was having a reaction to the Low Dex injection. Our vet uses an emergency service after hours. We call. They said to watch her close, to give her only a few ice chips hourly (which we did and we were up all night with her) and not let her drink freely from the water bowls. We had to move those to another part of the house for our other dogs.

    She refused food which she never does. We tried a few times to feed her a little something because she's on tramadol but nothing.

    The emergency vet said if she wasn't better by morning ( when we called it was around 8pm) to bring her in. The next morning she stopped the wanting of so much water. She started to slow down. She was walking a few steps then would sit down. She then just slept. She went out to potty and it was bright orange ( I'm thinking dehydration or the injection) but eventually she was willing to eat a small bowl of food but all day Saturday she slept and we just let her rest. We put her water bowl back out and she would drink a little then lay down.

    Today is Monday. I was able to talk to our regular Vet when she called with the results but I had already called her in the morning to report what happened over the weekend. She said Athena did great at the office when she had her test but that she felt the stress of being there all day long and noise of other dogs could have just stressed her. She's used to just us and our other dogs and it's peaceful and fun here for her.

    So the report today was as follows:

    Her baseline was 4.8
    the 4 hour test draw was 3.5
    the 8 hour test draw was 10.0

    She's a big lab, big boned lab and her weight is 115

    Our vet is real good and explained everything. She wanted to start her on 120mgs of Vetoryl. She explained she felt that was safe. She told us we had to watch for diarrhea, vomiting, gastro upset and if that happens call her asap and bring her in.

    She said if no side effects then she wants to see her in two weeks for a blood draw to check ACTH and Electrolytes. We have to be careful with the drug as to not give her an Addisons crisis.

    We are very worried. Athena has proven to be sensitive about thing. She has fought 3 bacterial infections with no source known since we had her as a puppy. Not sure if this is a result of her compromised immune system due to this Cushings or what.

    She tolerates her other meds well as in Tramadol for her sore hind legs. She always tolerated anitibiotics fairly well.

    I asked if we could start her on 90mgs vs 120mg. I know she's the Vet but I'm anxious about this drug and the amount and wondered if it was better to start her at a lower amount initially and if she tolerates it well to up the dose. Any thoughts? I'm a Nurse (RN) and at home I always start with small doses for things and increase as needed vs a big whopping dose of something.

    We are beside ourselves tonight because there is a minefield of info on the web and I'm cross eyed from reading and not sure what to believe about this drug. I know just as with humans everyone responds a certain way to a certain drug.

    All our dogs are our life. We have no kids. Our dogs are the kiddos. Athena in particular has been a great source of love and healing for my Marine who was injured in combat a few years back in Afghanistan. She has been a wonderful member of our family and we want to do what is best for her.

    This has been alot to take in as we have a 14 year old and 9 year old pitbull who are the picture of health even at those ages and our youngest is a 2 year old blue nose pitty. We are meticulous in how we care for them and give them plenty of love, play time, trip to the beach and mountains and where we go...they go..if they can't go..we don't go. They have never been boarded or anything.

    Is there any other information I can give you to help? If so, please just ask away. Sorry to be long winded. Just very concerned. Depending on what you read and who you talk to you get a different story and finding this site I saw that it appears to be a rock solid place of good info and great people.

    Does anyone have experience with the drug Vetoryl? Side effects? Effectiveness?

    Are there any other treatment options out there? Anything else we can do to help her?

    Thanks for your time...
    Last edited by WeLoveAthena; 02-12-2016 at 04:05 PM. Reason: title change

  2. #2
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    Default Re: New here. Diagnosis today for our Silver Lab of PD Cushings. Guidance please.

    Hi and welcome to you and Athena!

    First, I understand how frightful you are but I want you to know that Cushing's is not a death sentence for a dog, with proper treatment a dog can have a good quality of life and there is every reason to believe that they can live out their normal life span.

    Thank you for the detailed information about your sweet girl, that helps us to provide our best feedback. But, of course, I still have a few more questions Did Athena have a CBC/chemistry blood panel performed, and if so, could you post those values that are marked abnormal (H or L) with the normal reference ranges....as an example.....ALP 150 U/L (5-75)...thanks! Was an urinalysis done to rule out an UTI, and does Athena have diluted urine with a low specific gravity? Does Athena have an underlying illness that she is taking any herbs/supplements/medications for?

    Those test results you posted are from a low-dose dexamethasone suppression (LDDS) test and do point to Cushing's, but to my knowledge are not indicative to the pituitary type of Cushing's. The criteria used to interpret the LDDS test:
    Test interpretation. When interpreting LDDS test results, first evaluate the eight-hour post-dexamethasone administration cortisol concentration. If it is above the reference range, the dog probably has hyperadrenocorticism (false positive results may occur in dogs with nonadrenal illness). I

    If the eight-hour post-dexamethasone administration cortisol concentration is above the reference range, then evaluate the baseline and four-hour postdexamethasone administration cortisol concentrations to see whether cortisol suppression occurred during the eight hours. If at least 50% cortisol concentration suppression is present at the four- or eight-hour time points, the definitive diagnosis is PDH and additional adrenal function tests are not needed.
    http://veterinarymedicine.dvm360.com...n-test-results

    I am sorry that Athena had such a bad reaction to the dexamethasone, although not real common it can happen, sounds like this may have been a gut issue for Athena and I am glad to hear she is feeling more like herself.

    The starting dose of Vetoryl that is recommended is 1 mg per pound of a dog's weight, so for Athena's weight of 115, that 120 mg is reasonable; however, seeing that she can be sensitive to certain medications I would opt to start her at a lower dose, maybe at 60 mg. Over a period of time larger dogs do seem to need smaller doses of Vetoryl to control their Cushing's.

    Did the vet mention that the Vetoryl has to be given with a meal to be properly absorbed? And the timing of those monitoring ACTH stimulation tests are crucial ~ Dechra recommends that the ACTH stim tests be performed 4-6 hours after the Vetoryl is given. We have information regarding Vetoryl/Trilostane in our Resource Forum which I'll post a handy link to:http://www.k9cushings.com/forum/showthread.php?t=185

    Athena, her brothers and sisters sure hit the jackpot with such loving pet parents as you are, they are a lucky bunch!

    Cushing's sure can be a scary but when knowledge of the disease grows it does become less frightening, we are some of the best hand holders and are here for you, so lean on us, ok If you have any questions please do ask them.

    Hugs, Lori

  3. #3
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    Default Re: New here. Diagnosis today for our Silver Lab of PD Cushings. Guidance please.

    Hello and welcome. This is a wonderful site and you will get lots of helpful information. I am new and can only say that it has helped me tremendously with my precious Lena and her diagnosis. I have gained a lot of information and so much support. I went nuts searching for information after we were told that Lena had Cushing's and I was panic stricken until I stumbled on this forum...they are all wonderful.

    Joan

  4. #4
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    Default Re: New here. Diagnosis today for our Silver Lab of PD Cushings. Guidance please.

    Hi Lori

    Hello Lori. Thanks so much! Yes, it's very overwhelming but trying to stay level headed although it's hard.

    Quick?? Are you saying after the first dose they should draw her blood within hours? The Vet said she wanted to draw in 2 weeks from the first dose. Is that normal or waiting too long? I will be speaking with the Vet tomorrow so any info will help.

    Here are the lab values of the bloodwork done two weeks prior to her cushings test and I will be able to post the actual numbers to her Cushings results tomorrow when I pick them up at the Vet with her meds.

    The only things on her initial labwork that were out of range were the following


    EOS Range 0.06-1.23 and her result was 1.45
    ALKP Range 23-212 and her result was 459
    TT4 Range 1.0-4.0 and her result was 1.3

    as a RN I saw some of her values on the low side but they weren't marked as being bad because they were within range but I felt they were on the low side such as the following

    BUN Range 7-27 Her result was 11
    CGT Range 0-11 Her result was just 0 ( Vet didn't say anything about it)


    I felt her T4 was of course within the range BUT it's what I think they call "Euthyroid Sick".

    They didn't say a U/A was done but I will know when I pick up results in the morning but they have never done any U/A on her. Is that normal?


    Athena takes Tramadol in the morning and at night ( 1 tablet) because she has soreness in her hind legs whether it's from this Cushings or what she limps and when she stands her legs shift alot. Her Xrays and MRI showed no damage as in an injury so they felt that her weight could be contributing to her being sore in her hind legs and put her on Tramadol and it seems to help her rest and do better.

    They did mention that she must eat with her med and to give it in the morning.
    They wanted her on 120mgs but I asked to start smaller. Just due to her being sensitive and what she just went through with the Cushings test.

    There are no words that I could say that would ever properly explain how thankful I am for your posting and this site. THANKS!!!

    We are both exhausted and worried about her.

  5. #5
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    Default Re: New here. Diagnosis today for our Silver Lab of PD Cushings. Guidance please.

    Thank you Joan. So grateful for your words and kindness.

  6. #6
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    Default Re: New here. Diagnosis today for our Silver Lab of PD Cushings. Guidance please.

    I am still learning about this disease, but I don't need to learn how it feels...I already know, and it breaks my heart each time I hear that someone else is going through it too.

  7. #7
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    Default Re: New here. Diagnosis today for our Silver Lab of PD Cushings. Guidance please.

    Welcome to the forum. We all came here terrified for our furry kids, so your in good company. I agree with Lori that I would mention starting a bit lower than the 120 just because of her reaction so maybe until you see how she does on the medication lower would be better for all of you.

    14 (corrected from 24 UGH) days is the recommended time frame for the first five low up test which is an ACTH. On the test day you give the meds with her breakfast and 4-6 hours later she goes in for the test. I go st about 4.5 hours. They do a first draw. Baseline and then an hour after that they do the second blood draw after giving an injection that basically makes the adrenal glands dump the excess cortisol. The post tests how much excess the glands are making.
    You are looking for a post ACTH result of under 5.0 ug it can be as high as 9.0 ug if symptoms are controlled.
    Normally you don't want to withhold water in general as they need the water to stay hydrated because the kidneys work over time. I do understand the reasoning though as she was throwing up from drinking too fast and probably having an upset stomach too.
    The high cortisol tends to cause ligaments and tendons to weaken and rear leg weakness is common in Cushing's dogs. The wreight probably doesn't help with that so maybe try supplementing when she is hungry with something low cal but filling like cooked green beans etc.
    Another thought is to try water therapy to strenghen them.
    We do see a lot of lower thyroid results in initially diagnosed Cushing's dogs so that might straighten up as the cortisol comes down.
    They often go a UA to rule out a UTI and to see how she is concentrating her urine.
    You will be surprised how fast you pick up the Cushing's info. It tends to become second nature almost.

    This is a link to info on Cushing's and vetroyl from the manufacturer Dechra. I find the flow chart to be a very handy guide for ns I gating through what to do when.

    http://www.dechra.us/Admin/Public/Do...US-046-TEC.pdf

    Again. Welcome.
    Sharlene and the late great diva - Molly muffin (always missed and never forgotten)

  8. #8
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    Default Re: New here. Diagnosis today for our Silver Lab of PD Cushings. Guidance please.

    Welcome!

    It is a fact that some dogs over 100 pounds will achieve ideal control taking trilostane at an initial dose of 60 mg. It upsets me that the vet didn't hear your concern to start Athena at 90. Have you purchased the vetoryl yet? If not, you can ask her if starting at 60 mg BID could be an option. This will not only reduce the risk of over suppression but also keep her cortisol levels balanced evenly throughout the day since vetoryl has a short half life of 8-10 hours.

    My dog also had trouble with his hind legs because of his weight. He weighed 83 pounds when diagnosed. He's been on vetoryl for 7 months now and has lost a total of 14 pounds which has helped him significantly. It took him 9 days post treatment for the PU/PD to resolve and about a month before his energy levels increased. I honestly thought he was just old and didn't want to walk or play as much. I can barely keep up with him now. This drug saved my dog. Athena is quite young. It's rare but this disease can occur in younger dogs. I truly hope you see improvements in symptoms soon. Keep in mind that response time is different for each dog. It can take anywhere from a few days to a month or two.

    The link below is to help guide you with the timing of the ACT tests after a dog begins treatment with vetoryl.

    http://www.dechra-us.com/therapy-areas/companion-animal/endocrinology/canine-hyperadrenocorticism/monitoring-cushings

    ~Katherine

  9. #9
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    Default Re: New here. Diagnosis today for our Silver Lab of PD Cushings. Guidance please.

    Welcome from me, too!

    I see that you've already gotten excellent advice, so I only have a couple of comments to add. First, I think that Sharlene's auto-spell might have run amok in her answer above , because I'm sure what she meant to say is that the "first followup" ACTH test should be run 10-14 days after you start giving the trilostane (not "24" days). So your vet's testing recommendation conforms with the recommended protocol.

    Secondly, if you decided to dose twice daily rather than 90 mg. once daily, I would recommend giving 60 mg. in the morning and 30 mg. at night (if you are using brand name Vetoryl capsules). I would not exceed 90 mg. as the daily total, and might even start as low as 30 mg. twice daily. This is because studies have shown that dogs dosed twice daily often actually end up needing less total daily dosage than do dogs dosed only once daily. As Katherine says, I imagine this is because cortisol levels never elevate quite as highly at any time during the day when the med is given at twelve hour intervals.

    Some specialists do indeed prefer twice daily dosing in order to keep cortisol suppressed more consistently throughout the day. However, many dogs seem to do fine in terms of overt symptom resolution on only once daily dosing, and here is a quote from noted endocrinologist, Dr. David Bruyette, who tells us that dogs being dosed twice daily actually may need to be monitored even more closely for the development of low cortisol or electrolyte imbalances.

    With regards to once vs twice a day dosing if we look at all the studies throughout the world you will see that about 80% of dogs do well with once daily dosing. One huge advantage of once daily dosing is owner compliance which goes up substantially when owners only have to dose once a day. While twice a day dosing may result in a lower amount of trilostane being used pre day it will require closer monitoring as the ACTH stimulation tests tend to be lower so we have to look for both hypocortisolemia and electrolyte abnormalities.
    Marianne

  10. #10
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    Default Re: New here. Diagnosis today for our Silver Lab of PD Cushings. Guidance please.

    I also want to add one more note to stress what Lori has said above: Athena's LDDS results can be consistent with either the pituitary or adrenal form of Cushing's. So unless your vet has performed an ultrasound or other secondary diagnostic test to differentiate between the two forms of the disease, it remains a question mark. The reason why this is significant is because in the situation of an adrenal tumor, complete surgical cure is a possibility. Adrenal surgery is very expensive and also risky, so it is not a viable option for all owners. But given Athena's young age, I just want you to know that the option may exist for her, depending upon the outcome of additional diagnostics.

    Marianne

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