Our Silver Belle Labrador~Athena has crossed the Rainbow Bridge

[budindian]

I'm fairly new here and first of all welcome, you are in the best possible place for cushings and other things. You said your baby was sensitive and I can relate to that , my baby was started to high on the Vetoryl and it had a very bad effect on him. I stopped the Vetoryl immediately and called the vet, it was the information from this site that told me they started him to high so what I did is started him at the lowest dose possible and we worked our way up as he tolerated it. My vet told me my baby has a sensitive system.
I hope all goes well with your baby.

[lulusmom]

Hi and welcome to you and Athena.

I am sorry the reasons that brought you here and I'm glad you found us. The symptoms you list are certainly those associated with cushing's but with Athena's young age and so few lab abnormalities, I am wondering why your vet did not recommend an abdominal ultrasound to determine which form of the disease Athena has. My first cushdog was only three years old at diagnosis. She had every symptom in the proverbial book and her specialist was beyond comprehensive in confirming a cushing's diagnosis. She had an LDDS, ACTH stimulation test, abdominal ultrasound. which confirmed pituitary based disease, and because she was a nordic breed prone to sex hormone imbalances, she even had a full adrenal panel done by the University of Tennessee Knoxville. If my Lulu had an adrenal tumor, which is a lot more serious than PDH, I most certainly would have opted for surgery. While the minority of dogs with cushing's have an adrenal tumor, a lot of credible resources state that larger breeds seem to be more affected than smaller breeds and females are more affected than males. My own experience in following a lot of case studies over the years would support that statement which is why I am concerned that your vet has not done adequate testing.
Labrador Retrievers are also a breed listed as being more affected with pheochromocytomas than other breeds and symptoms for this specific adrenal tumor does have overlapping symptoms with cushing's. It is rare but some dogs actually have both types of tumors. The symptoms you describe seeing after Athena had the LDDS are symptoms associated with pheochromocytomas. There are recorded cases where humans with pheochromocytomas have gone into crisis after receiving dexamethasone but I believe at higher doses but because there have been no formal studies done, who knows how a dog with a pheo could be affected by a low dose of dexamethasone?

Pheochromocytoma crisis induced by glucocorticoids: a report of four cases and review of the literature
http://www.eje-online.org/content/158/3/423.full

If Athena were my dog, I would not start treatment without knowing for sure that she does not have an adrenal tumor of any kind. Dogs with pituitary dependent disease can live out their normal lifespan, with a very good quality of life, but the prognosis for a dog with a functional adrenal tumor that is not surgically addressed, is very guarded. My intent is not to scare you but to provide you with as much information as possible before starting treatment so that you are making an educated decision for Athena. If Athena has already had an abdominal ultrasound, I apologize for making you read all of this. If so, can you please share the radiologist's interpretation?

Adrenal gland tumours. Different clinical presentations
in three dogs: a case report
http://vri.cz/docs/vetmed/58-7-377.pdf

Glynda

[WeLoveAthena]

I wanted to post this info real quick to help answer some questions folks may have and this evening I'm going to go over each posting here and read everything and respond because it's very important to us to read everything you have all written and respond. You have all be so kind in giving us our time, guidance and reassurance and it's a priceless gift to us all just being hit with all this. Thank you. I'm sure people think I'm crazy but Ive been sick about this since it all went down. In tears but I don't show that to Athena. She's very sensitive if she see's anyone upset. She's such a jewel. Always the friend, listener, protector and caretaker. We want the best for her and we are so grateful we came across this site. No way could we do this without all of you. Thanks with all of our hearts.

Here is the info from what went down today so far.


Hello to all. Thank you so much for all the input and responses. We are beyond grateful to each and everyone of you. It's as if I don't even have to try and explain how we feel. Each of you truly "gets it". Thank you for that.

We started Athena on her medication today. The Vet agreed to the scale back. She offered to do 90mgs vs 120 and I asked if we could do 60. So that's what we will do but they had already filled the 90 ( which was a box of 60 and a box of 30mgs) so we have both. I'll keep the 30's on hand to maybe increase later.

I made Athena a little med flow sheet where I can write the time she was given her meal, meds and anything that we notice. I want to keep track and take it to her next appt in two weeks.

She ate her meal just fine and we gave her the meds. I won't lie. My heart was beating just giving her this med. How crazy right? I'm an RN and have been in emergency nursing forever but when it comes to our dogs I'm just a regular person trying to do the best for our dogs. I can handle just about any human emergency but with my dogs it's different. I can't stand for them to be sick or have to suffer in anyway. I honestly feel it. Sounds crazy but I'm sure the awesome people here totally get it.

So she took the med and nothing so far and it's been 6 hours. She has not been showing any signs of feeling sick. She was a bit hot but she's been that way since she got home from her Cushings test. Just that her head is so warm. Not sure if that is the steroid in her still or what that is. Vet said its nothing to be concerned about.

Meds were very $ but I'd pay whatever it costs to help our girl. I just didn't expect it to be that pricey. For both boxes it was $254.00. Is that the normal cost of this medication? I don't care what I have to do but we will always find a way to cover whatever our dogs need.

I also was given a copy of her Cushings Low Dex Test and this is how it reads:

Baseline Cort 4.8ug/dl
4 hour post low dose dex 3.5 ug.dl
8 hour post low dose dex >10.0 ug/dl

This is the info under these lab values. Will type just as it reads

Both 4 and 8 hour <1ug/dl- Normal

Both 4 and 8 hour =1-1.5 ug/dl - Inconclusive consider repeat test 8 weeks

Both 4 and 8 hour >1.5 ug/dl and 50% of baseline= Consistent with Cushings Syndrome; consider HDDST to rule out adrenal tumor

4 hour < 1.5 ug.dl or <50% of baseline and 8 hour> 1.5 ug.dl and 50% of baseline is consistent with PDH

4 hour < 1.5 ug/dl or <50% of baseline and 8 hour >1.5 ug/dl and <50% of baseline is consistent with PDH

4 hour > 1.5 ug/dl or >50% of baseline and 8 hour > 1.5 ug/dl and <50% of baseline is consistent with PDH

Tests were done by IDEXX Labratories


Thank you and will post again this evening. May you each have a beautiful day.

[Joan2517]

Oh, we all know how you feel! I give Lena her pill at least an hour and a half before I go to work, just in case. And my hands still shake when I take it out of the case. And I still hesitate, wondering if this is the right thing to do. And then I watch....I hate leaving her and going to work. I wish I was able to just stay home and take care of her. The days drag.......

The minute I get to my front door, the first thing I do is look through the window to make sure she is there, and then I can really breath for the first time all day.

So, you are not alone....

Joan

[labblab]

You take all the time you need to read and process the info we've offered to you. We all understand only too well how overwhelming this diagnosis may feel as you are starting out.

I just want to reassure you about one thing, however. You can definitely purchase the Vetoryl for a much less expensive price. I quickly scanned a couple of reputable internet pharmacies and found a range of $120-140 for both boxes in total. Perhaps your own vet will be willing to price match. But if not, we can tell you how to search for credentialed pharmacies from whom to buy veterinary Rx's.

Marianne

[Renee]

I've been purchasing from California Pet Pharmacy for the last 2 years. Never had an issue, except when first switching, they had some trouble coordinating with my vet, but it's been smooth sailing since then. It's about half the price. And, free shipping!

[molly muffin]

There are several good online pharmacies to order from, they just need the prescription from your vet and they will ship to you. Most of our members, use something of this sort to keep prices in check.

[Lola]

I have been using California Pet Pharmacy as well. Used them for over a year and a half without any issues. I get Vetoryl at almost half what it would normally cost me at the vet's office. Very convenient and saved me a lot of money.

[labblab]

Baseline Cort 4.8ug/dl
4 hour post low dose dex 3.5 ug.dl
8 hour post low dose dex >10.0 ug/dl

This is the info under these lab values. Will type just as it reads.

Both 4 and 8 hour >1.5 ug/dl and 50% of baseline= Consistent with Cushings Syndrome; consider HDDST to rule out adrenal tumor

Just wanted to stop back to highlight the lab's interpretation that fits Athena's LDDS results. Her 8 hour result was greater than 1.5, and both her 4 and 8-hour results were greater than 50% of baseline. Therefore, an adrenal tumor, rather than PDH, is a possibility. Personally, though, I would put my money towards an ultrasound rather than a HDDST test. With an ultrasound, not only do you get important info about the adrenals, but also about other internal organs, as well. And if an adrenal tumor is present, the imaging will give specific info as to size and location.

Has the vet said anything at all about further diagnostics? I think Glynda's speculation about the possibility of a pheo is very interesting, given Athena's very odd response to the LDDS test.

Marianne

[budindian]

I just want to say if your crazy we are all crazy, I cried almost everyday last week because my precious little furbaby wouldn't eat.
When Bandit had a bad reaction to the Vetoryl the first time I didn't give my vet much choice in lowering the dose after I had gotten the information from this site. I always listen to what she has to say and then give her my opinion and what I think would work for him, after all I am the one that lives with him and knows him. I really like my vet she does take the time to listen to me even tho I am hysterical sometimes. Your just like everyone here, just wanting whats best for your loved one.