REMY diagnosed last week

[Remy’s Mom]

An update on Remy. He went in for ACTH test yesterday. Result: Pre 6.0, post 6.6. His doctor feels he is very well managed and doing great! He’s back to being a picky eater and no issues with excessive water consumption or urination so everything looks good!! So glad we caught this early and 10 mg once a day is doing the trick.

Meanwhile toy poodle Angel is at LSU for ‘possible’ pancreatitis. She has always had liver issues and also has transitional cell carcinoma but had been doing very well until the past few weeks when inappetence set in. Everything looks good on ultrasound but test for pancreatitis showed a slight elevation (430) even though pancreas appears quite normal. They may keep her for a couple of days of fluids and IV meds. I hate the thought of that but we will do whatever is best for her. She has been on chlorambucil for seven months (metronomic chemotherapy) so we may also give her a brief break from her medication to some if the inappetence has improved. There has been no progression of the TCC since last September and if it is pancreatitis the hospital is the best place. At least Remy is doing great and hopefully my little fur family will be back together soon!

[Squirt's Mom]

Glad to hear our Remy is doing so well and pray the trend continues! I will also keep Angel in my prayers for a swift recovery so that she is soon back home where she belongs. You have your hands full, Mom, and are doing a great job!

[Remy’s Mom]

Thank you so much! Prayers are always appreciated!! Little Angel is home. She wouldn’t eat at the hospital but I got some GI diet food down her at home. Granted she looked at me with disgust when I offered but I am holding firm! We will schedule an Internal Medicine consult for her to see if we can figure out what’s going on. Things are up in the air with the Covid-19 situation affection the veterinary schools. The good news is her problem does not seem related to her cancer which is great news!

[Remy’s Mom]

I just put out a new note on Angel and the pancreatitis. I’ve never dealt with it before and searching for suggestions and advice. Kind of an emotional wreck tonight I guess. ��

[Remy’s Mom]

Remy has had Cushings for almost 4 years. Pretty much same dose of Vetoryl, 10mg morning and 5 mg night. He developed diabetes almost 3 years ago and we have never been able to get it regulated. Lately he has developed tremors. Primary care says it’s common in old dogs which I understand. Could it be due to organ damage from the diabetes? Now I started wondering about his Cushings and if he could be moving to Addisons? Louisiana State University Small Animal now has an internist who is an endocrine specialist so I am going to get an appointment with her to see if she can figure this out. So far his primary care and internist have been unable to come up with a solution to the difficulties in regulating Remy’s glucose levels. The only consistent thing is his inconsistency.Any thoughts and suggestions would be much appreciated. Thanks so much,
Claire

[labblab]

Hello Remy’s Mom, and welcome back. I’m surely sorry Remy is having this problem with tremors, and I’ll come back tomorrow to write more. But in the meantime, I’ve added your new question to Remy’s original thread so that we can have the chance to refresh our memories regarding his overall history. So as I say, I’lll be back again later to add some more thoughts.

Until then, once again, welcome back.
Marianne

[Harley PoMMom]

Hi Claire,

Reading back on your posts I saw that Remy was taking 10 mg once a day, when was the 5 mg added in and why was his dose increased? Can you share his most recent monitoring ACTH stimulation test results? How is his appetite, and is he displaying any Cushing's symptoms? Sorry for all these questions but the more we know the better our advice can be...thanks!

Hugs, Lori

[Remy’s Mom]

I’ll have to check back further as to exactly when they added in the 5 mg. But it’s been well over a year. His last Cushings test was 4/23/23 at LSU. They use a different reference scale I think. He was 42.5 no l/L at 1 hr and 55.2nmol/L at 5 hrs. 40-140 is normal. Prior to that 5/27/22 pre 1.3 and post 1.9. His Cushings gets forgotten because of all his problems with diabetes. He eats because we feed him with a spoon. We’ve done that for over a year and a half because otherwise he just picks and grazes which doesn’t work with a diabetic dog. He never begs for food at all and if I weren’t hand feeding I don’t think he would eat much. We’ve kept his weight stable by doing the spoon feeding. He only drinks excessively when his glucose is high. Other than that he’s normal. His coat isn’t too bad for his age and living in a super hot climate. Not much undercoat but what he has grows very fast. No potbelly, panting or other Cushings symptoms. The tremors started back in the early summer and seem to be increasing in frequency. Due to his inactivity he does have some muscle wasting. We also learned his hip joints are extremely bad so no doubt his discomfort is one reason he is inactive. The diabetes has been a constant problem and we have not been able to regulate it. I think his doctors truly don’t know what to do with him. I started looking for things that might cause the tremor and saw Addisons so I wondered if maybe he’s on too much Vetoryl now. Of course there are many things that can cause tremor in old dogs including organ damage from diabetes. His most recent blood work was last week but they did not test Cushings. I think everyone is so wrapped up in the diabetes the Cushings goes by the wayside.

[Remy’s Mom]

Vetoryl increased from 10mg to 10mg am and 5 mg pm 1/4/21. Will try to find earlier records. He was having syncope events at that time which turned out to be hypertension. Cardiologist increased his amlodipine and also discovered small heart murmur of grade 1-2 which has been stable. Right after that in early February was when he was diagnosed with diabetes.

[labblab]

Thanks so much for this additional information. Given the fact that Remy’s cortisol level was at the low end of the desired therapeutic range back in April, I definitely encourage you to have it rechecked as soon as you can arrange it. Various problems could account for both tremors and a lack of appetite, but low cortisol is indeed one possible explanation that could cause even more serious problems if it continues.

I think it will be great if you can get an appointment with the new LSU endocrine specialist ASAP. I know how hard it can be to deal with both Cushing’s and diabetes at the same time. So the input of a specialist would be such a gift. Please do let us know how things develop, OK?

Marianne