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Thread: Max test results help

  1. #11
    Join Date
    Jul 2020
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    14

    Default Re: Max test results help

    Our vet sent over the referral, but they are unable to get us in until August 11th. I am definitely worried about waiting another 5 weeks. We did have them put us on the waiting list for a cancellation. Is waiting that long detrimental or in the long run typical and ok? I know beginning treatment as soon as possible is obviously the best option. Any advice is appreciated!

  2. #12
    Join Date
    Apr 2009
    Location
    Georgia
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    14,378

    Default Re: Max test results help

    Hey Elizabeth, I don’t think I’d worry unduly about the wait. Cushing’s is typically a disease that progresses slowly, so I wouldn’t expect to see significant worsening in another month’s time. As long as everything stays pretty much status quo, I’d think you’d be fine. The one exception is if by any chance you started to see skin lesions appearing. If there’s evidence of calcinosis cutis setting in, then starting treatment might take on additional urgency.

    I’d also hold off on starting the thyroid supplementation until Max has been seen. This is because the supplementation would invalidate any additional diagnostic thyroid testing. I don’t know that the internist will be interested in pursuing any more thyroid testing right now, but if so, the supplementation would have to be discontinued for a period of time before the testing could be done.

    Hopefully things will stay pretty quiet for you two, though, until August rolls around!
    Marianne

  3. #13
    Join Date
    Jul 2020
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    14

    Default Re: Max test results help

    Thanks so much!
    His main issue right now is "allergies"...licking and chewing feet and licking belly area. He is on Hydroxyzine which honestly I am not sure it helps. He sometimes vomits if he takes Benadryl. We also rinse his paws and apply a mousse for calming the skin. Summer allergies are always worse for him. He does seem to cry for food as well. I thought it was just that he wasn't getting full on the Royal Canin HP since the daily feeding guidelines at 4.5 cups for his size and it is lower in protein than he's used to. Any recommendations for healthy snacks that might help? He's normally happy if I acknowledge him and give him a few pieces of kibble or a "cookie". Thanks for your input!

    To all reading...please know whomever you are...we are sending good vibes to all those going through tough times!

  4. #14
    Join Date
    Apr 2009
    Location
    Georgia
    Posts
    14,378

    Default Re: Max test results help

    We are indeed, and that's so kind of you to reach out to others who are struggling, too!

    Reading about Max's allergies make me doubly glad that you'll be meeting with the internist. It's a bit odd that Max would be suffering so much at a time when presumably his cortisol level is elevated. As a natural steroid, you'd think that his allergies would be somewhat under control right now. The more typical scenario with Cushpups is for allergies or other inflammatory conditions to worsen or become "unmasked" *after* cortisol levels have been lowered -- not before. So Max's situation does trigger some question marks, but we shall see what the specialist suggests.

    I wish I had some great ideas re: healthy snacks. I've seen green beans or carrots suggested before, but hopefully some other members will have some better suggestions in that regard.

    Marianne

  5. #15
    Join Date
    Jul 2020
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    14

    Default Re: Max test results help

    Hello everyone! We were able to get an earlier appointment for Monday 8/3/20 with the internist! So thankful to get in a little quicker, but nervous. I am spending the weekend double checking all points I would like to go over and getting a list of Max's history and supplements on paper. Anything tips as a newbie on things I might not think to ask?

    My top questions are:
    -Medications and amounts as he is sometimes reactive to medications (would like to start at the lowest dose possible) I have found a few articles about dogs >30kg and lower doses but would love to see solid research based articles that are recent.
    -Diet (moving from hydrolyzed protein diet to a better quality kibble or home cooked)
    -Supplements for his issues with his right leg at times (has happened a few times over the last few years cruciate ligament is always ok when they check, but does show an area on back for osteoarthritis in xrays) and will favor his left with a little limp at times (has done this a few times over the last few years) It doesn't keep him from running like a maniac in the yard; which I wish he'd slow down a tad. Currently takes Dasaquin with MSM chews...bumped back up to 2 a day since he seems to be having issues with his right leg over the last week. Stiff upon rising and lowering, but once he starts walking seems better. Trying to have him rest which has always helped in the past. He did the same thing this time last summer almost to the day, but we were able to give a few days of anti-inflammatory meds which helped.
    -blood work from previous tests (the "anemia" or lower blood levels on some tests)
    -additional tests (his urine ratio test was done incorrectly, urine from the clinic not collected over time..I know the LDDS test he took was pretty straightforward, but I want to mention the urine may not be accurate)
    -hypothyroidism and his slightly raised tsh and thoughts on that

    I just want to not forget any big things...most important to me is treatment plan and NOT starting a dose that is too high. I am advocating for a much lower dose to start. Any advice appreciated! Have a great weekend everyone!

  6. #16
    Join Date
    Apr 2009
    Location
    Georgia
    Posts
    14,378

    Default Re: Max test results help

    I’m so glad to hear that your appointment has been moved up! I think you’ve got all the important points already covered— good job! But I’ll continue to give it some thought and check back again by this evening if anything more comes to mind. But for sure, good luck!!

    Marianne

  7. #17
    Join Date
    Jul 2020
    Posts
    14

    Default Re: Max test results help

    Thank you so much!

  8. #18
    Join Date
    Apr 2009
    Location
    Georgia
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    14,378

    Default Re: Max test results help

    It’s me, back again for a quick moment. I really do think you’ve done a good job of identifying your central questions, and I still don’t have a lot to add. I’ve spent a few minutes trying to find more recent studies re: the efficacy of especially lower doses in large dogs, but all the summaries I’ve found keep referring back to that original 2012-13 research. In the process, though, I did find this 2018 Canadian literature review covering a wide range of accumulated info (and remaining questions) re: the use of trilostane, generally. I don’t know whether you want to spend time reviewing all this tonight, but it does seem to offer a helpful summary of a variety of research conducted up through that time.

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5855282/

    Once again, good luck with your appointment tomorrow, and we’ll be so anxious for an update when you get the chance.

  9. #19
    Join Date
    Jul 2020
    Posts
    14

    Default Re: Max test results help

    Thank you so much! I did read that study as I was looking for info in general for trilostane. I am definitely hoping that being a specialty group they are diligent in their continuing research education. I have all of my info ready and on paper to take with us. I will definitely drive home the point that I am not comfortable going over 1 mg/lb if that is the medication route he wants to go. I would rather start lower and will definitely ask. I also am also relieved in reading his bio online that his special interests include endocrine issues.

    I will absolutely touch base with you all tomorrow evening...tomorrow starts the first day back to school for teachers in our area! Whew...busy next few weeks, but thankful my husband is home until October to keep an eye on Max! Happy Sunday everyone! Have a great evening!

  10. #20
    Join Date
    Jul 2020
    Posts
    14

    Default Re: Max test results help

    Hi everyone! We had a pretty good visit with the internist today. I liked him very much even though with Covid they are only allowing patients in the building so we talked over the phone. I sent in all of my notes for him to review before speaking to me. He asked why my vet decided to screen for Cushings to begin with due to his alkaline phosphate being the only marker elevated to 700. I told him my vet knows Max very well and knew that was off for him. She immediately thought a blood or immune disorder/cancer or possible Cushings.

    He said Max looks to be in perfect health. He said his muscle tone, coat, teeth, etc look great and his weight isn't too low or high (84 lbs). He said at this point he is not showing any symptoms of Cushings. He said in that Max may or may not show symptoms in the future as he knows that there are dogs who have Cushings "on paper", but never experience issues that require treatment...he also said or he could begin having symptoms as time goes on. He described him as being in a grey zone at this point. He said that he did not think treatment is warranted at this point with no overt clinical symptoms. He explained the whole reason to use the medication is for managing the symptoms. He felt that I am an observant pet owner and would quickly identify changes such as the ones that go along with Cushings. He calmed my biggest worry which was beginning a medication before he actually needed it. I am ok with being watchful and waiting.

    Thyroid: he looked over his labs and said boxers are known for hypothyroidism, but felt that his tsh number wasn't enough to consider it at this point. He said we typically use tsh in humans to treat, but his other levels were fine and doesn't feel we should medicate at this point...again be watchful of it! There was something he mentioned about the tsh and how sometimes it can run a tad high...but again I cannot remember. I was trying to remember everything and talk on the phone.

    We did go ahead and retest his PCV/TS which is still low normal about 39/8.6. He also wanted to check his blood pressure which once he calmed down was great as well as sent urine to IDEXX to check protein-Creatinine ratio. Since Max has had some protein in his urine at times. I cannot remember exactly why, but in his notes it says, "looking for problems (proteinuria, hypertension) that occur concurrently with Cushings disease and will treat accordingly.

    As of now we will wait for the UP:C results to see if any suggested treatment is needed.

    Thoughts....have there been others who has had a conservative internist that didn't rush to treat when a dog is not showing symptoms? Curious about that as my vet was ready to treat both that and thyroid. I feel that for us it is the right thing to do. We are working to boost his immune system at home just with a mushroom complex and fish oil as well as a blood support vitamin which he said was fine. Just trying to keep him as healthy as we can! I welcome any thoughts, or concerns.

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