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Thread: Suni

  1. #11
    Join Date
    May 2009
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    631

    Default Re: Suni

    Just talked to the vet and she said by all means wean her off the eye drops. She said since I had only been using them every other day or so to use them every three days for a week and then twice a week. She said there's a chance that it was playing a big part in her elevated alp and contributed to some of the cushings symptoms. She said the neo/poly/bacitracin would be a good fit for both eyes, so bam!!

    Y'all are the best!!! 2 or 3 heads are always better than one old wore out one!! Thank y'all so much for being there to help. Love you both!
    Last edited by sunimist; 05-12-2021 at 07:48 PM.

  2. #12
    Join Date
    Apr 2008
    Location
    Tennessee
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    6,592

    Default Re: Suni

    Shelba, I am so sorry to hear that you have had so many health issues. Holy cow, you really have been through the wringer with very serious conditions so I'm happy you are still with us. To answer your question about the ALP liver enzyme, I believe long term use of dexamethasone, even if eye drops, can cause an increase in ALP. Dexamethasone is 30 times stronger than our body's natural cortisol so you can expect to see the same lab abnormalities and symptoms as you would see in a dog with naturally occurring cushing's. Poodles are a breed you see in the textbooks as being over represented in cushing's but I really don't see that many Poodles in the facebook groups. I agree with Leslie and Marianne that you try to get Suni off of the steroidal eye drops. If that's the problem, you should see symptoms resolve on their own. If they persist, then you may be hanging around here for a while. Did your general practice vet prescribe the eye drops or did you see an opthalmologist? I think it's strange that your vet has prescribed long term use of a steroidal eye drop for cherry eye. I've had dogs with cherry eye and it was not pretty but it wasn't life threatening nor did it require short or long term treatment with steroids. I don't trust any gp vet when it comes to my dogs' eyes so if Suni has not seen an opthalmologist, you may want to consider asking your vet for a referral. I've taken a few rescue dogs to an opthalmologist after gp vets misdiagnosed the problem and prescribed eye drops with steroids which exacerbated the problem. Since your vet was sure Suni has naturally occurring cushing's, he doesn't seem to be familiar with iatrogenic cushing's caused by long term exogenous steroid use. He may therefore not know how to properly wean Suni off of the eye drops. He may need some help from an internal medicine specialist. By the way, dexamethasone is not good for Suni's collapsing trachea and it is also the likely culprit for the heat intolerance, panting, inability to jump on on things and the the usual increase in thirst, urination and appetite. How is her skin and coat?

  3. #13
    Join Date
    May 2009
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    631

    Default Re: Suni

    Hey Glynda!

    Suni's coat and skin is ok so far.

    Our vet offered to send her to an ophthalmologist but at the time it was out of the question. It still could happen. The eyedrops were originally prescribed "as needed' but she had difficulty with the eye and it bothered her, so I am the one that gave her the eyedrops more than prescribed. For the past year she has had them every 2-3 days, depending on how the eye looked.

  4. #14
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    Apr 2008
    Location
    Tennessee
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    Default Re: Suni

    You know Suni best and if you think she has a chronic issue with her eyes, I would strongly recommend you have her seen by an opthalmologist. They ain't cheap but they can sure get to the bottom of a problem and solve it with appropriate treatment(s). The dex eye drops are definitely the first suspect that has to be ruled out so if after weaning her off and symptoms don't go away, then it's highly possible she has naturally occurring cushing's. She's a senior Poodle so that would not be a surprise.

  5. #15
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    May 2009
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    Default Re: Suni

    You are very right and I agree 100 percent, and I will. Meanwhile, I hope to get this steroid issue resolved. Have already got the meds without steroids so I can start the weaning immediately. Thanks for your help my friend!

  6. #16
    Join Date
    Apr 2008
    Location
    Tennessee
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    6,592

    Default Re: Suni

    We all love you, Shelba, and everybody has done a great job of identifying the problem. Please keep us posted and I'll be keeping hoping and praying that all of the symptoms go away after weaning off of the dex eye drops. (((HUGE HUGS)))

  7. #17
    Join Date
    May 2009
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    631

    Default Re: Suni

    Well, I certainly love all of y'all too!! That's the way families roll, right? I want to introduce you all to our sweet Mandi a little later on. Suni's little sister.

  8. #18
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    May 2009
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    631

    Default Re: Suni

    Is Lysodren the preferred treatment? I am hoping something far less harsh has been developed. I see a vast majority are using vetoryl. Where is Anipryl ranked now? And also, is the stim test still relied on for testing and maintaining? I would do the ultrasound first, but need a little guidance otherwise since i have forgot most of what I knew about this mean old disease! Thanks.

  9. #19
    Join Date
    Mar 2009
    Location
    rural central ARK
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    Default Re: Suni

    Most vets are using Vetoryl these days (compound name Trilostane). It has the same risk factors as Lysodren but has a much shorter life in the body than Lyso so if, IF, there is a problem with the cortisol dropping too low it is leaving the system more quickly. This means simply stopped the drug for a week or so will usually take care of the issue, rarely needing Prednisone to support the adrenal glands. The flip side is that Vetoryl is given daily (no loading phase as with Lyso), it is not as stable as Lysodren so the cortisol can suddenly drop or rise even if the dog has been on the same dose for a while, and it can take a while to get the correct dose....all of this means there is a great deal more testing with Vetoryl than with Lysodren because with every dose change the testing schedule starts all over at the 2 week mark. ACTH testing schedule for Vetoryl is 10-14 days after starting, another at 30 days after starting, then every 3 months as long as the cortisol is controlled. If the dose has to be adjusted, and most dogs have several adjustments, this schedule starts all over. So while each Vetoryl pill is less expensive than the Lsyodren pills the testing makes it more expensive to use in most cases. I am the oddball and much prefer Lysodren to Vetoryl for these reasons and others but most feel the opposite because of the short life in the body in cases of overdose. Anipryl is not in favor for most dogs because it is rarely effective and even when it is, it doesn't work very long. For Anipryl to be effective the dog must have the pituitary form and the tumor must be on the pars intermedia portion of that gland. Most pups do have PDH but only about 20% of them have the tumor on that portion of the pituitary gland.

    For dogs with the adrenal based form Vetoryl is the preferred treatment because ADH requires higher and higher doses over time and Lysodren is very hard on the stomach making increasing doses tough for the pup. Vetoryl is also preferred for diabetic pups if memory serves.

    If Suni does have naturally occurring Cushing's VS Iatrogenic we can help you with the starting dose for either drug so don't let the vet convince you that you have to use what they prescribe. Sadly many vets still don't understand these drugs and often overdose from the beginning, especially with Vetoryl. Also, Dechra refuses to update their literature so vets are operating on outdated info for starting and increasing Vetoryl doses. So come talk to us before accepting treatment.

    As for testing, the LDDS is notorious for false positives if any other health issue is present but is still considered the gold standard for diagnosing Cushing's. The ACTH is the test that should be used in diabetic dogs for this reason. If it is feasibly possible it is always best to have both tests done along with the ultrasound. Establishing a base with the ACTH before starting allows us to see how far the cortisol has dropped at that first ACTH monitoring test.

    One thing to keep in mind....for a pup who has been on long term steroid use the adrenal glands can become inactive, even atrophied, because they haven't been having to do their job...the steroid has been doing it for them. So for this reason you want to give the pup long enough off the steroids for the adrenal to fully recoup. When you are seeing strong cush signs you know they are functioning again. Some adrenals never recover if the steroid use has been high enough and used long enough, putting the pup in an Addison's state, but this is not typical. For Suni, I wouldn't rush into any testing right now but rather give her time to get all the effects of the steroids out of her system. I would wait for those cush signs to show up the test. If you don't remember those signs I can give you a list to watch for.

    Remember to get copies of all the test results so you can play 20 Questions with us.

    I hope she is doing well and you too....you've all been through enough for a while!

    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. #20
    Join Date
    May 2009
    Posts
    631

    Default Re: Suni

    Thank you Leslie! So much information I had forgotten and you gave me some valuable reminders! One more question...Suni has the cushings symptoms now, so how long will it be before they start resolving if she does in fact have Iatrogenic cushings? When will I be able to tell? And if they do start to resolve, that means she doesn't have the regular form of cushings? See how dumb I have become not keeping up with this important part of my past. Regrets! Yes, I have always, and still do, get copies of all lab work ever since Misty started this hateful journey! Thanks for the reminder though.
    Last edited by sunimist; 05-17-2021 at 12:00 PM.

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