Sausage Dog with ? Cushings

[labblab]

Hello again from me! Like Leslie, I’ll be anxious to hear how Daisy’s bloodwork turned out this week. From our earlier discussion, I’m guessing this will be her first monitoring testing done after the first month of treatment. So it’ll indeed be interesting to see where her cortisol level has landed.

That’s great that you initially were seeing positive results, but it’s true that Daisy’s dosing needs may have shifted during these first 30 days. Most commonly, cortisol levels drift downward during this initial phase. Her new lack of appetite could be caused by a cortisol drop that’s lower than is comfortable for her. Usually an increase in thirst is due to higher rather than lower cortisol. But as Leslie says, low cortisol could be the cause of that, too. So we’ll be anxious to hear how the testing turned out, and whether any dosing changes seem advisable. Do let us know.

Marianne

[Pinkcat]

Hello again from me! Like Leslie, I’ll be anxious to hear how Daisy’s bloodwork turned out this week. From our earlier discussion, I’m guessing this will be her first monitoring testing done after the first month of treatment. So it’ll indeed be interesting to see where her cortisol level has landed.

That’s great that you initially were seeing positive results, but it’s true that Daisy’s dosing needs may have shifted during these first 30 days. Most commonly, cortisol levels drift downward during this initial phase. Her new lack of appetite could be caused by a cortisol drop that’s lower than is comfortable for her. Usually an increase in thirst is due to higher rather than lower cortisol. But as Leslie says, low cortisol could be the cause of that, too. So we’ll be anxious to hear how the testing turned out, and whether any dosing changes seem advisable. Do let us know.

Marianne

Hi so the vet called and said that she needs more vetoryl and that she is upping it to 15mg per day. She starts today. She has asked to see her again in ten days but for us to go earlier if we see any of the following, lack of interest in food, depression, lethargy - unforunately because of the need for a 5 and a 10 capsule this has cost £170 for one months supply - we are insured but have a limit so once she’s settled on a dose for a few month I will move to buying online with prescription from the vet. I don’t have a copy of the results but could get one if you think it useful thanks

[labblab]

It sounds as though your vet is following recommended protocol, but yes, it’s always helpful for us to find out the actual numbers for testing results. So when you return to the vet in ten days, it would be great if you could get a copy of the numbers or at least write them down to relay to us.

My one concern right now is about her appetite — you had said earlier that she was surprisingly picky one day last week. Did that continue, or was that just a one-off?

Marianne

[Squirt's Mom]

It would be helpful if you could you get the actual test results numbers and share them here with us? I know it's difficult to get those in the UK but it can be done. At least sometimes you can get them to tell you the pre and post number along with the lab ranges for the ACTH. For the PVC, which is most commonly used in the UK now, you will probably only have one result number along with ranges. Too often we have seen these results misinterpreted, doses changed as a result, and the dog does not do well. So we like to see those test results if at all possible just to be sure everything is on track.

You're doing a great job, Pink!
Hugs,
Leslie

[Pinkcat]

It would be helpful if you could you get the actual test results numbers and share them here with us? I know it's difficult to get those in the UK but it can be done. At least sometimes you can get them to tell you the pre and post number along with the lab ranges for the ACTH. For the PVC, which is most commonly used in the UK now, you will probably only have one result number along with ranges. Too often we have seen these results misinterpreted, doses changed as a result, and the dog does not do well. So we like to see those test results if at all possible just to be sure everything is on track.

You're doing a great job, Pink!
Hugs,
Leslie

Hi both

Sorry for late reply. The eating thing lasted for a couple of days - I think it was literally because she has been having wet food with her tablets on a morning she wanted it with her tea as well! She barks when her water isn’t cold enough always has 🙈 she seems ok at the minute getting out for plenty of walks - I will do my best to try and get the results from the vets when I go next and let you know thanks again for al your help

[Pinkcat]

Hi both

Sorry for late reply. The eating thing lasted for a couple of days - I think it was literally because she has been having wet food with her tablets on a morning she wanted it with her tea as well! She barks when her water isn’t cold enough always has 🙈 she seems ok at the minute getting out for plenty of walks - I will do my best to try and get the results from the vets when I go next and let you know thanks again for al your help

Hi

I have all daisys blood results but I can’t figure out how to upload can you advise me please thanks

[labblab]

That’s great! One option is to take a digital photo of the paper, and then upload the photo to a personal photo album that you create for yourself here on the forum:

https://www.k9cushings.com/forum/faq...faq_vb3_albums

If that’s not possible, you can just type the relevant results in a reply here. We’ll want to see all results that are marked as being tests of cortisol (such as ACTH, LDDS, or straight cortisol tests). Just type those results as you see them on the page. As far as regular blood work, we only need to see results that are marked as being abnormally high or low, along with the normal range for that particular lab value.

Hope this helps, but just let us know of additional questions.
Marianne

[Pinkcat]

Please see below results:-

10/2/22 - ACTH stimulation
Basal cortisol 229.1 (nmo/l 50 - 250)
Cortisol post ACTH - 404.1

17/2/22 - Low Dose Dexamethasone Supression Test
Basal Cortisol H 298.1 (nmol/l - 50 - 250)
Cortisol 2 - <37.3
Cortisol 3 - 119.5

18/3/22 - Basal Cortisol
Cortisol Basal 196.6 (nmo/l - 50 - 250)

Hope that helps. Personally, Im thinking she seems a bit lethargic today although was very active at the weekend out and about. She is not off food but definitely drinking less. Please let me know if you feel any of the above seems out of sorts. Thanks

[labblab]

Thanks so much for giving us these test results! For the benefit of our U.S. readers, I’m going to convert the results into the units that are most often seen here.

Original diagnostic ACTH done in February
Basal cortisol: 8.3 ug/dL
Post-ACTH: 14.6 ug/dL

Diagnostic LDDS done in February
Basal cortisol: 10.8 ug/dL
Cortisol 2: <1.3
Cortisol 3: 4.3

Current monitoring pre-pill basal cortisol: 7.1 ug/dL

So, the results of the two diagnostic tests do correspond exactly with what your vet originally told you. The initial ACTH was negative for Cushing’s. However, “false negatives” on the ACTH are relatively common. So your vet proceeded to the LDDS, and it was positive for the pituitary form of Cushing’s. Therefore, Vetoryl treatment was begun, and you’re now at the the 30-day mark.

This monitoring cortisol level is indeed higher than is preferred at the 30-day mark (around 5.0 ug/dL), especially if symptoms remain. So the dosage increase does make sense. I’m going to give you a link below that maps out the monitoring protocol for dogs who are having their pre-pill cortisol checked. As you’ll see, to further lower cortisol, two options are given: increasing the once daily dose, or dividing the daily dose to be given 12 hours apart instead of only in the morning. Under your circumstances, simply increasing the once daily dose is indeed an option. However, some dogs do end up with better control if they are switched to twice daily dosing. In that case, if two pills of equal size are not being given, the larger of the two should be dosed in the morning.

Anyway, it sounds as though your vet is right on course for the moment, and we’ll continue to be anxious to hear how things are going. In the meantime, here’s the link to that monitoring flowchart:

https://drive.google.com/file/d/1gqU...L9Y6RtbrcaKAE8

Marianne

[Pinkcat]

Thanks so much for giving us these test results! For the benefit of our U.S. readers, I’m going to convert the results into the units that are most often seen here.

Original diagnostic ACTH done in February
Basal cortisol: 8.3 ug/dL
Post-ACTH: 14.6 ug/dL

Diagnostic LDDS done in February
Basal cortisol: 10.8 ug/dL
Cortisol 2: <1.3
Cortisol 3: 4.3

Current monitoring pre-pill basal cortisol: 7.1 ug/dL

So, the results of the two diagnostic tests do correspond exactly with what your vet originally told you. The initial ACTH was negative for Cushing’s. However, “false negatives” on the ACTH are relatively common. So your vet proceeded to the LDDS, and it was positive for the pituitary form of Cushing’s. Therefore, Vetoryl treatment was begun, and you’re now at the the 30-day mark.

This monitoring cortisol level is indeed higher than is preferred at the 30-day mark (around 5.0 ug/dL), especially if symptoms remain. So the dosage increase does make sense. I’m going to give you a link below that maps out the monitoring protocol for dogs who are having their pre-pill cortisol checked. As you’ll see, to further lower cortisol, two options are given: increasing the once daily dose, or dividing the daily dose to be given 12 hours apart instead of only in the morning. Under your circumstances, simply increasing the once daily dose is indeed an option. However, some dogs do end up with better control if they are switched to twice daily dosing. In that case, if two pills of equal size are not being given, the larger of the two should be dosed in the morning.

Anyway, it sounds as though your vet is right on course for the moment, and we’ll continue to be anxious to hear how things are going. In the meantime, here’s the link to that monitoring flowchart:

https://drive.google.com/file/d/1gqU...L9Y6RtbrcaKAE8

Marianne

Hi

Thank you so much for this - it’s very good to know the vet is on track. As I felt daisy is a bit lethargic I ve popped into vets today to ask about the morning and evening dose they are going to phone me tomorrow but next check up is next Wednesday anyway thanks so much again