Questions about Cushings - Charlotte has crossed the Bridge

[DoxieMama]

Yay! I'm so happy to hear this news, and hope she continues to do well.

[Joan2517]

Wonderful news...you must feel so relieved!

[Squirt's Mom]

Oh goodness! This is GREAT news! Low cortisol was the best hope for what was going on and it sounds like that was exactly what the problem was! YAY!!!!

[LaurieS]

Thanks everyone! Charlotte has that cute Boxer expression back on her face that I haven't seen in quite awhile. She is acting almost like she used to before she got sick with Cushings. But now we have a new problem. She doesn't want to settle down. She slept a little last night but for very short periods. She would wake up and walk all over the house, like she wanted us to get up with her. She would walk over to my side of the bed and stare at me like she wanted me to get up. I'm thinking the 2 injections of steroids in 2 days was probably too much. Maybe it has caused her to have insomnia? I was worried at first she was in pain and couldn't get comfortable but I would get up with her and she was so perky and would trot outside when I let her out to potty. It's like she's all "hopped" up on something and I assume it's the cortisone. Does that make sense?

Laurie

[labblab]

Yes, I would think the steroid injections could be contributing to insomnia and restlessness, so hopefully that will abate as the steroid level normalizes a bit. What instructions have you been given re: timing and dosage of oral prednisone if you do switch to that? And does the Davis specialist yet know about these changes in Charlotte?

As pleased as I am that she is doing better, it does raise a host of questions in my mind. Her ACTH results were right within therapeutic range for a Cushpup, and so this dramatic turnaround while being given supplemental steroids is a puzzler to me. Has the Cushing's diagnosis been an error? Is there something else going on that the steroids are addressing? And not to be a downer , is the macrotumor still a possibility, with the supplemental steroid offering enough relief from the pressure and swelling to normalize some of her behavior but not all of it? I'd be curious to know what the vets at Davis think about this whole scenario...

Marianne

[LaurieS]

Yes, I would think the steroid injections could be contributing to insomnia and restlessness, so hopefully that will abate as the steroid level normalizes a bit. What instructions have you been given re: timing and dosage of oral prednisone if you do switch to that? And does the Davis specialist yet know about these changes in Charlotte?

As pleased as I am that she is doing better, it does raise a host of questions in my mind. Her ACTH results were right within therapeutic range for a Cushpup, and so this dramatic turnaround while being given supplemental steroids is a puzzler to me. Has the Cushing's diagnosis been an error? Is there something else going on that the steroids are addressing? And not to be a downer , is the macrotumor still a possibility, with the supplemental steroid offering enough relief from the pressure and swelling to normalize some of her behavior but not all of it? I'd be curious to know what the vets at Davis think about this whole scenario...

Marianne

Yes Marianne, all of this has occurred to me as well. I spoke with Charlotte's Davis Vet the night we brought her home and filled him in, then emailed him yesterday with an update and asked him about oral pred and this was his reply:

"Thanks for the update. Glad she is doing better! I think another dex injection is fine, but i would not do oral pred — she will have plenty of steroids in her from the Cushing’s now that she is off of trilostane.

Remember, we did the acth stim to prove that her cortisol wasn’t dangerously low - and it isn’t. I’d give her time w/o extra steroids. They resume the trilostane at a lower dose (15mg twice/day?) when she is symptomatic again.

The only treatments for macroadenoma are surgery (in the Netherlands) or radiation. There is no medicine for it (although sometimes the anti inflammatory effects of the Cushing’s steroid hormones helps to shrink it a little)."

This all makes sense to me but since we aren't completely sure what we are dealing with it does make it a little harder to decide what to do. The Trilostane did not do her many favors. It helped with her water intake/frequent urination and she did perk up a little, but not a lot. After the first couple of weeks she started to go down hill and ended up much worse than before we started her on it. So I think we are all in agreement the dosage was too high for her, and maybe at a lower dose she will do better on it. But I guess my question is why not a low dose of pred to keep the inflammation down? I guess his explanation was that she may get some anti-inflammatory effects from the Cushings steroid hormones, which is maybe why she got worse on a high does of trilo that was suppressing those hormones?

I have a tremendous amount of respect for the vets at US Davis for the obvious reasons. My local vet has treated cushings but admits he is not an expert. But at Davis they push more testing and treatment which I simply can't afford, and my local vet understands my financial limitations. We want to do the very best for Charlotte and I know the best would be a CT scan to be sure what we are dealing with. Unfortunately we just can't afford it right now. So not sure what to do at this point other than just watch her and see how it goes day to day.

Laurie

[labblab]

I would do exactly as you are right now, Laurie. I think the Davis response makes sense, in that I wouldn't launch into oral prednisone right away, either, since she's totally off the Vetoryl right now and cortisol does offer similar anti-inflammatory benefits. I would want to wait a bit and see how she responds once the injection wears off and her natural cortisol level builds back up. If she truly has a macro and Cushing's, you'd be looking for a balance between offering relief from the neurological symptoms and also the classic Cushing's issues. Layering prednisone on top of uncontrolled cortisol could perhaps tip things too far in the other direction. I do think that's why some neurologists prescribe both trilo and pred simultaneously -- in order to control the cortisol level in addition to a specific dose of prednisone. But I'm honestly not sure how well that regimen truly works. So for right now, what Davis is recommending makes sense. And we'll all be right here alongside you, taking things a day at a time. Once again, I think you and your husband are doing an awesome job of caring for Charlotte under such emotionally trying circumstances!

Marianne

[LaurieS]

I would do exactly as you are right now, Laurie. I think the Davis response makes sense, in that I wouldn't launch into oral prednisone right away, either, since she's totally off the Vetoryl right now and cortisol does offer similar anti-inflammatory benefits. I would want to wait a bit and see how she responds once the injection wears off and her natural cortisol level builds back up. If she truly has a macro and Cushing's, you'd be looking for a balance between offering relief from the neurological symptoms and also the classic Cushing's issues. Layering prednisone on top of uncontrolled cortisol could perhaps tip things too far in the other direction. I do think that's why some neurologists prescribe both trilo and pred simultaneously -- in order to control the cortisol level in addition to a specific dose of prednisone. But I'm honestly not sure how well that regimen truly works. So for right now, what Davis is recommending makes sense. And we'll all be right here alongside you, taking things a day at a time. Once again, I think you and your husband are doing an awesome job of caring for Charlotte under such emotionally trying circumstances!

Marianne

I totally agree with you Marianne. I think at this point we just wait on both the pred and the trilo. Just watch her and see how she reacts once the steroids are worn off. Maybe with the higher cortisol level she will do alright for awhile without any drugs at all. I sure wish we could afford to do the CT scan so we would know for sure if we were dealing with a macrotumor, but that is what makes the most sense right now.

Of course after keeping us up all night, now she is sleeping!

[molly muffin]

Whew. Oh my goodness. I can't believe what a horrible weekend you had and a terrifying one too. I bet you just want to sleep for a week after that.

I'm glad she is doing better. yay for that! It does seem to be a trial and error right now and the plan you have is a good one. So crossing fingers that she continue to do okay and be more like herself.

[labblab]

Hi Laurie, I just now saw your new reply posted on the "Macroadenoma" thread, and I'm wondering how Charlotte is doing today. You mentioned there that you had started the oral prednisone after all. How are things going for you guys?

Marianne