Where To Start? Confirmed Cushings

[Red Dog NZ]

Kelly Louise ... from what I have read .... electrolytes should always be checked every time a stim is done for those dogs on trilostane as it can increase their potassium. With Lysodren I have only had Sabre's electrolytes checked when he is low ie low ACTH stim test or non-stimulatory stim test. His electrolytes were ok. If the aren't then florine (think that it what it is called) is required to bring their electrolytes back into balance.

Does he/she give you the results .. out of interest how low has she gone?

Edited January 18, 2010 by Red Dog NZ

[Kelly_Louise]

He doesn't always give me the actual results (if they are good etc we mostly just talk about the plan of action), but most of the time he does. The last time, her levels were well below 28, which isn't good. The month before, they were at approx 120 - so it was a big drop that we weren't expecting (indicating to me that she might have gone into remission). She was taken off Trilostane immediately, and appears since then to be well, so I assume her adrenals are working okay.

I do know that when she was coming out of remission last time he definitely did check her electrolytes and some other levels - but otherwise has never mentioned them. He does always tell me that everything else is fine - which may include electrolytes too. But I will ask him about whether they are getting checked each time. Is it just done via a normal blood test?

Thanks for that information, I have also briefly read the product info and it is very handy to know. I guess the more we know, the more we can be prepared and ask the right questions

[Red Dog NZ]

Mmm that is low. The electrolytes are just checked on a normal blood draw - our vet checks potassium and sodium. We sometimes also get liver values checked as well. Here in NZ it only costs about $20-30 to get the electrolytes checked. When we think that something is slightly amiss I request the vet to take more blood on the first draw, they courier it with the other vials and it's at the lab as a back up if we want further tests done.

I have a rather large folder with all of Sabre's tests and always get copies of the results. I keep these not only for my reference but just in case he crashes when on holiday or we have to go to an emergency vet who is not familar with his case so all the information is on hand.

[Kelly_Louise]

That is a good idea - we don't physically get Chloe's results, we just discuss them over the phone when they come in. Her levels were very low, and it came as a surprise because she really didn't 'crash' as such. There were probably VERY slight symptoms, that could also have been attributed by the really hot weather we had (40 plus degrees). But certainly there were no obvious symptoms, which is what worries me.

Chloe doesn't go too far these days, so we don't have any issues with her going to a different vet. My mum is even afraid of going on holidays as she doesn't trust Dad to give Chloe her medication correctly... I have to say, mum is really dedicated and committed - even though she doesn't understand the disease (I've tried to explain it) so I just tell her what she needs to know, and what she needs to tell me if she notices, what she needs to measure and monitor, Dad does the vet runs as he's home during the day - and I handle the technical side... so far, we've made a good team And Chloe is the ever resilient patient.

But I think for the others in the thread with Cushinoids - it would be really handy for them to have the results physically so they can monitor and become familiar with the levels etc - and of course in case they are away from home and get into trouble.

Juice - do you have any results yet?

[Kelly_Louise]

Just got Chloe's results, and they were quite normal (180) and it looks like they are on their way back up again (no remission ). So we are starting off on 5mg once a day (very small dose) and will re-test in 2 weeks to see where she is at and what direction we need to head in.

Red dog, I asked about her electrolytes - he said he did test them yesterday (and they were normal), but he does not do it as a standard - he only checks them when he feels it necessary (ie when levels are low). He said he feels that it's probably not necessary to do it each time, and it helps keep costs down if it's only done when necessary.

So, mixed result - but we have a plan and that's all we need

ETA - we have now been given some Macrolone to give Chloe in case of a Addisons crisis, which is good to have on hand (just in case).

Edited January 19, 2010 by Kelly_Louise

[j]

Good news KL (as good as it can get I guess) At least you know what you're dealing with and there doesn't seem to be anything new.

Occy actually still had some food in his bowl last night when I went to feed him and give him his tablet. Yay!

[Kelly_Louise]

Thanks J - how is Occy within himself otherwise? There is a fine line between not being ravenously hungry, and going off their food due to medication overload so I've found out

Like I said to the specialist today - alot of this disease is about going back to the drawing board and starting from scratch when dosages go wrong... just gotta roll with it I guess!

[Red Dog NZ]

Kelly Louise that's great to hear that she is within range. Yes ... costs are an issue even when things are not that expensive but they all tend to add up in the long run.

[Loraine]

http://www.ehow.com/way_5143131_treatment-...gs-disease.html

Just found this site - discusses all of the various drugs.

KL fantastic news that Chloe is steadying, shame about the test costs. I dare not think of how much I spent on tests and drugs during Coco's Cushing"s. He was worth every penny, even if we had to get the belt really tight.

[Kelly_Louise]

Tight belt? OMG, we've even had to sell our belts

Agree, they're worth every cent... but I'm sure there does come a point when some people just can't continue anymore even though they'd love nothing more - and I can honestly say I understand and would not hold it against them if they'd tried their hardest.

But, while I can keep squeezing every cent out - I will

Thanks for the link too - it all makes for very interesting reading

[juice]

yes, we are neg for cushings!!

pathologist says if he has been on cortisone for years it can cause the symptoms sometimes, and being as he is from the pound, i have no history on him, its possible.

in the last week, he has really settled down, have changed his food, and he isn't starving anymore, but do need to sort out his skin, hoping the change of food will do it.

have to say, wasn't happy with my vet, will be using another vet we use for rescue instead, further away, but lost confidence in this one.

i learnt alot about cushings! and the support here was something else!!! thanks guys

[Kelly_Louise]

Ohhhh lucky you Juice!!! That's great news - I know at first I was also hoping that Chloe had Iatrogenic cushings and that it would go away once medication was stopped... but no such luck for us

That's great news anyway, I do hope he continues to improve. There are lots of other products on the market to help with skin issues that do not contain cortisone and are friendly to Cushinoids. If you are looking for something to soothe persistent rashes/itches/skin irritations - try Epi-Soothe or Resi-Soothe. These should be safe to use and shouldn't push him into cushing symptoms. We use it with Chloe and it's fine. You do have to buy it from a vet though and they may have to get it in for you - or may also be available online.

Very happy for you and your boy Juice, do persist with finding the problem if there are any lingering symptoms... but breathe a sigh of relief that it's not Cushings Your financial wellbeing is now intact again (well as intact as it can be with dogs!! ).

[j]

Occy went in for his check up and ACTH stim test today. Results are expected tomorrow but vet was fairly confident they would be good.

On the downside, he has a skin infection - lots of red and crusty bits all over, though he isn't scratching. So on a dose of antibiotics to try and sort that out and regular bathing with aloveen till it clears up.

On the plus side, she is very impressed with the progress of his leg and thinks he will be able to get away with no surgery

Double plus side, he has lost 300grams, so now down to 5.3kgs. Yay

[j]

Well, his results weren't good. I mentioned to her that I had noticed his appetite was creeping up again.

His cortisol level is apparently meant to be between 30-100 (of whatever it is that they measure cortisol in) and it was 475 So we have to start all over again.

I'm up in Queensland this week, so we will have to start the daily dosing again when I get back.

Bugger

[j]

Occy went back in today for his next lot of ACTH stim test today. Should get the results tomorrow.

Apparently he can never go in for just one thing. Today he also came home with ear drops for a yeast and bacterial infection in his ear. I mentioned that he appeared to going deaf.

He is still really itchy. Poor little fellah. He is such a trooper. They really love having him there, he is really easy to work with, doesn't complain at all. They take him out for a wee break and he does his business and comes straight back to them to go back inside.

ETA - he was back up to 5.7kilos, so all the hard work had been undone. Such a little porker at the moment

Edited March 10, 2010 by j

[Kelly_Louise]

Hi J... welcome to our world I'm really sorry to hear of the roller coaster ride you've been having with little Occy. Sometimes, you have to be really patient while you wipe the slate clean and start all over again. It can be trying, I know - especially considering the costs. But you will sort it out eventually.

How's his symptoms going for the last month? Do you feel he will be over or under or 'just right' this time in? I do hope you can find a happy medium with his meds soon - nothing worse than the yo-yoing effect on them.

He sounds like a real little trooper, bless his little paws.

I also understand the struggle with weight. For us, it's one step forward (losing a couple of kilos) and then 10 steps back (slowing gaining it back). But, we do it because we love them. :D

Thankfully on her very low dosage, Chloe has remained quite stable (although also looks like she's put on a little weight), which is fantastic and a sigh of relief for us all.

Fingers crossed for the results

ETA - if you get a chance (and aren't already a member), you should join us over at http://www.k9cushings.com/forum/ They are lovely people who have been there and done that with Cushings, and share the stresses and triumphs with you

Edited March 11, 2010 by Kelly_Louise

[j]

Results weren't good. Too far down this time. Level was at 10 whatever they measure cortisol in. He wasn't well last night. I had to give him some of the cortate tablets (reversal) but over night he has vomited a couple of times and pooed inside (He NEVER does that, and he didn't scratch to go outside so he must have been caught unawares) so we are off to the vet this morning.

I have an unwell cat as well so he is also booked in. Sigh.

[Kelly_Louise]

Ohh you poor, poor thing. I feel for you. It's good that you caught it in time though before it became an Addisonian crisis. Unfortunately, in order to get dosage right we have to go through this hard part (the ups and downs – and also when their body's change too). At least you know that the dosage he is on now is way too much – and it gives you a better idea of where you should be headed. Do you know much about Addisons disease (opposite of Cushings)? I think it's important to be very familiar with the symptoms so that you always know what's happening if he's heading that way and can catch it early. In saying that though, the times that Chloe has been Addisonian, she was a little different – but not massively so, and certainly didn't present a lot of the symptoms that are considered common for Addisons disease. You will get used to the signs though, you will learn the changes in Occy over time – unfortunately it usually means having to learn it the hard way though

Keep your chin up. Your vet will now have a better indication of where his meds should be at (he was too high before, too low now so it's gotta be somewhere in between for the meantime). Sometimes it means starting from scratch and starting low and building up from there (which is what we do with Chloe now).

Big hugs to you all, especially Occy. Don't feel alone in this. I know exactly how you feel and most of us with Cushinoids have been right where you are now. You're on a downslide, but remember you and Occy will pick up again.

Best of luck with the vet appointment today (it never rains but it pours doesn't it… just when you think one is getting better one of the others goes bung)!!

Edited March 11, 2010 by Kelly_Louise

[Red Dog NZ]

I presume this is the post value - 10 nmol/l. Did the vet/specialist advise you to give prednisone? (Sorry just say she gave you something not familar with) Were his electrolytes checked as well? Sometimes you can tell this by offering a little salt in your hand. So you can understand the results I usually convert to the american reporting of ug/dl ... you divide by 27.59 and your post should be between 1 and 5. If you convert his results they are 0.36 . As you can see this is very low - the reason for giving him cortate. I am not familiar with this form of corticosteriod - most vets give prednisone orally for 2 - 3 days ... sometimes longer dependent upon the symptoms. I can't remember whether he is on Trilostane or Lysodren but neither of these drugs should be given until another ACTH stim is done to ensure they are in the appropriate range to recommence at a lower dose. Any ACTH stim test should be done at least 24 hours after the last dose of pred. Some dogs can take as little as a week to bump into range whereas others ... like my Sabre can take months. As Kelly Louise said ... pop over to the K9cushings site ... you can give the full history and results and everyone can assist you along the way! All the best and take care.

[Kelly_Louise]

Yes very important to not give meds until he is improving. Our very strict rule now is... no eat breakfast, no get medication... But not sure if that also applies with Lysodren