Not the best news; Brick has been diagnosed with Cushing's
I figured it was the doxy he started on 10/31. I brought it up with the vet last Tuesday (11/11) when he went in for the Snap 4DX+ test due to the tick bite. They had me bring a sample of urine in the next morning and they tested the cortisol/creatinine ratio. It should be around 32 to 1 (cortisol to creatinine). His was 156 to 1. That means a lot of cortisol but no reason why. Next came the low dose dexamethasone suppression test. This test confirms Cushing's and often tells you what's causing it, the adrenal glands or the pituitary gland. Brick's test confirmed that it was Cushing's but didn't specify what was causing it. He goes in for an ultrasound of his adrenal glands on Thursday. They either see a mass (or masses) on 1 or both of the adrenal glands (which would lead them to the diagnosis of ADH, adrenal dependent hyperadrenalcorticism) or they don't (which leads them to PDH, pituitary dependent hyperadrenalcorticism). If they see a mass (or masses) on the adrenals, they remove the masses via surgery. If no masses, then he will have to go on medication for the rest of his life. The medication might be either Lysodren or trilostane. The most difficult part of this condition is getting the medication dosage and dosing schedule just right. If he gets too much it could send him into shock or worse. Hopefully we'll utilize a "start low and go slow" protocol; to sneak up on the perfect dosage. So it looks like Brick & I hit our first bump in the road. But after reading stuff about Cushing's online, it really does seem to be a controllable condition. So I'm cautiously optimistic that we'll work thru this little hiccup. With all that said, if anyone can spare some Airezen, prayers, good thoughts/vibes, we'd certainly appreciate them. |
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| Oh bless, not good news, but fingers and all paws crossed that all will be well, hugs to you all xx |
Poor Brick, sending you all prayers and hugs you all get through this bump with no major complications.  |
| we'll be thinking of you guys- lots of hugs from us! |
| We'll be thinking of you two. Hopefully meds will do the trick and stabilizing will be easy. Think Bricky will be see vet often in next few months for tests. Hopefully he'll enjoy the outings. |
| Poor Brick and poor daddy. Hope you get it right quickly and easily. |
| Poor brickel. Hoping for the best. |
| Oh, poor guy. And poor Dad. Hugs to both of you. |
| Poor Bricky! Here's some encouragement, though - my Beagle/Brittany Spaniel mix had Cushings, and we controlled it with meds for quite a few years. (Her eventual demise was due to one of the myriad of other issues she had.) Hopefully you'll find the right balance, and Bricky will be his old self again soon. Benson sends Bricky kisses!  |
| So sorry to hear this news about Brick but me and Nonc will be thinking about y'all and sending positive energy. |
| Hugs to Brick- and you too! Sending good thoughts and keeping fingers and paws crossed that the meds will regulate easily and that Brick will be ok!! |
Hoping you get the best news possible.  |
| Thanks guys. We appreciate all the good thoughts. I'm trying to get the ultrasound appointment moved to today at 1 PM EST but not having much luck. If I can't get it moved, it will happen on Thursday at 1 PM EST. |
| Adding you to our prayer list and sending all kinds of happy, positive thoughts! |
One of our early OES, Winston, was diagnosed with Cushing's when he was around 7 yrs. old. He lived to be almost 14 yrs. old and was on Lysodren. Hang in there, take one day at a time and enjoy every day.  |
| Sending good thoughts and hugs your way. |
| How is Brick doing? Any updates? How are you? |
| He's doing OK. I'm just about ready to leave work so I can pick him up and take him to his ultrasound appt. I imagine the radiologist will tell me if he sees anything in his abdomen. But seeing as he had an ultrasound 3 months ago and there were no abnormalities, I expect good results today. I'll report back in a few hours. |
| We just got back from his ultrasound. Nothing remarkable. His adrenal glands are slightly enlarged. Not terribly enlarged but just a little larger than normal. The liver was just a little enlarged, too. These 2 things are consistent with Cushing's. The good news is there were no masses found in his abdomen, which is a relief. Being that no growths were found on the adrenal glands, that will lead to a diagnosis of Pituitary Dependent Hyperadrenalcorticism, or PDH for short. There is no fix for this. A medicinal treatment program will be developed for him and he will be on this for the rest of his life. Next step is developing the treatment program with his vet. I hope we can do it tomorrow. I'm off next week and can watch him 24/7, which is needed when a dog starts one of these treatments. Gotta get the dosing & dosing schedule just right or it could be dangerous for him. One step closer to getting him good.  |
| Overall good news! And meds are definitely do-able. Our little Nina did great on hers for years. Good luck! |
CamVal1 wrote: One step closer to getting him good. Absolutely. My mother's dog lived a good long life on meds for cushings, and so will our Bricky. He's tough. Hugs to you, Mark, throughout this recovery. |
| Vet just looked at the ultrasound report and has concluded PDH (pituitary dependent hyperadrenalcorticism). Treatment is medication. I have a choice of 2, Lysodren and trilostane. They both have their positives & negatives. She's working up pricing now. The sucky part is that she doesn't have any in stock. Either way, it'll have to be ordered. She doesn't know when it would get here for 2 reasons: the storm in Buffalo that they're still digging out from, and Thanksgiving. I say, overnight it. I'll pay. Need to get him on it this week as I'm on vacation. |
| Hope this goes well for you and Brick. At least you know there is a treatment and with luck and good care, which we know you will give, he should be fine. |
| When we had to give Lysodren to Winston, it was a human medication. Can your vet get it at a local pharmacy? |
| Any way we go, it wouldn't be here until tomorrow. I decided to go with the trilostane. It's less harmful to his system and easier for him to tolerate. Plus it doesn't require a loading dose to start, which can be dangerous. It won't permanently damage any of his body like Lysodren does. The downside? Cost. It's not cheap. About $190 per month. The vet is overnighting it and we can start him on it tomorrow. |
| Brick had an accident in the bed last night. My fault. I let him drink a ton of water before bed. But he's always gotten up when he has to go and is relentless in letting me know he has to go out. I get the medicine today, but I can't start till tomorrow because it has to be given in the morning with breakfast. And I'm a little worried about the medicine. I just read the safety & efficacy data that comes with the stuff. Something like 8 or 10 dogs out of 100 died after starting it. That's not very confidence inspiring. See these following links: http://www.fda.gov/AnimalVeterinary/Pro ... 049823.htm http://www.cliniciansbrief.com/sites/de ... 5B1%5D.pdf I think we'll be starting him at 60mg once per day. Some other protocols are saying that it should be 1 mg/kg of weight. He's about 26-27 kg (58 lbs). That means he should be starting out at 26-27 mg once per day (they don't make that size, so it would have to be 30mg) according to this alternate protocol. This alternate protocol was not developed by the drug manufacturer but by University of Davis. I'm at odds at what to do. My gut says lets start at the 30mg and adjust from there. My vet says 60mg. She doesn't know how I feel. I also don't want to question her knowledge. |
| I picked up his trilostane this evening. She's got us at 120 mg, once a day, starting on this Friday. I'm nervous about that dosage. I expressed this to her. She said she is using the protocol that is most widely used and accepted by most endocrinologists and the most proven. |
| Your vet has obviously done her homework, go with what she's recommending. It is a scary situation but the alternative (not medicating enough and not being effective) is scarier. Give Brick a hug from us. We've been through this too. It's a lot to digest, getting the diagnosis of Cushing's is scary enough in itself. Take it one day at a time and you'll find things aren't quite as scary as you'd originally feared.  |
| Thanks Nita, When is the most critical time when starting meds? The first few hours, the first day, the first few days. In other words, when is one able to relax a bit after starting one of these regimens? Or to put it another way, if you make it past X number of days with no issues, you're in the clear. How many days is X equal to? |
| Wow, it's been a lot of years since we dealt with Cushing's. There was no internet and not a lot of information readily available back in the 1980's. At the time we didn't realize how serious it was so we were actually lucky not to have gotten worked up by negative information we may have otherwise found on-line. We trusted our vet, who was in constant communication with Purdue University Vet School, and gave the medication a chance to work. Winston was on Lysodren so I'm not sure about dosing instructions on the prescription you're using. We never noticed any adverse reactions from the meds, just positive things happening. In Winston's case, his hair had gotten very thin bilaterally on his body and his skin had gotten thin and dark. The meds caused the hair to grow back and become thicker and he drank less water. Focus on the fact that many dogs have done very well on either medication and have lived a full life despite having Cushing's. It's a difficult diagnosis to accept but be thankful that it is condition that is generally manageable. With your TLC I'll bet Brick does fabulously. |
| I just learned that the drug manufacturer reduced it's starting dose recommendation. It used to be 2 mg/lb (which is what she gave me) but they reduced it earlier this year to 1 mg/lb. Should I bring this up to the vet? |
| I called Dechra U.S. and they told me the recommended dose is 1 to 3 mg/lb. My vet has us at 2mg/lb. However, they tell owners & vets, when they call, to start at the 1mg/lb dose unless there are serious issues that demand the Cushing's get under full control as soon as possible. Dechra UK is updating their inserts to the 1mg/lb spec. The girl I spoke with believes that the U.S. spec will be officially updated to 1mg/lb, too. I called Cornell and they wouldn't talk to me unless I was a patient. I also called the local internists and they can't talk to me either without an initial visit & records review. The earliest they could get me in is December 3. They need a referral from my vet & his records. I'm sure that will start a s*** storm with my vet. |
| Hi all, Bricky had another accident this afternoon.  Kinda our fault (I should say it was my brother's fault). He gets so upset when the dogs get under foot during dinner, he puts a gate up so they can't get to us. I tell him to stay home if the dogs bother him so much. That blocks their path to the back door. Brick couldn't get to the door to tell me he had to go, so he went in the dining room. Thankfully it's tiled, so easy clean-up. I'm praying I can get the dosage question settled with the vet tomorrow. Even if I do, he wouldn't start the meds until either Saturday or Sunday. I just wish I could help him faster. |
| Finally talked to the vet today. Reiterated my concerns with the dosage and that I wanted to start lower. Told her that I contacted the manufacturer and they said to start lower rather than higher. She said she consulted 3 professional monographs and had spoken with an internist to determine his dosage. She then paused and then asked me if she had ever done anything in the past that would make me not trust her professional expertise. I said absolutely not. That they've never steered me wrong in the past. She then asked me why I'm pushing for the lower dose. I said I'm ultimately responsible for Brick's health & welfare and that I really don't trust the medicine. She then asked me "then why are we talking about it". I said because there was no better alternative. I also reiterated that there was no risk at starting lower. She capitulated and said she would get the 60mg capsules. I had found them locally at a few other vet offices. They said they would sell to me as long as my vet sent a script to them. My vet said she absolutely would not do that; that it was illegal and unethical. I didn't push that part. But that means he won't go on the meds until sometime next week. My poor boy. I just hope my actions haven't ruined the relationship with the vet & her office. I really do trust & like her & everyone at the office. |
| The vet thing is tough I've been there too when Tiggy had a nail bed infection that wasn't settling and I went to see a specialist vet. I brought up an alternative diagnosis and he got really grumpy. I offered a sincere apology and explained that I wasn't casting aspersions on him but that I was nervous because I'd had a previous experience with my Mom's poodle where the diagnosis was incorrect and it took over six months, two unnecessary surgeries, one ultrasound , 7 courses of antibiotics a mountain of money and me driving a six hour round trip on four occasions to sort the problem with a relatively minor procedure to fix what we thought was the problem all along. Turns out he had helped the vet who treated Mom's poodle and he settled down. I've also explained to my own doctors that I'm a worrier so its me being me rather than me doubting them and that seemed to help too. Good luck with it all. |
| It's so hard when they get ill - I think we need to follow our stomach feelings and what we learn and become our dogs best lawyers. I hope you find the best treatment both to your dog and your vet. They understand that we worry and want the best for our dogs. Brick is in my prayers - hugs to you both |
| I have found that my gut is never wrong and if you think about this situation in another light for a moment....You would never forgive yourself if something happened to Brick because you went solely on your vets recommendation. When dealing with my 2 legged children my philosophy is (in all regards) they can NEVER be replaced! I can never get another Robert, Davis or Aensley so there is no such thing as too much effort, or letting something go, or maybe next time. that philosophy/theory has trickled down into my 4 legged babes a little bit. If it makes you feel better explain to your vet just as you explained to all of us that you value her and all of her hard work that you are only working WITH her to provide the best possible treatment not AGAINST her. Sweet Brick is what matters and I think you are both in agreement on that much. |
| Sorry to hear about Brick's diagnosis. How is he doing? Are you still waiting on the meds to arrive? |
| Hi Judi, He's holding up. Yes, I am still waiting for the meds. They weren't in yesterday. I hope they come in today. If they do, he can start them on Friday. That way, the initial 10 day dosing period will end on a Monday, when he would have to have more blood work to check the effectiveness of the drug & dosage. |
| Meds are in. I'll pick them up in just a little bit. I'm guessing they won't want me to start him on them until Friday due to the test that has to be run 10 days from starting. Can't have day 10 fall on a Friday, Saturday, or Sunday. Can't do testing or receive results on those days. |
| Mark, does the testing have to coincide with the end of the medicine? Or at least could you start on Thursday because then he will have had a full ten day of doses. |
| Hi Judi, The medicine doesn't end after 10 days. He'll be on it everyday for the rest of his life. The first check is done 10 days after the first dose. Monday the 15th is the 10th day after he starts on Friday the 5th. He actually will have had 11 doses when he's tested. Then he's checked a month later and then every 3 months from there on out. If we change the dosage, then the testing cycle starts all over again. |
| WOW! I have NEVER had any issues with my vets with me asking questions. They always answer my questions honestly, even if its not what I wanted to hear, always with compassion and understanding that I only want to understand their course of treatment. Was given prescriptions to take to local pharmacy for generic metacam because it was much cheaper for Bear Bear than what they had available. My vets truly care about my pets and the care I am able to give them. When funds were low, I was able to chose alternatives rather than no care at all. And not made to feel guilty about it either. I don't know if its because I dont live in a very large city, or if I am just lucky to have wonderful vets. I hope yours will understand you question out of love for your baby, and you have to be sure you make the right decisions. And if you do not ask questions, then you would not forgive yourself for not having all the information you needed to make the right decision. I also always thank them for explaining things to me, not rushing me in and out and take them cookies, candy and cupcakes and write thank you from what ever pet they just saw. It's not much, a 3.00 special large chocolate raspberry filled cupcake from Publix to Dr Mike, for being so patient with me saying goodby to Lucy. He looked like he had just won the lottery when I gave it to him and said thanks, well I did get a hug in return. |
| I will send good thoughts and hugs that Brick does well on his meds. ( I think I ran out of room on previous post before I finished.) |
| Mark you are doing great for brick. I would be the same. Hope brick is feeling well. Sending hugs The university of Florida and university of California Davis vet schools responded to my emails. They are great. I don't know if you want any more opinions. |
| Hi Carol, There actually is a veterinary endocrinologist at UC Davis that is rewriting the treatment of Cushing's. The hard part is getting regular vets to investigate & accept his work. |
| Tomorrow is the big day. He starts on his meds. I'm nervous, anxious, and excited all at the same time. I keep telling Brick that tomorrow is the first day of the rest of his life. |
| Thinking of you and Brick |
| Thinking of you today - sending you positive EVERYTHING ..... vibes, thoughts, prayers and hugs! |
| First dose is on board. Hope everything goes OK today. If no issues, then I'll check in at the end of the day. Thanks for all the prayers, good thoughts, good vibes, and Airezen. We appreciate it. |
| So no issues yesterday. He seemed to tolerate the medicine well. No improvement in symptoms but that will take around 2 weeks. The next hurdle is making sure this dosage doesn't drop his cortisol levels TOO much. That can be dangerous. And like the improvements in the symptoms, this won't be evident until he's about 2 weeks in. So monitoring is still the name of the game. |
| Hi Mark, Hope Brick is doing better. I am sure with all the love you are showering on him and you giving him the best medical care possible, he will pull through this OK. The first part of the medical protocol is the toughest but once everything gets regulated I am sure he will be feeling much better (and so will you). I am sure that at the end of the day the vet will sit back and realize that you love your dog and only want the best available for him. She will probably even think more of you for being such a good advocate for him, after all, she is an animal lover too. I think it is great that you have done so much research and gathered so much information. She probably is not use to that sort of thing. I agree with "mable4ever". I think a nice card thanking her for all she has done for Brick and a tray of cookies for her and the staff would ease the tension that might exist. Sending you and Brick best wishes! Barb |
| Fantastic no problems!!! I'm sure you will feel a ton better after the 14 days is up but I'm sure you are watching him like a hawk for now. The bone pictures are leading me to believe he is A. super happy and B. occupied and distracted! Haha! I think you are doing a great job keeping your frazzled nerves at bay and your sweet baby healthy! |
| If you get a minute can we get an update |
| Hi all, Just gave him his capsule for day 6. He seems to be tolerating the meds well. No adverse reactions thus far. The next thing we'll have to monitor for is his cortisol levels. Even though he tolerates the meds themselves OK, he might not tolerate the drop in cortisol that the drug will bring around. Hopefully the dose is not high enough to drop the cortisol levels too low. He'll have his cortisol levels checked on Monday (15th). That will give us a good indication of how his body is reacting to the drug. In the meantime, I think I'm seeing some improvement in his symptoms. I'm not sure but I don't think he's drinking quite as much. His pees seem shorter. I've started tracking his water uptake on a spreadsheet with a graph. I know it will ebb & flow from day to day, but I'll be looking for a downward trend line over a longer period of time. That will be a good indicator of the effectiveness of the treatment. |
| So it is safe to say that is the absolute best news you could expect thus far and that is great!!! He couldn't be doing any better! 5 more days to go.... then maybe you can relax just a little! I just keep seeing the bone pictures in my head and they were both so content and cozy looking... Hang in there! |
| Sending good thoughts things continue to go well. |
| Brick had his 1st ACTH Stim test today. I should have results on Wednesday. Woo dogie, was that expensive! In addition to the Stim test, there was the Cortosyn, and the full blood panel/CBC. And then we repeat again in 3 weeks. Good thing I have a decent job. Don't know what I'd do if I didn't. |
| You are a very good dad! Sometimes it is not easy doing the things we do for our pups but it is so obvious from your posts that you only want the very best for Brick.....what a lucky dog! Best wishes for great results on Wednesday! I |
| Oh my goodness with this waiting! I should be calming you down right?! The cost.....right before Christmas too. I was amazed at how much Steel's Protein C test was. One little blood sample sent to Cornell and WHAM! Ever think about pet Insurance? Is this going to be ongoing? Would it make monetary sense? I'm sure you have considered it already. Thinking about that sweet boy every day. |
| Hi Aleece, I thought about insurance when he was a pup, did some math, and figured that it wasn't cost effective. Probably still isn't as long as a dog stays relatively healthy throughout it's life. I bet it would be difficult to get an almost 11 year old dog with a pre-existing disease insurance at this point. And yes, his Cushing's management will be on-going. It's expensive in the beginning because of all the testing needed to get the disease diagnosed and then the meds dialed in. |
| Brick threw up this morning at about 4:15 AM. Not sure if it was because of the meds or something else. There doesn't seem to be any other symptoms associated with the meds, so maybe it was just a general, unrelated tummy upset. Maybe from the stress of yesterday's testing or the testing meds. Don't know. I called the ER vet and she said if no other symptoms, then wait and call regular vet when they open, which is what I'm waiting to do now. I did not feed him this morning and I withheld his meds. His poops were good. I don't think there's any lethargy I gated him off in another room when I fed Zeke. Brick hopped off the bed as soon as he heard the scoop going thru the food, stood at the gate, tail wagging, and barking. I let him out after Zeke finished. Brick licked Zeke's empty food bowl, licked his own empty food bowl, drank water, and then was "snorfeling" the floor eating anything that resembled food to him. I'm eating breakfast now and he's lying down next to me. |
| Mark...I agree that you are doing everything you can to make sure that Brick is getting the best care from your vet and from YOU..I know how much you care about your furkids ~~I am sorry you both have to go through this. |
| Other than the 1 vomit, I don't see any other out-of-the-ordinary signs. I just went downstairs to get my shoes. He came down with me. Then he saw his leash and tried to get it. And then he saw Zeke's leash and DID get his leash. He tried to hump Zeke. He tried to hump my leg. I just called my vet. The tech said she'd get me some guidance from the vet. Hope they call back soon. |
| Vet said to feed him some chicken and rice and then give him a prednisone. No trilostane until we get the blood work results back. |
| So it looks like he did OK today. He had more chicken & rice for dinner tonight. It seems like he's peeing a bit longer tonight. Could be the effects of the trilo wear off that fast. I'm sure the pred is contributing to it, as well He's lying next to me right now chewing on a bone. Nervous and excited about his results tomorrow. |
| fingers crossed for good results tomorrow. |
| Yes, fingers and paws crossed that the results are positive! |
| I know I have to wake up before everyone else in the world but oh man I am so anxious to hear the news - I can't stand it! I wish this transferred to my cell phone like my email does! (different acct) Alright best dog daddy ever get all set for some great news because it's just all headed that way. The pukey thing - was a freak occurrence. He went right on about his day afterward. I think you said it probably just happy to be settled with you- no stressful testing. Doubling up on the positive thoughts, prayers everything this morning..... |
| Results are in. Not what I was hoping for. His electrolytes were good. Kidney levels were good. Liver enzymes elevated: ALP = 1051 ALT = 252 GGT = 27 Not the best news for the ACTH results: Pre ACTH = 10.7 Post ACTH = 11.2 Would have been nice to know what the ACTH Stim numbers were before starting meds but we didn't run the test. I really thought we were moving the ball in the right direction. We saw some improvements since starting. Small, but improvements none the less. She wants me to give him the 120mg capsules now. It scares me, but then I see his stim results and can understand why we should go up. They're so far out. The PRE stim wasn't even in spec, for cripes sake! And his ALP went UP!?! This is so disheartening. I'm pretty dejected right now. |
| It is very frustrating but you are doing all you can for him. Fingers crossed that things get better. |
| The folks on the Cushing's forum & FB page say you're not supposed to up the dosage within the first 30 days. The med manufacturer says this, too. And then if you have to make a change, you should do it by small amounts. I'm so tired of this. Mainly because I don't know what questions to ask and the fact that my vet makes me feel like I can't be part of the decision making process. I wouldn't even know how to find other vets in my area that are well versed in Cushing's AND are willing to let me make the decisions. |
| You have got to find a way to work this out with your vet. There is no need for you to be dealing with the added stress of that on top of the actual issue. That's my opinion anyway. You would find a new one the same way you would any other dr..... by interviewing any and all prospects. The thing is if you did actually find one near you that was well versed in Cushing's that vet may be lacking in other areas. Since up until now you were very satisfied with your current vet I would try to find out why she was snippy with you that day. She seems to have a general poopy attitude thinking you are unsure of her ability when that isn't the case - you are just very much up to speed on the care of Bricky and she probably isn't used to that. She is probably used to clients just taking her word for things and you may scare her a little bit. She may have answers/responses for all the things you stated in the prior post but you feeling like you can't discuss them with her is wrong - you pay for her knowledge! Again just my opinion but I would skip past the cookies at this point and just make an appt to sit down and talk to her. The talk being about how the relationship between you and she should continue not necessarily about Brick. My vet office had 2 vets... The older one who owned the office (male) and a newer one he brought in (female). I aways used the male as he was wiser and was the only one there when I started going there. As he aged he started becoming very condescending. Started cutting me off before I could finish my sentences and doing procedures in front of my kids. I started seeing the female slowly but more often. The male sold to the female and I started hearing from the girls up front that many clients were saying the same thing. He is still there 1 day a week as he loves animals but stay away from me ya grump! The switch was tough although in vet, I was loyal to him. I'm a strong female but having to raise my voice to someone I trusted my babes with wasn't easy. It left a hole in my stomach to feel like I couldn't trust him. If you still feel like you trust her and just need to iron this out and a talk with her will fix it - it is so worth it. You need to lessen your load - you are doing amazing, absolutely amazing with this so I just hate to see added ick for no reason. |
| I gave him a 60mg dose this morning. I guess I can expect a fight later today. <sigh> |
| Hi Mark, No, not the best lab results for Brick. Why don't you contact the vet school at Cornell. They really are not all that far from you. Ask them if they have a specialist, or if they can give you a recommendation for a vet in the Syracuse area that does know a lot about Cushings. I have gone up to the clinics at the vet school a number of times when I have had odd issues my vet wasn't familiar with. When I was having all the trouble with Oscar's ears I got the recommendation for the dermatology vet in my area from them. Certainly worth the effort of a few phone calls. Good luck with everything and Happy Holidays! Kathie |
| So Cornell is not able to provide me with any recommendations for Cushing's experienced vets in my area. Not that there aren't any, but it's not something they do. I called my vet back and discussed the flow chart. She said she is familiar with the manufacturer's recommendations but her experience has shown her otherwise; that the manufacturer recommendations are optimistic at best; and that small dosage changes don't do anything. But what I also did was to make an appointment with a specialist/internist at another office. I need a second opinion from an experienced specialist. My mind is swimming right now. I don't know who or what to believe. |
| Mark--just catching up on Brick's situation. Frustrating for you for sure. Thoughts are with you, you are doing all you can to make sure Brick gets the best care. A second opinion is a good thing. |
| Mark, I don't know if PA is out of your range but this is an excellent vet school. A friend of mine brought her dog here from DC and they saved her. Here is the link: http://www.vet.upenn.edu. You need to keep asking questions; your vet will get over it. |
CamVal1 wrote: So Cornell is not able to provide me with any recommendations for Cushing's experienced vets in my area. Not that there aren't any, but it's not something they do. I called my vet back and discussed the flow chart. She said she is familiar with the manufacturer's recommendations but her experience has shown her otherwise; that the manufacturer recommendations are optimistic at best; and that small dosage changes don't do anything. But what I also did was to make an appointment with a specialist/internist at another office. I need a second opinion from an experienced specialist. My mind is swimming right now. I don't know who or what to believe. When your vet says that his/her experience says otherwise, ask how much experience they have with Cushings. Are they basing that on having worked with one dog with Cushings over their career? Two? Several? I am so very very cynical about vets these days that I have had to learn to ask many many questions. I don't accept anything they say anymore at face value. I know that there are terrific vets out there and a good vet shouldn't mind being challenged or questioned. A good vet should be out there doing research, consulting with other vets. I know our vet often goes on some vet forum to ask questions if something comes up that she can't answer. I think that I have gone from being their favourite customer to being a bit of a pain, but I try to do it in a nice way. Brick has the best medicine of all, a dad who will be his advocate and will try to make the very best decisions for him. |
| We see the specialist tomorrow morning at 9 AM (EST). Any particular questions I should ask? |
| Just got back. Liked this doc very much. She is younger than his regular vet, so it seemed that she was more open to new research. But that might be because she is an internist and has to stay on top of the latest & greatest procedures & info. She found no fault with all the diagnostic work his regular vet did (I never did, either). She agreed with the opening dose of 60 mg. I told her I had to fight for it and she seemed a little surprised. She asked what dose his vet wanted and I said 120. She said, "well, he might have been OK at that dose". She was pretty happy with the 1st stim test results. Didn't really feel the need to up the dose at this time, but she gave me the option if I wanted to. Actually, she gave me a few options: up the dose now, do another stim test now, and do another stim test in a few weeks. None of those choices would be wrong. When it comes to increases, she said that the Vetoryl capsules are available in 10 and 30 mg capsules, so we can tweak the dosage carefully. It was clear that she believes in the low & slow methodology. She wants to see a post stim of 2-6. Ideally, she'd like to see a pre stim of 3 and a post stim of 5. But, more than anything else, the relieving of the symptoms is the most important factor. She said even if the numbers are not perfect, but the dog has no symptoms, then that's the best indicator that we got the dose right. Split dosages: Typically it's done for dogs that are constantly getting up in the night to pee. Brick's not doing that. But we can pursue that if I like, but it typically comes after we get the symptoms under control with once-a-day dosing. One thing that didn't see anywhere else is that we don't have to split equally. We may give 60mg in the morning and 30mg in the evening. She said that we don't always have to do the full blown testing at every stim test. If he's doing well with no symptoms, then we can do more limited testing. She hooked me up with www.allivet.com for his meds. They're half of what his regular vet charges. She's open to holistic approaches as well. Some owners want to go only that route while others like to mix it in with traditional treatments. She told me to pick up some melatonin and start him on that at night, but only 1 pill to start to see how he reacts. She said she loves internal medicine, including endocrinology. That, along with only a few other disciplines, is all she focuses on. She's treated a lot of cushnoid dogs, all with positive results. She said she's never had one go Addisonian. Oh, and they have Saturday hours for the stim tests, so I won't have to take time off from work. That's a big plus. And she gave me her e-mail addresses and told me I could e-mail her any time. His regular vet doesn't even have e-mail. Overall, I'm very pleased with today's meeting. I've set up his next stim test for 1/17/15. I'm sure we'll make a change to his dosage then, but I'm relieved that it will be a small increase and not doubled. |
 So happy that you found this vet.I really hope she can help you better and that you don't need to fight against anything else than his illness! Best wishes from us......Hope he will be better. |
| WOO HOO!!! Hallelujah! What a great way to start the new year! Get out the bones and oh my goodness you probably slept well for the first time in weeks last night!!! Just as said above it will seem like a relief for you to only concentrate on his illness instead of all the other bullllogna. Yay, yay, yay! I'm so happy for you I could bust! HUGE step in the right direction is what it sounds like for both of you! |
| I like this vet too!!!! Sounds like you found a great one who focuses on the pet and not so much on $$$$ and seems like she wants to give you as much info as you need without you having to beg for it. Hope all goes well in the future. |
| So glad that you sought a second opinion, and found someone with experience in endocrinology. Sounds like you and Brick have landed in a good place. Laurie and Oscar |
| I know the appt is set for later this week, but I was wondering how Brick is doing? |
| He is doing well. Water consumption is down. I can't measure the dogs independently as they drink out of each others bowls, so I measure both their consumption. I don't have a baseline number but the amount has dropped since I started him on the meds. They're below the average of 1oz of water per pound. No accidents in the house. Pees are shorter. They used to be 30-35 seconds. Now they might be 8-12 seconds. He's not gulping his food nor is he begging as much. I'm sure we'll have to make an increase in the meds but I'm sure it will only be by 10 or 20 mg. His next ACTH Stim test is this Saturday. It'll take a few days to get the results back. Thank you for thinking of us. |
 Thank goodness for the new Vet So glad to hear your good news about Brick. Seems like you are on the right track....finally |
| Glad to see things are improving and the specialist is willing to work with your! Shorter pees, especially in winter, are a blessing for both of you,  |
| Brick had his second ACTH Stim test today; his first with his internist. I gave him his trilostane at 6:18 AM with his breakfast. He went in at 11:00 AM, they took the first draw at 11:35 AM, gave the Cortosyn right after, and the second draw at 12:35 PM. I picked him up at 1:00 PM. Should have results on Tuesday. The Saturday hours are really convenient. I was charged $225. I don't think we're doing the full blood work or electrolyte testing this time. |
| Fingers crossed for improved results! |
| Can't wait to hear from you on Tuesday... |
| Hoping for good new. Hugs to you guys! |
| Just got the call from the vet. Brick's ACTH Stim results are in. Drumroll please... . . . . . . . Pre Stim = 2.8 Post Stim = 4.9     Can't believe how good his numbers are. So pumped! I can't stop smiling. Doc said she wishes she could get all Cushing's patients to these numbers. I asked if it's normal to take upwards of 45 days to see good results. She said it's not uncommon. I then asked about the logic of increasing dosage after the first stim test (10-14 days after starting medicine) and she said that 1st test should just be used to insure that the dog isn't overmedicated. It shouldn't be used as a gauge to increase meds. 10-14 days in is too soon to increase. Takes time to take effect. So now I just keep him on his 60mg per day. Watch to see if symptoms get worse and of course continue to watch for signs of crashing. Otherwise, we're looking great. She would want to see him again no sooner than 4 weeks and no later than 8 weeks. I imagine we'd check his electrolytes & full blood panel at his next test. I just want to thank all of you here for your support & good thoughts. You guys got me thru this. Thank you. |
| Wonderful news Mark. So happy for you and Brick. |
| Excellent news!!! Laurie and Oscar |
| WOOOOO HOOOOO! |
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| So glad things are looking up and you have this great vet now to help him with this. Don't forget to hug yourselves as well for being such diligent and loving parents. That love helps them feel better when they are sick and do not understand why they feel so bad. If they could only talk to us. I will continue to pray he continues to feel better. A question, Does Zeke sense his brother does not feel so well? May the sun continue to shine in your world. |
| Great news! |
| Great news. |
mable4ever wrote: Does Zeke sense his brother does not feel so well? Nah. I'm not positive, but I don't think either of them would care if something happened to the other. When Zeke left me the first time, Brick didn't seem to care at all. |
| Yayyyyyyyyy. So happy!! Give him a kiss and hug! |
| Brick had another ACTH Stim test done this past weekend. His cortisol levels dropped a little more. So he's doing well on his treatment. His numbers are: pre-Stim = 2.0 post-Stim = 3.3 This is a bit lower than his last one, but still good. Actually great. And in reality, if it gets any lower, we'll have to cut his dose. So no changes. We'll check him again but we can wait 3 months since he's under control. Just have to watch him for any negative signs, which I haven't seen. |
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| So do they give you the results while you are there or do they call you later? I don't remember? I'm just wondering if someone video taped you doing a happy dance in the parking lot on the way out or if you did it in the privacy of your own home?! Long term good news, that is fantastic! |
Sonny, Skye & Steel wrote: So do they give you the results while you are there or do they call you later? I don't remember? I'm just wondering if someone video taped you doing a happy dance in the parking lot on the way out or if you did it in the privacy of your own home?! Long term good news, that is fantastic!  No, it takes a few days to get the results back. They call me with the results. |
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| I realized I haven't updated in a while: Brick had another ACTH Stim test on June 27th. Results: - pre-Stim: 1.1 - post-Stim: 1.5 So yeah, he was right on the edge, maybe even a bit low. His intern suggested we reduce his dosage. And also to stop the meds until the new dosage arrives. I went with the 30mg once per day. He was on 60mg once per day. |
| And he had ANOTHER ACTH Stim test this past Tuesday (7/28). Results: pre-Stim: 1.9 post-Stim: 2.3 Remember, he is on the 30mg once per day instead of the 60mg once per day. His numbers popped up a bit but kinda not enough. So we're reducing the dosage to 10mg once per day. We suspect that his numbers will rise to the 3.0 to 4.0 range on the new dosage, which is really the sweet spot. If they don't rise, or if they rise initially but continue to fall over the long term, we'll take him off the meds altogether. He seems to be doing well. No real Cushing's symptoms. No over medication symptoms. I'm pleased with his progress and care. |
| so glad he is doing well |
| It it's not bad news, it's good news!! |
| Brick's latest stim test results came back today. Remember, he is on 10mg of trilostane. He stimmed at 2.7, which is really good. So he'll stay on the 10mg dosage and we'll retest in 3 months. |
| Way to go, Brick!! |
| Good boy Bricky! that's great news! |
| Great news for Brick. |
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