Update on Baby-Day 8

Appetite:
Baby appears to have a better appetite in the evening versus the morning. She does eat her food very slowly and she tends to leave a little in the bowl. This morning I had to wet it down for her and get her interested. She seems to prefer her treats to actual dog food and has no hesitation in eating them. Maybe she’s being temperamental?

Activity Level:
We walked around the block last night with no problem; she seems to have the best energy level in the early evening. In the morning she seems lethargic. She readily gets up to go outside and eliminate, but after eating she lies down and somewhat hesitates to rise when called. As I said, evenings are much better.

Other:
I have also noticed she has some weakness in her hindquarters. She’s having some minor issues when jumping up onto furniture. She also has some intermittent trembling. Drinking and elimination are normal, although she has been having 2 BMs in the evening.

Wondering...
Should we skip an evening dose and see if that improves her morning appetite?

All things considered, we’re happy with her progress. She seems so much more at ease now.


-- Post From My iPhone

Hmmmm...

This morning brought a significant change in Baby's appetite. She did not immediately eat her food when it was presented, it took a minute or so for her to get started and when she did it was slowly and she only ate half of it.

Last night LacubriousToo took her out in the yard and she wandered around actively. She's still playing with her toys when prompted.

Stools are normal.

Water input/output is reduced as well.

The ACTH stim is scheduled for May 3rd.

-- Post From My iPhone


***Vet's response***

"This could be potentially worrisome, meaning that the medicine does not usually have that dramatic of an effest that quickly, however it is posssible that Baby's Trilostane dose is too high. I would like you to monitor Baby for 24-36 hours. If her appetite and water intake do not improve or continue to decrease, then give us a call tomorrow and we will reschedule her stim for this Friday to make sure that her Trilostane dose is not too high."

4 Doses and all is well...

Another update...Baby has had 4 doses. She had one loose stool but all others are ok. Appetite and water intake seem closer to normal, still excessive but not as intense as before. The panting is completely gone! I'm hopeful she continues to progress on this treatment.

-- Post From My iPhone

The results are...

LDDS Test Results on Baby confirm that she has Cushing's. Most likely PDH, Pituitary Dependent Hyperandrenalcorticism. Meds are on order from Roadrunner Pharmacy and should be arriving tomorrow!

Dex Suppression (3 Samples)
Time 815
Time 1215
Time 415
Cortisol Sample 1 5.6 Range: 1.0-5.0 μg/dL HIGH
Cortisol Sample 2 Dex 4.3 Range: 0.0-1.4 μg/dL HIGH
Cortisol Sample 3 Dex 5.2 Range: 0.0-1.4 μg/dL HIGH
INTERPRETATION OF THE DEXAMETHASONE SUPPRESSION TESTS:
*
Low-dose dexamethasone suppression test:
Normal: Cortisol level less than 1.4 ug/dl 8hrs post-dex.
Hyperadrenocorticism: Cortisol level greater than 1.4 ug/dl 8hrs
post-dex.
...
If the 8hr post dex. cortisol level is greater than 1.4 ug/dl,
the following can be used to differentiate pituitary dependent
hyperadrenocorticism (PDH) from an adrenal tumor:
1. Cortisol level less than 1.4 ug/dl 4hrs post-dex is
consistent with PDH.
2. Cortisol level less than half the baseline level at either 4 or 8
hours post-dex is consistent with PDH.(Samples taken at 2 or 6hrs are interpreted the same way as a 4hr
sample)
...
If neither of these criteria is met, further testing is needed to
differentiate PDH from adrenal tumor Cushings.
...
NOTE: Approx. 5% of dogs with PDH have normal results.
False positives may occur with stress/nonadrenal illness.

Trilostane AKA: Vetoryl

The drug recommended by our Vet for the treatment of Baby's Hyperadrenocorticism is called Trilostane, AKA: Vetoryl.

I found a detailed article that discusses how the drug works, how to monitor its effectiveness, and possible adverse reactions.

We are still trying to work out the appointment for the LDDS, Low Dose Dexamethasone Test for next week. It's a busy work week and fitting in a full day at the vet is challenging but I really feel that the sooner we get Baby oon the treatment the better she will feel.

Today she's a bit lethargic again and her belly appears bloated. It seems like these symptoms wax and wane every few days and I'm not sure why. I also wonder if she is having any pain. I understand that cortisol is a steroid and as such should mitigate any inflammatory response, but does that mean the dog is not in any discomfort? Also in my research, the added cortisol can affect the GI tract and so giving NSAIDS to an untreated cushingoid dog can cause GI bleeding.

Do they have doggy narcotics? Those are probably metabolized by the liver which is not a good option either.

I guess she's just going to have feel better from having a good meal and maybe a full body massage...doggy spa style!

Cushing's Anyone?

jl-0178_NI
Originally uploaded by dehmystic

Well, I just got the call from the Vet Specialist. Baby's test results were as follows:

ALP: 2800
Cholesterol: High
Platelets: High
Thyroid: Normal
Urine: Dilute
Blood Pressure: High
Liver Aspiration: VH - Vascular Hepatopathy (typical in cushings, NOT CANCER!)
Spleen: EMH - extramedullary hematopoiesis (not typically treated, NOT CANCER!)

So the Vet (as was I) is leaning towards Cushings. Next step is a Low Dose Dex test, probably next week sometime. It's an 8 hour test where they will do 3 blood draws after they administer Dexamethasone. They will be testing for cortisol suppression, if there is any, then no Cushiings, most likely there will be none and she'll be diagnosed Cushingoid. Their recommended treatment is with a drug called Trilostane. On going follow-up by ACTH testing every 3 months for monitoring dosage.

So, as always, we're keeping it real...real interesting!

Baby Mastering The Stairs

Morning update...IL-12 Injection Day 1

dogs0056_NI
Originally uploaded by dehmystic

Jen Wolf called from MU Vet School to let us know that Linus had a good night and was alert and in good spirits this morning. He was walked and went potty normally.

The plan for the day was to sedate him for the jugular catheterization (ewww) and inject the clinical trial meds. She promised to call around 5pm to give us an update on his status. She also confirmed that he will be in ICU until we pick him up on Wednesday.

WE miss him!

Yesterday I took him for a walk with Baby so he would be calmer for the ride. We headed out around 3pm to take him to Columbia and we stopped to buy him a plain hamburger (minus bread), which he LOVED! He even licked the wrapper! Then he settled in for the ride. We got delayed by a motorcycle accident on Hwy 47 just past Marthasville but I made up the time on the Interstate. (I will not tell you how fast I drove!) We ended up 15 minutes late but it was fine. We signed the Hospitalization Agreement and resuscitation authorization. Then they took him away. DH and I got the heck outta there before we put too much thought (tears) into it, headed to Flat Branch for a couple of beers and a snack then out of town and back home to Baby.

dogs0034_NI
Originally uploaded by dehmystic