Barney - 8yo Jack Russell Terrier

[Kelley]

Re: Barney - 8yo Jack Russell Terrier

Thanks for the info everyone. I hadn't heard about not handling the meds while pregnant, thanks so much for that. The treatment options on the report from Dr. Oliver are as follows (I wonder if these are in order of preference? anyone know?)
1. Ultrasound (we had one done in March)
2. Melatonin
3. Melatonin Implants
4. Flaxseed oil with lignans
5. Maintenance dose of Lysodren
6. Lysodren traditional treatment
7. Trilostane (it says in the notes that Lysodren may be preferred for Atypical Cushings)
8. Ketaconazole
9. Selegiline
10. Specific hypertrinism treatment
11. Ovarian remnant detection (he's a boy...)
12. Retained testicle detection

[stardeb55]

Re: Barney - 8yo Jack Russell Terrier

The recommendation sheet isn't in any specific order. There should have been a comment that was something to the effect that say treatments #2, 3, 4 are recommended.l

Debbie

[Kelley]

Re: Barney - 8yo Jack Russell Terrier

Unfortunately, there aren't any solid recommendations from Dr. Oliver. The comments say: Various treatment option considerations are attached. Some veterinarians consider items 2-6.

[Squirt's Mom]

Re: Barney - 8yo Jack Russell Terrier

Hi Kelley,

Did the ultrasound say anything about his adrenal glands? These are the glands looked for in an U/S on a cush pup so I am curious as to what they had to say about them.

As for the treatment options, it sounds as if Dr O would use either melatonin and lignans, or those plus the Lysodren as maintenance or with the usual loading approach. On Squirt's results, it states which numbers are "recommended" but I have noticed some of the latter results say "some veterinarians consider items..." like yours does. Still, whether recommended by Dr O directly or whether stated as it is on your sheet, I would stick with his ideas, which doesn't include Trilo. As high has some of her hormone levels are already, that would be playing with fire, IMHO. So I hope you simply got confused with what your vet said. Very easy to do with all these new terms, meds, etc!

You're doing a great job, so keep it up!
Hugs,
Leslie and the girls

PS. Since you are pregnant, please use gloves if you use the Lyso and wash your hands and arms off good after dosing, ok? We want all in your house to be well!

[Kelley]

Re: Barney - 8yo Jack Russell Terrier

The ultrasound just said that his kidneys are normal and a nodule was found in the spleen. I wonder if another ultrasound should be done to focus on the adrenal glands?

For the meds, she said she didn't want to use the one that destroyed the adrenal cells, just the one that inhibits them...does that help clear it up? I'm thinking if she suggests the Trilo, I'll have to disagree. Barney is also on an ACE inhibitor for his blood pressure and I read that Trilo is contraindicated with that as well.

[SasAndYunah]

Re: Barney - 8yo Jack Russell Terrier

Hi Kelley and Leslie,

I really want to emphasize that a pregnant woman should not be handling Lysodren (or Trilostane) at all. Not even wearing gloves. I thought that maybe it was "just" a Dutch regulation but found the same on an American site...

"Cautions:
Side effects include lethargy, weakness, and vomiting. If they occur, stop using the medication and contact your veterinarian. It should not be used in pregnant or nursing animals. Always wear disposable gloves when giving Lysodren to your pet and wash your hands after handling this medication. Pregnant women, or women trying to get pregnant should not handle this medication."

I really like this to be very clear...

Saskia and Yunah

[stardeb55]

Re: Barney - 8yo Jack Russell Terrier

Kelley, I'm certainly glad you mentioned the ACE inhibitor as you are absolutely correct that Trilo is contraindicated with this type of BP med. I would certainly think another abdominal US is warranted. I would take the $$$ you would spend on an LDDS, & use that for the US.

she didn't want to use the one that destroyed the adrenal cells

I must respectfully disagree with the vet who said this. Lysodren does necrose enough of the adrenal cortex where the cortisol is produced to stop the overproduction of cortisol, but the med does not destroy the adrenal gland by a long shot. My first Cushpup, Barkley, was successfully treated with lysodren for nearly 8 years, crossing the bridge at 15. As I mentioned yesterday, Harley, is also being treated with lysodren, & is doing well. It has been a little over a year since he was diagnosed.

Debbie

[afortunato]

Re: Barney - 8yo Jack Russell Terrier

My dog recently had been tested for Cushings. He is presently a diabetic dog. So, as of yet he was considered borderline. He also has cancer. Since 2005 I found this wonderful Chinese Vet. in Speonk, LI that has been treating my dog for his cancer with herbs from China. In 2005 the traditional vets only gave him to the end of the year. When he had a problem with his Trachea, he gave him herbs, when he had a problem with the bleeding from his nose (cancer) he gave him pills to stop the bleeding. And if he was to have cushings, he has herbs for treatment for the cushings disease. And when he was diagnosed with Pancreatis, he gave him the pills. SO I believe there is another way to treat animals without traditional drugs. I know alot of vets from diff. states call him with problems and he mails out the herbs to them for treatment. I had a co-worker how's dog had lymphomia, in 2007, he went to him and he is still here and doing wonderfully with the herbs.

[Squirt's Mom]

Re: Barney - 8yo Jack Russell Terrier

Hey Kelley,

Saskia is absolutely right.... you shouldn't handle the meds at all. Thanks Saskia!

You will need to get your hubby to dose Barney for you, clean up any time he throws up after a dose, which hopefully won't happen anyway, and just to be on the safe side, perhaps pick up after him in the yard if this is presently your job. It seems like the amount of drug in the feces isn't much if any but I'm sure someone here will know about that for sure.

Hang in there!
Hugs,
Leslie and the girls

[Kelley]

Re: Barney - 8yo Jack Russell Terrier

Barney goes in for his LDDS tomorrow morning, but I'm not quite sure why they are doing it. From what you've all said and everything I've read it dosen't seem necessary. The vet told me that the vets at the U of F were in disagreement as to weather or not Barn has Cushings, so they want to do another test for sure. I'll post the results as soon as I know!

Thanks for everything!

[stardeb55]

Re: Barney - 8yo Jack Russell Terrier

Kelley, none of us are vets, but Barney's UTK panel clearly indicates that he is both Pit Cushing's + Atypical. As I mentioned when I first posted to you, the IMS who diagnosed Harley told me she did not need the LDDS, she could make the diagnosis on the UTK panel results + an abdominal ultrasound. I, frankly, don't understand why the vets think they have to do the LDDS. I do need to point out to you that even though the LDDS is considered to be the "gold standard" for diagnosing Cushing's, the test has one big problem. It can show a false positive in the presence of non-adrenal illness.

[Kelley]

Re: Barney - 8yo Jack Russell Terrier

That's why I'm so confused Debbie
I don't' understand why we're doing the test but the vet said it's necessary. I'm going to ask about starting with another ultrasound instead, we'll see what they say.
I'll keep you updated.

[Wylie's Mom]

Re: Barney - 8yo Jack Russell Terrier

Hi Kelley,

I've never posted on your thread before, but I wanted to tell you that I had the UCCR & ACTH stim done initially with my former vet. My current GP vet saw the results (plus low urine specific gravity, elevated liver enzymes from former vet records & clinical signs) and she suggested I go straight to getting an ultrasound. I remember she had mentioned that the other vets in her practice always do the LDDS, but she felt that it was unecessary (at least, in my case). I'm not sure why, but now I'm guessing that it was because I had already done the ACTH stim test. (If I had found this site earlier, I would have done the UTK panel in lieu of the initial ACTH stim test.)

Basically, I'm with Debbie - use the $$$ for the ultrasound.

-Susy

[Squirt's Mom]

Re: Barney - 8yo Jack Russell Terrier

Hi Kelley,

The ACTH is a stimulation test while the LDDS is a suppression test. The ACTH test shows what cortisol the adrenals have in reserve. Alison, I think it is, describes the ACTH as squeezing the adrenals like a sponge to get all the cortisol out. That is the post number we see with an ACTH. With the LDDS the adrenals are suppressed to see how they handle being told to stop releasing cortisol. In a normal dog, one which doesn't have Cushing's, the adrenals will respond by slowing down. In a cush pup, the adrenal glands won't stop releasing cortisol even tho they have been suppressed by the dexamethasone. So the ACTH simply shows the amount of cortisol in the adrenals while the LDDS shows how well the adrenals are functioning. Since some of the docs involved in Tee Jay's case question the initial diagnosis, perhaps this is why they want another LDDS...to see how the adrenals are functioning now. I'm not saying they are right or wrong to want this, but thought I might offer an idea as to why.

From my own experiences with the ACTH and Squirt, her levels got high until that tumor was removed, then it went down dramatically. We hear about non-adrenal illnesses sometimes causing elevated cortisol and I didn't fully understand that until last year when all that was going on with Squirt. Now I do understand that sometimes an illness or problem other than Cushing's can cause cortisol levels to be in the range for a Cushing's diagnosis based on the ACTH only. If we had proceeded to treat with Lyso based on the UTK panel cortisol reading of 32.8 ug/dl instead of having the ultrasound (further testing), no telling what may have happened or if she would still be here.

It is extremely frustrating and can get expensive, but making absolutely sure of what you are dealing with first will make the journey much easier down the road...that's my thinking anyway.

Hang in there!
Hugs,
Leslie and the girls

[Kelley]

Re: Barney - 8yo Jack Russell Terrier

I got a call from the vet today and the results of the LDDS test were negative. I don't have the results yet, but she said they were all within normal range.
She called the University of Florida for some advice. The vet there plans to get in touch with the University of Tenn. for some advice and direction.
I asked her to explain to me why the positive results on the other test don't mean he has Cushings for sure. She said the levels on the first test do show all the signs of Cushings, however, he has no other "clinical signs". His adrenal glands are perfectly normal and the LDDS test was normal.
I asked her if we could at least start the melatonin and FSO as recommended on the first lab test. She said she didn't have a problem with starting the FSO but would hold off on the melatonin.
What are everyone's thoughts on this? The vets seem really stumped.

Thanks so much,
Kelley