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  #11  
Old 08-04-2013, 03:51 PM
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Default Re: Otis is out of control - Please help

The general feeling from experience and veterinary advice is that the LDDS is not the preferred test for trying to diagnose Cushing's in a dog with other significant health problems as it can produce false positive results.

Generally in a newly diagnosed diabetic we like to see the ACTH test done instead.

But even then, it can be difficult to diagnose Cushing's when the diabetes (and perhaps pancreatitis) are not under control.

I am always concerned about Cushing's diagnosed with a single test in a diabetic. The only time I feel pretty comfortable with such a diagnosis is if the dog physically has multiple overt symptoms of Cushing's disease.

Natalie
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  #12  
Old 08-04-2013, 04:20 PM
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Default Re: Otis is out of control - Please help

hmm

the raising of the dose does seem to see a deterioration in the numbers and a deepening curve higher highs and lower lows which may point to going in the wrong direction as far as dosing

on the forum we base dosing adjustments on the lowest number in a curve not the highest or the average and those lower numbers you were seeing even on the lower dose did not give any room for raising and its possible you may have had to reduced the dose at that time.

i have no knowledge of cushings but it appears a dog with cushings seems to have some resistance to insulin with overall numbers in a curve elevated and flat with a fairly high dose and not the big swings that you are seeing and the fairly big affect on blood sugar that you are seeing with insulin

just a thought
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  #13  
Old 08-04-2013, 05:12 PM
frijole frijole is offline
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Default Re: Otis is out of control - Please help

Hi, I'm Kim from the cushing's forum. (www.k9cushings.com)

Natalie is correct - you cannot diagnose cushings with simply the 8 hr LDDS test because when other illnesses are present you often get false positives. In your case not only the diabetes, but the pancreatitis could have caused false positives. I had 2 false positive LDDS tests on my Annie who was misdiagnosed - she had a non cushings adrenal tumor and not cushings.

Was the first test (the one where you don't have the result but the vet said all was fine) done before or after using trilostane? I'd really like to see that number, particularly if it was done before dosing.

It is my understanding that your dog weighs 15 lbs and is on 30 mg of trilostane. That is a hefty dose - really it is too high. The manufacturer has changed their recommendation to 1 mg per pound of weight. In your case that would be 15 mgs vs 30 mgs of trilostane. Since the pills are available in either 10 or 20 mgs that would have been the recommended dose. (note Dechra hasn't changed their dosing on their packaging to reflect the lower recommendation which is unbelievable). You can phone the manufacturer (Dechra) and they will open a case on your dog and they are very very helpful. They will talk to you directly and answer questions and give advice. Before you go that route you really need to get copies of every single acth test because they are going to need to know the results and dosages for each test. UC Davis has done research and they've gone even lower with their recommendations - your dog would be on 8 mgs.

Your last acth test the first number was below 1.0 which can be a sign that the dose is too high and your dog's cortisol is too low. Dogs need cortisol to live so it is important that you adjust the dose upwards or you could run into serious issues. Signs of overdose/distress are vomiting, diarrhea, lethargy as in you think they are dying. When in doubt you go to the ER vet and cease giving the drug.

Is your vet a regular vet or a specialist? I ask simply because dealing with cushings (if it is cushings) and diabetes can be very difficult for any vet and that's where specialists can help them through tough cases. I would be headed that way if it is an option.

I didn't see any symptoms of cushings listed other than urination which is obviously also a symptom of diabetes. Kim

Last edited by frijole; 08-04-2013 at 07:56 PM.
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  #14  
Old 08-05-2013, 04:07 AM
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Default Re: Otis is out of control - Please help

Hello, and welcome from me, too! Like Kim, I am one of the staffers over on K9Cushings.com. I just want to "second" the advice Kim has already given you, particularly the recommendation that you contact Dechra and request their guidance in this situation. Their U.S. office is located in Kansas, and they have vets and vet techs on staff who are available to field phone calls and emails from owners and vets alike. Here's a link to their contact info:

http://www.dechra-us.com/Default.aspx?ID=365

Like Natalie, I'm concerned about the overall Cushing's diagnosis. And like Kim, I am worried about Otis' most recent monitoring ACTH test. While remaining on the same dose of Vetoryl, his cortisol level has continued to fall lower over the last two months. You do not want it to go any lower than it already is, and Dechra will probably advise you that Otis needs a dosing decrease ASAP because of that especially low "pre" number of .8 ug/dl. They become worried when either of the two ACTH numbers fall below 1.45 ug/dl.

If Otis indeed suffers from Cushing's (and I agree that there is still a big question mark about that right now), most specialists recommend that a diabetic dog is dosed with the same frequency as the insulin injections. So if Otis is getting insulin twice a day, it would probably be preferable if he were dosed with Vetoryl twice daily, too. This keeps the endocrinological system as consistent as possible throughout an entire 24-hour cycle. Since Dechra will likely recommend a dosing decrease anyway, one option they may suggest is giving him 10 mg. twice daily (since Vetoryl comes in 10 mg. as well as 30 mg. and larger capsules).

I really do join the others in feeling concerned about the Cushing's diagnosis and management, so I strongly encourage you to give Dechra a call!

Marianne
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  #15  
Old 08-05-2013, 04:26 AM
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Default Re: Otis is out of control - Please help

Hello and belated welcome to you. Wanted to share that my diabetic boy suffered from resistance and at one point we suspected he may be a cushings dog. He was overweight, had a pot belly, drank more than average, never chewed his food (inhaled it), had lack of fur regrowth on his scruff area which his diagnosing vet had shaved, a pointy head (muscle mass loss) and had on/off rear leg weakness. He also had a couple of belly infections that his vet was unable to identify/explain and an eye infection that was originally believed to be possible horner's syndrome but resolved in a couple of days with treatment. He had off the charts high cholesterol and slightly elevated liver enzymes.

For about six months his diabetes went uncontrolled (blood glucose ran mostly 300 -600+ during that time). When we began testing him for concurrent diseases cushings was one of the diseases we looked closely at. Our vet had recommended (can't remember which) either the ACHT or LDDS test but the great folks here recommended we start with the UCCR urine test. So we started there and the UCCR for him was normal and pretty much rule out cushings.

Turns out our boy was hypothyroid. Up till that point I never realized how many of the symptoms of the two disease overlapped with each other. When we looked back further in his history, the hypothyroidism diagnosis made a lot of sense. When he was around three years old his behavior started to become very nervous and reactive to many things. He was medicated for the behavior but no blood work was ever run.

Guess my long winded point is that the folks here have a lot of experience in both cushings and diabetes. Had we listed to our vet and had Decker tested for cushings as she'd recommended and he tested positive (he was a high stressed dog - likely due to low thyroid) who knows what might have happened. And who knows how long it might have taken to get him correctly diagnosed.
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Last edited by momofdecker; 08-05-2013 at 04:39 AM.
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  #16  
Old 08-05-2013, 06:47 PM
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Default Re: Otis is out of control - Please help

Thank you all so much for all of the valuable information. I called Dechra today and they opened a case for Otis. The lady I spoke to said that dosing can go up to 3 mg per pound. But after we reviewed the numbers with her, she was in agreement that maybe Otis is being over medicated. The Dechra representative suggested that we talk to the Vet about these numbers. We told the rep that we were going to remove Otis from the Vetoryl until get some definite answers. She agreed that it was a good idea, and would not harm him.

The ACTH test on June 18th showed Amylase 601, and Cortisol 3.1. Both of these numbers were in the reference range, but after this test they declined substantially. The Dechra rep thought we should probably talk to the Vet about going to 10 mg. twice daily.

Our Vet has said that she is going to consult with an Internist who she is friendly with, and will call us later this week. We are going to set up an appointment to discuss our issues face to face.

Again, thank you all so much for your help, we will keep you informed on our progress.

Betty & Carl
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  #17  
Old 08-05-2013, 07:23 PM
frijole frijole is offline
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Default Re: Otis is out of control - Please help

Thanks. I am so happy you phoned Dechra. I know it is a big step but they are very helpful. I don't blame you for taking a break from the trilostane - doesn't hurt to see if you really need it.

I'm a bit confused by the June ACTH reading. The acth test has 2 numbers on it (a pre and a post) and it has nothing to do with Amalyse so I'm concerned that it isn't an acth test.

Was that test done AFTER starting the trilostane? I would assume so.

Keep us posted and good luck! Kim
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  #18  
Old 09-08-2013, 10:35 PM
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Default Re: Otis is out of control - Please help

I haven't checked K9C but was wondering how you and Otis are doing.

Natalie
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  #19  
Old 09-09-2013, 06:51 AM
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Default Re: Otis is out of control - Please help

Welcome...

I wanted to let you know that we had a similar start as you and Otis. Started on the K9Cushings site, because of a misdiagnosis.

My Abby had the ACTH test, and was tested positive, but at the time was also diagnosed as having diabetes. Her liver enzymes were high, and she even had an ultra sound, and her liver was enlarged. After plugging away at this for about 2.5 years, I am really convinced that she does not have Cushings. She does not have any other signs of Cushings. When diabetics goes undectected for awhile, these can tax the liver, cortisol, and give mix signals for some of these tests. I believe the best approach is to take it slow, and one thing at a time.

You will find some wonderful folks, on both forums, who are so knowledgeable.... much more than Vets.

Lets us know how Otis is doing...

Barb
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