I have always appreciated your input on these boards, and I have the utmost respect for your experience. I realize that pred can treat many of the possible conditions that Buddyroo's dog may have. Having seen the amazing transformation of my dog post-diagnosis and on proper treatment, I would encourage everyone who has an otherwise healthy dog to consider spending the money on the test if at all possible. The dose of pred used for Addison's is miniscule compared to that used for other indications (it is a physiologic dose rather than a therapeutic dose --my dog gets 0.5 pred per day as opposed to a standard dose of 10mg). Larger doses may help in the short term, but cause kidney damage long-term, so in a younger dog, IMHO, it is worth doing the test if at all possible.
Thank you IFG, I guess I didnt make myself more clear in that I was suggesting asking about a prednisone trial (something previously mentioned by her vets) BEFORE euthanasia. It is absolutely NOT the best route to go, but as the internists say "pred before dead". Some addisonian dogs dont require pred at all, most require it in very small amounts as you say. However, this dog has not been diagnosed with ANYTHING yet. While Addisons is still a rule out, so is IBD, lymphoma, granulomatous disease and and and and.... this is why I can understand that after spending x amount, money isnt unlimited. My simple suggestion, was to try pred before euthanasia. Obviously, work ups and diagnosis is FAR better for the dog, but a drug trial is better than being dead.
Originally Posted by IFG
BuddyRoo sounds like she knows her limits, and knows what she is doing. Im sure if she can manage it, she will follow the advice of the board certified vets at MSU and go to the next diagnostic step. It would be great if it IS addisons, even though her dog doesnt fall in the sterotpical signalment of an addisonian pet (usually female, between 4-7), as its generally the easiest to manage.
Also, generally pred trials consist of a high dose (5 or 10mg), followed by 2.5 mg, followed by 1.25 mg then off. Not, "lets try this dog on 10mg and keep it on that dose". Pred does have side effects, but very rarely does it have long term effects with the quickly tapering trials. Again NOT ideal, but I would always give it a go before I put my dog to sleep.
IFG and Squish--your input is invaluable. Thank you both for continuing to brainstorm and give information.
To be clear, the pred was suggested as a last resort thing if none of the tests pointed us towards a diagnosis and nothing else was helping his symptoms. Basically pred is the last option before euth. I think that when Dr. D at MSU brought this up, I had sent him an "I'm at the end of my rope, what do we do now?" email and he thought full well that another set of tests would have given us a diagnosis. But they haven't.
I'm not averse to doing the ACTH aside from the fact that at some point, I feel like I'm throwing good money after bad. The last few months have cost somewhere around 7k now (I don't even want to know for sure) and that's on top of the nearly 10k last year this time. I want my dog to be happy and feel good, but I don't have unlimited funds and now that I'm not working, I feel a lot less comfortable unilaterally deciding to spend "our" money. I'm pretty sure my husband gets it now that he's had a month to see what I've been dealing with for 3. He wants a solution as badly as I do and euthanasia doesn't make sense with a dog who is otherwise happy and feeling good.
I've had a fair bit of experience with Addison's in dogs but that was nearly 10 years ago when I was working at a clinic. My research during this episode suggests however that not a whole lot has changed. If he has it, he's pretty much the most atypical presentation I've ever seen.
I'm still waiting to hear back from Dr. D. Got an email from local vet too and gave her the update, nothing back. He's still on course to be in the study for IBD at TX A&M as well which will help defray future testing costs.
I suspect I'm going to bite the bullet and do the ACTH because I hate to leave a stone unturned. If he were terribly averse to going to the vet, I might not. But in spite of his many many pokes and prods over the years, he still LOVES going to the vet! He's a lab after all.
But it's not something I can do til next week anyway so I'm going to sit on my hands and resist the urge to blow up Dr. D's phone today. I suspect I'll hear back from him tonight or tomorrow and maybe the internist will have some other ideas.
In good news...it's been a week since we've had any accidents in the house. The kaopectate seems to be buying me a little more time. He is eating well, energetic and acting very much like his normal self which, in spite of being 9 1/2, is more like a 3YO.
Thanks again you guys. (all of you) I will keep you posted when I hear more.
I have not read the entire post so this suggestion may be completely unhelpful, but often with my patients I will start with a baseline cortisol if I am trying to rule out atypical addisons. This is significantly less expensive since the expensive part of the test is the cortrosyn and is needed for the second part of the test. If the baseline cortisol is over 2 there is not need to run the second (more expensive)part of the test. If under 2 you will need to do the entire test.
Buddyroo, I am happy that the house has been spared in the past week. I feel your frustration and pain. We so want to do the right thing, and, sometimes, even the best medical minds, cannot tell us what that is.
Good luck, and do please keep us posted!
BuudyRoo, Have you ever tried ENDOSORB? My dog has chronic colitis and it helps alot.
I think the weight gain is a good sign. You may just need more time. One of my receptionists adopted a dog with gi problems, and while we fairly quickly identified the small intestinal bacterial overgrowth and c. diff it still took about three months for his guts to heal. For him, the Standard Process nutraceuticals were a huge help.
FWIW, I would treat again for whipworm just to cover your boy. It is so hard to pick up on in a fecal, but can really contribute to diarrhea. Interceptor if you can find it or panacur will treat.
Marshfield, he's on Interceptor monthly and did a power pak about a month ago. You think that should be revisited?
Csaper58, I'm not familiar with endosorb. I can look into it. He's now off all meds and just on the Z/D. I'm not giving probiotics as of Saturday. (I'm out)
I'm still in a holding pattern waiting for some news back from the vets.
BTW, Squish and others,
Not to flog a dead horse (or dog), but for you edification (and I cannot help myself, I am an Academic) there is evidence that Addison's is not more common in female dogs, despite the wide-standing belief that females are more likely to get it than males. See the article below. Although the article is specific to Portuguese Water Dogs, the authors makes reference to a similar finding in Standard Poodles:
If you've got him on Interceptor, you should be fine.
So fo course, IFG, I have a SP too. LE sigh!!!
We have two Spoos!
Originally Posted by BuddyRoo
In certain breeds (Porties, Spoos and Bearded collies, its about 50%/50% female to male. These are among the most common breeds to have Addisons disease.
Originally Posted by IFG
In other breeds, a huge hypoadrenocorticism study showed, 69% of dogs of breeds not mentioned above diagnosed with addisons have been female. So "more" females are diagnosed with Addisons in general, but within those breeds mentioned above youare right....pretty darn close to 50/50.
However, theres 31% of the "other breeds" out there that arent females. I would never rule out a dog for being male!! Typical signalment though isnt An Older Male Labrador. But, neither does.....
the 17 year old shih tzu neutered male diagnosed with Addisons today!!!...go figure.
Hi BuddyRoo, Endosorb is not a drug it is more like bio-sponge. If you google it, click on prn pharmacal page for all the info. It is inexpensive and I get it at my vet, but I think you can order thru Amazon. It really helps the dogs with gas, and
uncontrollable diarrhea, cramping etc.
Well, I heard back from the doc at MSU last night. He still thinks it's worthwhile to do the ACTH but really doesn't think that that Addison's is the issue.
He thinks I should just give the diet change 6 weeks or so. Which is awesome because Z/D is so cheap! :no: Also, "sick" dog got into the brand new bag of Z/D last night and ate about 6 lbs of it. Super geeked about that and the fact that he then pooped all over the house overnight. However, was probably me that forgot to shut the door. (I could blame it on hubby, but it was probably me.)
If the ACTH for Addison's is negative, he recommends doing a trial of the pred anyway just to speed up the whole anti inflammatory thing.
I have researched steam carpet cleaners and am planning to go to Costco today to see if I can find one. I'm pretty over this. Not gonna lie!
I will check out the endosorb. Thanks all.