ACTH stim test in a difficult dog.

RE: ACTH stim test in a difficult dog.

Martin Atkinson — Wed, 14 Sep 2016 09:45:02 GMT

[quote user="Eilidh Corr"]Mind you're not too sympathetic there![/quote]No I'm just too old, cynical and experienced and can't be bothered with the aggravation of difficult owners and pets anymore. Life is too short.

RE: ACTH stim test in a difficult dog.

Eilidh Corr — Tue, 13 Sep 2016 21:35:20 GMT

[quote user="Martin Atkinson"] is their problem not ours if we can't do our job properly because they didn't train/can't control their own dog. [/quote]

Mind you're not too sympathetic there!

RE: ACTH stim test in a difficult dog.

Martin Atkinson — Tue, 13 Sep 2016 16:33:00 GMT

[quote user="Robin Grimmer"]Not worth farting around with an aggressive, difficult dog.[/quote]You're right, the owners need to be made aware is their problem not ours if we can't do our job properly because they didn't train/can't control their own dog. With a bit of luck they'll go somewhere else.

RE: ACTH stim test in a difficult dog.

Robin Grimmer — Tue, 13 Sep 2016 09:30:48 GMT

I agree with Martin. Dom torb. Leave it sedated while you do the test. You only need to make sure it's not going Addisonian. So if the test is normal or elevated as long as the dogs clinical signs are ok I wouldn't blues the dose. Not worth farting around with an aggressive, difficult dog.

RE: ACTH stim test in a difficult dog.

Braden Collins — Tue, 13 Sep 2016 08:20:29 GMT

Your need for monitoring will also be influenced by your treatment choice. Trilostane will need ongoing monitoring as the dose required can reduce over time, so you run the risk of an Addisonian issue 12-18 months+ after starting treatment.

For a cranky dog, Mitotane may be a better option, as once you achieve a stable dose your need to continue monitoring is reduced/removed (though in an ideal world with an ideal patient you would continue monitoring).

RE: ACTH stim test in a difficult dog.

Rach — Tue, 13 Sep 2016 07:45:04 GMT

My understanding is that the use of the ACTH stim when monitoring is primarily as a safety check, to ensure you are not overdosing the dog. With this in mind I wonder if a) the stress of the dog coming in may artificially elevate the cortisol, regardless of any sedation used and b) if urinary cortisol:creatinine measured at home could be used instead, I guess it would have to be used a bit like at home urinary glucose monitoring - i.e. If it was low you would be worried about over dose. I wonder whether the owners may have to settle for improvement in clinical signs but not tight control on the basis of safety in this dog? It might be worth a phone call to someone like Ian Ramsey at Glasgow for advice.

RE: ACTH stim test in a difficult dog.

Beats — Mon, 12 Sep 2016 22:32:41 GMT

ACTH in back of thigh, then bring back in an hour and medetomidine/butorphanol also IM to facilitate bloods 10-20mins later if necessary.

RE: ACTH stim test in a difficult dog.

Nicola Cole — Mon, 12 Sep 2016 21:07:00 GMT

May be shot down in flames for this reply-has he ever previously had things taken really slowly (obviously muzzled so safe) rather than heavily restrained? The whole book in on a quieter morning, spend time with him getting him used to it, then hardly any restraint so as not to freak him out? Or use saphenous so not expecting it. Don't get me wrong, obviously there are some dogs that just won't tolerate it but just on off chance.

If that's been tried before with no success and he really is that bad to handle then I would just use dom/torb as above and warn the owner it will not be perfect but should be consistent.

RE: ACTH stim test in a difficult dog.

Martin Atkinson — Mon, 12 Sep 2016 17:43:45 GMT

I would say the stress of not sedating and the ensuing fight would be worse. Whatever you can only deal with it as you can and advise the owner that the results may not be 100% reliable but at least it will be consistent if its always been sedated. I wouldn't see any reason to change my usual Torb/Dom combo in this case.