Considering Adopting Cushing's Dog-Questions re Treatment Costs

[purpledachshunds]

I have never posted in any forum before, so please bear with me!

My husband and I are considering adopting a dachshund with Cushing's disease. We are taking our time and have been scouring the internet for a few weeks now. We are so glad we found this forum!

The dachshund is an adorable 10 pound double dapple. He was diagnosed 4 months ago and given Vetoryl 30mg once daily. His symptoms improved but were still present so they increased his dosage to 30mg twice daily. His last ACTH was done 6-11-09 with results of: PRE 6.7mcg/dl POST 13mcg/dl. These results were obtained 3 weeks after increasing his Vetoryl dose from 30mg once a day to 30mg every 12 hours. (We understand from our research about Vetoryl that a small number of animals may require doses significantly in excess of 10 mg per kg bodyweight per day, and, in our opinion, 30mg twice daily for a 10 pound dog seems to fall into that category.)

Right now, we have 3 main questions:

1. We are concerned and confused by the results of the ACTH. Thanks to your forum, we finally found a range for ACTH test results! However, his results seem to fall well outside of this range. When we raised our concerns with his current vet, she responded that she does not consider his dose of Vetoryl excessive, and his clinical signs did not abate until he started taking 30mg every 12 hours. We were wondering if there is no upper limit to the range and the amount of drug is just increased until the symptoms abate. We are just really trying to understand how to interpret these test results so we can speak, at least halfway intelligently, to his veterinarian! Is there a good link explaining results outside of the "normal limits" that I may have missed?

2. The cheapest we have found Vetoryl 30mg is at valuevet.com. It is $48.75 for 30 capsules and shipping and handling is free for orders over $200.00, otherwise it is $6.00 per order. Does anyone know of a reliable yet cheaper place to purchase Vetoryl? Of course, it is cheaper from the UK, but no longer available to US citizens in the 30 mg dose! (Note: His veterinarian recommended against compounding Trilostane, but the prices I found were actually a little more expensive anyway.)

3. We also have an epileptic dachshund and found a wonderful website for dogs with epilepsy (http://www.canine-epilepsy-guardian-angels.com). Dr. Dodds, a veterinarian in California, offers lab testing of blood samples at a reduced rate through her work researching epilepsy. We are contacting her to see if she can perform the labs necessary for Cushing's dogs, too. According to his current vet, he will need an ACTH Stimulation test, CBC, chemistry panel including electrolytes, and urinalysis every six (6) months. She also says it would be best to check his T4 and TSH levels every six (6) months too. Does anyone know of a veterinarian performing research on Canine Cushing's that offers reduced rate testing pertinent to Cushing's disease?

We are trying to gather as much information as possible before we adopt this adorable little guy into our home and any advice offered will be much appreciated!

Thank you in advance!

[SaxLady]

Hi and welcome!
Do you know what type of Cushing's the little guy has? Pituitary or Adrenal? If adrenal he should not be given Trilostan because it can increase intermediate hormones that are already high in adrenal based Cushing's. That is what happened with my little doxsie. Before you officially adopt him would the person or people be willing cover the cost of a high resolution ultrasound and an adrenal panel blood work to be sent to the University of Tennessee? The ultrasound will determine if he has an adrenal tumor. The adrenal panel will give results of his hormone levels. This is not to discourage you from adopting the little guy, you just need to know about Cushings. He is young yet and with proper treatment will have many more years.
Others will be along shortly to help you. I have a hand tremor and it's acting up today, making it hard to type.
Hugs!
Candy

[SaxLady]

Hi again! I should have told you Trilostan and Vetoryl are the same. In germany, where my Doxie was treated they called it Vetoryl.

[Harley PoMMom]

Hi and welcome from me too!

Do you know what tests the vet used to dx'd the cushings in this pup? Could you find out and post these results along with the units that the lab used? Also could you find out what symptoms this sweet pup has that made the owners take him to the vet and get tested in the first place, and what symptoms he has now? Is he neutered?

Candy has made some good recommendations about the u/s and the full adrenal panel from the UTK, the only thing tho, the pup has to be off the Vetoryl for at least 3-4 weeks to get good readings for the full adrenal panel, but these two things are highly recommended.

Others with much more knowledge with Vetoryl/cushings will be along shortly I am sure...so hang in there...by the way what is your name...we are so friendly around here and "hey you" is so impersonal. :)

Hugs.
Lori

[purpledachshunds]

Candy and Lori - Thanks for the quick responses! Such great information! Sorry you're having trouble typing, Candy. We have been very impressed with this group of volunteers that foster and adopt the dachshunds. They have answered several questions over the last few weeks. I asked his foster mom specifically about the type of Cushing's. She forwarded this and my other questions to the president of their organization who knows more about Bree's (the little guy's name, obviously) care. Following is my original question to them and their response.

Question: "Did the vet test Bree for the type of Cushing’s--is it Pituitary Dependent Hyperadrenocorticism or Adrenal-Based Hyperadrenocorticism? From the research I have done some vets do further testing once Cushing’s is diagnosed while others just start medication since both types respond to oral treatment."

Response: "Dr. Villines said that the vast majority of Cushing's cases are pituitary. To find out for sure, we'd have to do an ultrasound to see if there is a tumor on the adrenal gland. But in either case, Vetoryl is the leading treatment. It is possible to do radiation treatment on a dog, which will at least temporarily "cure" the Cushing's but might cause the opposite, Addison's disease."

They said when he first came to them he had the classic pot belly, thirst, and thinning skin/hair. Once diagnosis was made, he was put on 30mg Vetoryl and the symptoms improved, but were still present. After increasing the dose to 30mg Vetoryl twice daily the symptoms subsided. We asked about his symptoms because he does appear asymptomatic his pictures. We will have to find out what procedures were used in his diagnosis. He is scheduled to have a follow-up echocardiogram in a couple of weeks, as his first one showed he has mitral valve disease that may eventually lead to congestive heart failure. Right now, he takes no additional medication for his heart condition. However, he does have an idiopathic cough, possibly caused by the mitral valve disease, for which he occasionally takes medication. However, my dachshund with seizures is highly allergic to this particular medication! The vet says she will change it, but wants to await the result of his next echocardiogram first. Once he is cleared for general anesthesia, he will be neutered. He also has a mass on his chest that they are going to biopsy. We are curious about the interaction about Cushing's treatment and cancer treatment if the mass proves malignant.

I will be sure to bring up your concerns and ask them if they are willing to accommodate the request for additional testing. Any information we can garner, good or bad, will greatly help us make an informed decision about adoption, and, more importantly assist us in caring for him should he come to live with us. So far, both the adoption agency and we feel he would fit in well at our home. We just want to try to be prepared for any and every aspect of his care, good or bad, and do as much research as possible about it before he arrives. Obviously, it is impossible to anticipate all of his future problems, but as you can see, he is a very special needs dog.

Thank you again for the information!

Myrna

P.S. In doing my research, I learned that Trilostane is the drug name, the marketing name for animals is Vetoryl, and the marketing name for human use is Mondrenal. We checked with our local pharmacist to see if the human drug might be cheaper, as sometimes they are. They said they would have to research it as they had never heard of either Trilostane of Mondrenal.

[Truffa's Mom]

Hi and welcome from me too.

Glad you found us. I am sure members with more experience and knowledge with Trilostane (Vetoryl) will chime into your thread. I don't have this kind of knowledge.

What a beautiful and generous soul you and your husband are. The web site that helps epileptic dogs is wonderful also, glad you have a close liaison with them.

Meanwhile you could check the Resources (http://www.k9cushings.com/forum/forumdisplay.php?f=10) section of this forum to seek for more info.

Hope to hear from you and your new family member

[gpgscott]

Welcome Myrna, and Bree, and thanks for joining.

We are a community of people who have or have had pups with various form of Cushing's and we share personal experience, study and practical advice.

In order for anyone to respond to your treatment we would need to know more, such as age, wt, symptoms, tests and results.

Trilostane has unintended issues with intermediate hormones which many Drs. are either unaware of or choose to ignore. When I see a pup on an escalating dose of Trilo without relief of symptoms I become very concerned.

Please let us know more, I am sure we can help you to understand more about this treatment.

Scott

[labblab]

Dear Myrna,

Welcome from me, as well! You and your husband have my utmost respect and appreciation for considering the adoption of this special needs baby!!! So any information and support that we can supply will be our pleasure. Clearly, you have already spent a great deal of time performing your own research. And our members who have already welcomed you have asked some excellent questions. Here are a few more thoughts to throw out. I'll start out with some of the "yucky" stuff to begin with :(, to get it out of the way. And then we can focus on the Cushing's questions.

First off, you have mentioned a chest mass that will be biopsied. Is this an internal mass or a mass on the skin? If it were me, I think I would actually "bump" this issue up to the top of my priority list. Because depending upon the nature of the mass and the outcome of the biopsy, I think you are correct in thinking that this pup's entire course of treatment may be altered if it turns out to be cancer. I do not have answers for you in that regard, but I think it is an issue that you will want to pursue further with the vet.

Secondly, you have mentioned the possibility of congestive heart failure. I just want to let you know that Vetoryl (trilostane) is not recommended for use in conjunction with either ACE inhibitors or potassium-sparing diuretics. So for pups with cardio-vascular issues, medication contraindications do need to be considered, and Lysodren (the other primary Cushing's medication used in the U.S.) may turn out to be a better treatment choice than Vetoryl depending on any given pup's specific medical profile.

Now on to the Cushings...you are right that 30 mg. of Vetoryl twice daily is trending up to a "high" dose for a pup the size of this little doxie. You are also right that the most recent ACTH results are still higher than the desired therapeutic range. Per the manufacturers of Vetoryl, a post-ACTH result of no higher than approx. 9 ug/dl (or 9 mcg/dl -- they both "mean" the same thing) is desired. And if the Cushing's symptoms are not resolved at that level, then even a lower post-ACTH result would be sought. So a key question right now would be: are the pup's symptoms well-controlled at this time? You have probably already found this thread, but here is a link to our Trilostane/Vetoryl Resources and Information:

http://www.k9cushings.com/forum/showthread.php?t=185

I agree with the others who are advocating for additional testing to distinguish between pituitary and adrenal Cushing's, particularly since this pup seems to require a higher dose of Vetoryl to achieve symptom control. If he has adrenal Cushing's, a total cure may be possible with surgery. (Surgery is traditionally the "treatment of choice" for adrenal Cushings; surgery is now being used experimentally for treatment of pituitary tumors by a veterinary specialty practice in Los Angeles; radiation therapy is usually reserved for treatment of pituitary tumors that are enlarging in the brain and creating neurological problems). If surgery is not an option, a better medication choice for adrenal Cushing's may be Lysodren rather than Vetoryl. Lysodren acts directly upon the tissue of the adrenal gland, and has the potential to actually reduce adrenal tumor growth (whereas Vetoryl does not).

As the others have suggested, an abdominal ultrasound is a great diagnostic tool. But there are also a couple of other blood tests that can be used to try to distinguish between pituitary and adrenal Cushing's. So if you can find out more about the initial diagnostic testing that was performed (types of tests and specific test results), that can help us with further suggestions in this regard.

Last but not least, it will be interesting to see what your local pharmacist finds out about the current availability of Modrenal (the "human" version of trilostane). Five years ago when I treated my own Cushpup with trilostane, I was able to import Modrenal from the U.K. where it was manufactured (trilostane was not then nor is it now FDA-approved for human use in the U.S.). At that time, Vetoryl was very difficult to import, and Modrenal was indeed less expensive. However, Modrenal was only available in 60 mg. and 120 mg. capsule strengths. And now that Vetoryl is both FDA-approved and widely available in the U.S., I do not know whether Modrenal remains an imported or compounded option at all.

Sorry for having written such a "book" here...:o But thank you so much in advance for whatever additional information you can give us!

Marianne

[purpledachshunds]

Thank you to everyone who is responding to our plea for help. While the following is quite lengthy, I thought I would post the questions and responses we have asked thus far regarding Bree’s care. I was hopeful it would give you a better idea of where we are in the process and what additional questions we need to ask. While we have done extensive research, we are confident these questions will reveal to all of you experts our glaring naivety about Cushing’s disease! Thank you in advance for answering questions we are sure you’ve already answered a thousand times over to other Cushing’s newbies!

Questions answered by Bree’s foster mom:

Question: What meds and dosages is he on for his medical conditions?
Response: Bree takes Vetoryl twice a day for his Cushing's disease. He also takes Torbitrol as needed for the associated coughing that he occasionally has.

Question: Do you have an exact weight for Bree?
Response: Bree is about 10 pounds but could stand to put on another pound. He is a great size for carrying underneath your arm like a football.

Question: Does he have a special diet?
Response: No, we just feed him Nutro small bites (lamb and rice) twice a day.

Questions answered by the group president and lady overseeing Bree’s medical care:

Question: Can you please let us know how many milligrams Bree takes both per day and at each administration? (We know from experience in dosing Tazmyn (our epileptic dachshund) that sometimes the day’s total dose is divided into two (2) unequal rations.)
Response: For the dose -- Bree is on 30 mg twice a day. Dr. Villines (Bree's vet at Village Vets) reported this is close to the low end of the acceptable range for a dog his size. We started out with half that dose to even see if it would make a difference. When that showed improvement, we went up to twice a day.

Question: We noticed that he is taking Torbitrol for his cough. Tazmyn is highly allergic to Torbutrol. I have researched these drugs to determine if they are the same or different and have come up with conflicting responses, but the general consensus is they are different. One forum said Torbitrol is Oxycodone and Torbutrol is Butorphanal. However, both are opioids. I am confident we could administer the medication without Tazmyn coming in contact with it. My concern lies with the possibility of Bree vomiting and Tazmyn, being a normal dog, taking advantage of a free meal before I could clean it up. Roger has asked Chris to find out if the emergency vet thinks this presents a potential problem or if the two (2) opioids are different enough to alleviate my concerns.
Response: The torbutrol could be easily switched out with something else to suppress the cough. He doesn’t cough all that often usually so he doesn't need his cough medicine too often.

Question: What is the cause of Bree’s cough?
Response: We don't really know. It could be something as benign as tracheal irritation, or it could be related to his heart. The torbutrol could be easily switched out with something else to suppress the cough. His chest x-rays didn't show lung disease.

Question: We assume that since 80% of Cushing’s dogs have diabetes that Bree has been checked, but we wanted to ask to make sure. Do you know if he has been tested and what the results indicated?
Response: Bree had extensive bloodwork done, and none of the original signals for diabetes were present! Bree's blood glucose on both his CBC blood tests (about 1 month apart) were normal. His urinalysis did not show glucose in the urine. So no diabetes!

Question: Why is Bree available for adoption? Do you know much about his history prior to coming to live with you?
Response: Bree was turned in to animal control with 2 other dachshunds (one other double dapple). The people did not give a reason, but I assume since they turned in all 3 dogs, that they were in economic distress.

Question: When was Bree diagnosed with Cushing’s? We notice none of the telltale signs in the pictures.
Response: He was diagnosed when he first came in. He had the classic pot belly, thirst, and thinning skin/hair. Since he has been on the Vetoryl, all the symptoms have subsided.

Question: Has Bree taken any medication other than Vetoryl for his Cushing’s?
Response: No. We tried Vetoryl (first once per day) for a month, and the bloodwork and symptoms began to improve, but symptoms were still present. After adding the second dose per day, the symptoms subsided.

Question: How long has Bree been taking Vetoryl?
Response: I think 4 months?

Question: When was his last ACTH stimulation test?
Response: I think 2 months ago. We were going to repeat the test at 6 months, since he is doing well.

Question: What other tests have been performed related to his medical conditions?
Response: Extensive blood work and we took him to a vet cardiologist to have his heart murmur evaluated to see if he could withstand anesthesia for neutering. She recommended waiting until we got the Cushing's under control. He is due for a recheck there in mid-August.

Question: From his pictures and from your description, he looks and sounds like a happy boy. What does his current vet say about his prognosis?
Response: He really is a funny, special personality! At first, with the Cushing's and the heart murmur, we were concerned. He also has what appears to be a fatty tumor on his upper chest. But so far he has responded to treatment well. He is about 10 years old, now that he is getting treatment for the Cushing's he can be expected to have at least several years left.

Question: What ongoing care does his current vet recommend? This is another question we are asking the vet at the small clinic and having Chris ask the emergency vet. We want to make sure they are well able to handle any of Bree’s needs.
Response: Meds for Cushing's!

Question: Did the vet test Bree for the type of Cushing’s--is it Pituitary Dependent Hyperadrenocorticism or Adrenal-Based Hyperadrenocorticism? From the research I have done some vets do further testing once Cushing’s is diagnosed while others just start medication since both types respond to oral treatment.
Response: Dr. Villines said that the vast majority of Cushing's cases are pituitary. To find out for sure, we'd have to do an ultrasound to see if there is a tumor on the adrenal gland. But in either case, Vetoryl is the leading treatment. It is possible to do radiation treatment on a dog, which will at least temporarily "cure" the Cushing's but might cause the opposite, Addison's disease.

Questions answered by Bree’s current veterinarian:
(NOTE to members of the forum: First we detailed the information we had found regarding Vetoryl, then we asked the questions that follow.)

We are both concerned and confused about the dose of Vetoryl that Bree is taking. We understand he is taking 30mg twice daily. According to the Vetoryl website, www.vetoryl-shop.com, and the "Electronic Summary of Product" from the Veterinary Medicines Directorate (VMD) in the U.K. (found by going to http://www.caninecushings.net/forums/showthread.php?t=180 and clicking on “Vetoryl 30 mg capsules” under the post by acushdogsmom), the starting dose for a dog weighing ten (10) pounds is three (3) to ten (10) mg/kg. Furthermore the “Electronic Summary of Product” states,
“In clinical studies, most dogs were eventually stabilised on doses between 2 – 10 mg/kg/day. Should symptoms not be adequately controlled for an entire 24 hour inter-dose period, consideration should be given to increasing the daily dose by as small an increment as possible and dividing it between morning and evening doses. Do not divide or open capsules.
A small number of animals may require doses significantly in excess of 10 mg per kg body weight per day. In these situations appropriate additional monitoring should be implemented.
Due to the limitation in capsule size, it may not be possible to provide optimal control for smaller dogs requiring lower doses of trilostane.”
In regard to monitoring treatment, both websites recommend performing Biochemistry (Including Electrolytes) and ACTH stimulation tests every three (3) months. However, on some other websites written by veterinarians, testing every six (6) months is recommended. Moreover, according to the information provided by the adoption agency, Bree has been on this medication approximately four (4) months and his last ACTH was about two (2) months ago, with his next test recommended in six (6) months. Furthermore, the “Electronic Summary of Product” information quoted above states that if the dog is taking in excess of 10 mg per kg of body weight per day of Vetoryl, appropriate additional monitoring [we assume in excess of testing every three (3) months] should be implemented.
Based on the above research and Bree’s other medical conditions, we have the following questions:

Question: Are we interpreting correctly that Bree is taking a dose that qualifies as “significantly is excess of 10 mg per kg body weight per day”?
Response: I do not consider Bree's dose of Vetoryl excessive, and his clinical signs did not abate until he started taking 30mg every 12 hours.

Question: How often do you recommend Bree be monitored?
Response: Bree should be monitored every 6 months unless he shows signs of illness.

Question: Do you agree that Bree will need both the Biochemistry (Including Electrolytes) and ACTH stimulation tests at the intervals you recommend in Question 2.?
Response: Bree should have an ACTH Stimulation test, CBC, chemistry panel including electrolytes and urinalysis every 6 months. It would not hurt to check his T4 and TSH levels every 6 months either.

Question: What were the results of his last ACTH stimulation test?
Response: The results of the ACTH Stim test done 6-11-09 were: PRE 6.7mcg/dl POST 13mcg/dl. These results were obtained 3 weeks after increasing his Vetoryl dose from 30mg once a day to 30mg every 12 hours. I was informed that his clinical signs were under control and that he was doing well, so I did not further increase his dose.

Question: When was his last Biochemistry (Including Electrolytes)? What were the results and when is the next test scheduled?
Response: Bree's last CBC, chem panel, electrolytes and U/A were done 5-8-09. There was a mild-moderate elevation in his white blood count which I felt was either due to stress or unregulated Cushing's. It was then that I put him on Vetoryl 30mg twice a day because Kristin said his symptoms were still not under control. The rest of the labwork was normal. The next labwork is scheduled for December along with his next ACTH Stim test.

Question: Would it be possible and/or advisable to obtain the maximum dose for a dog his size without exceeding the recommended dose by having the trilostane compounded? We know that it is sometimes hard to control compounded drugs as they are unregulated.
Response: I do not recommend compounded Trilostane.

Question: The Vetoryl websites also state that it is best when possible to administer Vetoryl in one (1) daily dose because it aids in monitoring. We have read that Vetoryl has a short half life of eight (8) hours. How does dosing twice daily, which is also recommended on their websites for certain situations like Bree’s, change the outcome of the monitoring tests?
Response: Twice daily dosing is recommended when once daily dosing does not control clinical signs of Cushing's disease. The ACTH Stim test is done 4-6 hours after the morning dose of Vetoryl.

Question: What other ongoing tests do you recommend Bree undergo for all of his medical conditions and how often do you advise these tests be performed?
Response: Bree has a variety of medical problems. His heart has been evaluated by a veterinary internal medicine specialist via echocardiogram. The specialist found mitral valve disease that she believes will eventually lead to congestive heart failure. Bree's next echocardiogram is scheduled for this month, and he will need to have re-evaluations every 3 to 6 months. He is currently not on any cardiac medications. He also has severe dental disease that will need to be addressed as soon as we can determine he is a safe candidate for general anesthesia. He also has a retained testicle in his abdomen that will need to be surgically removed during a castration procedure that will need to be addressed, again as soon as we can determine he can safely undergo general anesthesia. The dental procedure and the castration procedure will need to be done on separate occasions to minimize duration of time under anesthesia. We have also found a mass on the front of his chest that we will need to biopsy, and this can be done with either the dental or the castration procedure.

Question: We understand that Bree takes Torbitrol as needed for an idiopathic cough which could be caused by his heart murmur. Tazmyn, one of our other dachshunds with idiopathic epilepsy that is very difficult to control, is highly allergic to Torbutrol. We have researched these drugs to determine if they are the same or different and have come up with conflicting responses, but the general consensus is they are different. One forum said Torbitrol is Oxycodone and Torbutrol is Butorphanal. If this is true, both are opioids. We are confident we could administer the medication without Tazmyn coming in contact with it. Our concern lies with the possibility of Bree vomiting and Tazmyn, being a normal dog, taking advantage of a free meal before we could clean it up. Do you think this presents a potential problem or are the two (2) opioids different enough to alleviate our concerns? The adoption agency said Bree could be given a different
medication for his cough. Do you recommend an alternative medication, and, if so, which drug, what is the dosage, and how would it be administered?
Response: Torbutrol is butorphanol. Oxycodone is not otherwise known as Torbitrol - I believe this is a misspelling of the previous medication. I would not recommend either medication in your circumstance. I would like to see the results of Bree's next echocardiogram before making a decision on another cough medication.

Question: May our veterinarian contact you with any questions that may arise?
Response: Your veterinarian may certainly contact me.

Question: If the adoption agency decides our home is a good fit for Bree and they are agreeable, may we have a copy of his medical records?
Response: You may certainly have a copy of Bree's medical records should you decide to adopt him.

Question: We have found a wonderful website for canine epilepsy, http://www.canine-epilepsy-guardian-angels.com/site_map.htm. We have been searching with futility for a similar site for Cushing’s disease. Do you know of any such site?
Response: I do not know of a website for canine Cushing's disease.

Question: Do you have any other advice for us as potential adoptive parents of Bree?
Response: Bree is a very special dog with many medical problems. Though I would love to see him adopted into a loving home, his new family needs to be aware that caring for him will most likely be quite expensive.

That’s it guys—all of the questions we have asked so far about Cushing’s and Bree. As soon as we received the responses from Dr. Villines, we forwarded a copy to his foster mom and asked her to please have his biopsy done when he was neutered instead of with the dental, of course, assuming he was going to be neutered first, as we wanted those results as soon as possible.

As I have stated previously, the adoption agency is wonderful and welcomes any questions. I am sure we can ask Dr. Villines additional questions, too, but I would prefer to ask as many as we can at once to keep from pestering a busy doctor. We will ask if they have an exact weight and ask the questions that Candy and Lori posed…will probably pretty much cut and paste from the forum…hope this is ok! Based on the above questions and responses, are there any additional questions we should ask Dr. Villines at this time. I know once we have answers to your current questions, they will prompt additional follow-up questions—just wanted to see if anyone had any more suggestions before we contacted her again.

By the way, just to complicate matters further, our much trusted and respected vet of over 18 years suddenly retired last year without warning! No one likes change, but we have been several times under the new owner, and have become increasingly disenchanted, so we are in the process of finding a new vet! What are the main questions to ask a potential new vet? What are the glaring signs to make us want to keep looking?

Also, I have researched a little bit today about Universities that do diagnostic testing—never crossed my mind until I read Candy’s post. I noticed some colleges have significantly reduced rates for some of the ongoing tests Bree will need. Is there a thread somewhere on this forum that addresses the cost of medication and treatment and/or does anyone have suggestions about minimizing costs? Of course, we want the best care for Bree, but, common sense, we want the best care for the best price, especially in this economy!

Thank you again for taking the time to answer our questions and being so kind, thorough, and supportive. Like I said I am a true newbie to any forum and this has been a great experience! Maybe I will be a little more tolerant of my husband spending so much time on his gardening forum...maybe!

Thanks again - Myrna

P.S. The Cushing’s forum I mentioned above is one that is no longer active, so we are so glad we found this one!

[purpledachshunds]

Marianne - I knew Labblab sounded familiar...you posted on the inactive forum I mentioned in my previous post! I noticed that it said you lived in Georgia. Do you still live in Georgia and, if so, may I ask where? We live just outside of Savannah...small world!

Myrna

[labblab]

Hi Myrna,

Yes, you have definitely rejoined "family" here, because all of the Administrators and Moderators here were previously members of caninecushings.net. :)

Sadly, for reasons to which we are not privy, the owner of the original website decided to close it down. So we have forged onward to create this "new" website, but with so many "old" and familiar faces...:o I am so glad you found us and have rejoined us as well.

And I live in the metro Atlanta area. Savannah is such a beautiful city, though (and with such excellent food!!!!)...:) :)

Marianne

[purpledachshunds]

On the thread "Financial Resources to help with Vet bills", at the bottom there are two caninecushings.net. How can we view those since we can't log onto the site?

http://www.caninecushings.net/forums...ead.php?t=2038

http://www.caninecushings.net/forums...ead.php?t=3294

Thanks

Roger

[Squirt's Mom]

Hi Roger,

Those last two links are to threads on the old site that is now closed. So those threads cannot be accessed...even for those of us who can still sign in. Those two threads contain info about what members have paid for testing etc related to Cushing's so new folks could get an idea of the expenses involved around the world. The links prior to those are the ones that offer info on financial help.

Hope that answers and explains!
Hugs,
Leslie and the girls

[purpledachshunds]

Thanks, I was afraid of that.

[frijole]

Roger, I am not sure if this is what you are looking for but just like the other site, there is a resource section here. Here is a link to financial resources. Kim

http://www.k9cushings.com/forum/showthread.php?t=212

[AlisonandMia]

Kim, it looks like the some old links to cc.net have some how managed to make their way to that thread - and no they cannot be viewed, unfortunately. I'll go and remove them.

Hopefully, if we are very lucky, someone will have a copy of the info from those threads (the ballpark costs for testing) and we can re post it.

Alison

[purpledachshunds]

We are the couple that is considering adopting Bree, a Cushing’s dachshund. We are also in between veterinarians, as our trusted vet of 18 years suddenly quit without warning. Since the link on ballpark testing and medication costs is irretrievably lost, we were wondering if anyone would care to share their experience concerning costs of caring for their Cushing’s dog. We are finding a gap in pricing just in our area! Also, we have no specialists in our area and would appreciate feedback from anyone using their regular vet for maintenance and traveling to specialists as needed.

Bree’s current vet recommends an ACTH stimulation test, CBC, chemistry panel including electrolytes, and urinalysis every 6 months. She also says it would not hurt to check his T4 and TSH levels every 6 months either. Bree also has mitral valve disease which needs to be monitored every 3-6 months via echocardiogram. He takes no medication for his heart condition, but it may lead to congestive heart failure. So far, 2 clinics have provided pricing. We are awaiting return calls from some others. Here is what we have learned:

The 2 clinics that have responded offer a package for the CBC, chemistry panel including electrolytes, T4, and urinalysis for $121.00.

One clinic charges $226.00 ($100.00 for the pre- and post-tests and $126.00 for the cortisone) for the ACTH, the other charges $150.00, pre- and post-tests and cortisone inclusive.

One clinic says the TSH would be about $25.00 while the other says it is $66.00.

As far as the echocardiogram, we have only found one clinic that offers it for “between $200.00 to $300.00, probably around $270.00”. The other clinic says we need to go to Jacksonville (we live around the Savannah, Georgia area).

When I called about the high resolution ultrasound which was highly recommended by members of this forum, I was told it would be $255.49 to have an ultrasound of the abdomen. When I confirmed that this was a high resolution test, they said their machine was 10MHz. However, when I look up “MHz for high resolution ultrasound” online, they seem to range from 20MHz to 50MHz. I wonder what the lowest MHz that can actually pick up the adrenal tumors would be?!?...Does anyone know?

While we know prices will vary by region (they obviously vary from clinic to clinic in a region!), we are just covering all of our bases as much as possible before bringing Bree into our home.

By the way, as previously posted, he takes Vetoryl 30mg twice daily. The cheapest we have found it so far is $48.75 for 30 capsules.

We are awaiting a copy of his medical records from his current vet and will post the results from his diagnostic and ongoing testing upon receipt.

Thank you again for being so supportive, kind, caring, and helpful. We truly appreciate the members of this forum!

Roger and Myrna

[lulusmom]

Hi Roger and Myrna,

Bless you for trying to figure out a way to give Bree a forever home. Cushing's is not an inexpensive proposition but the good news is that diagnostic phase is the most expense part of the journey so I happy to hear that that part is over for Bree.

When checking for prices on the ACTH, make sure you are comparing apples to apples. I've found, through research and my experience with my two cushdogs, that the most consistent stimulating agent used for an ACTH is Cosyntropin/Cortrosyn and unfortunately, it is more expensive than the ACTH gel. The function and accuracy of ACTH gel is questionable so cushing's savvy vets and internal medicine specialists use Cortrosyn. I would be in heaven if I could find somebody to do the acth stim test for $150 so good for you. Just make sure that they are using the cortrosyn.

We adopted one of our cushdogs, Jojo, from a rescue. We fostered him for a few weeks and already having a cushdog, I recognized the symptoms in Jojo and asked the rescue to have him tested. The rescue paid for the diagnosis and we ultimately adopted him because we felt he was unadoptable. Jojo has been our boy for two years and is doing well. What an incredible difference from the day he walked into our lives. He was a horrific mess.

Both of my cushdogs started treatment with Lysodren, then we switched them to a compounded Trilostane (Vetoryl), and because the Trilostane was adversely impacting Lulu's already elevated sex hormones, we switched back to Lysodren. The meds are not cheap and many of us use compounded versions of both Trilostane and Lysodren. I purchased Trilostane from Diamondback Drugs in Scottsdale, AZ. Because they are so big, their compounded drugs are more than competitive. Many members also get their Trilostane from Diamondback. I am always refilling one of 10 prescriptions so I spoke to Diamondback yesterday and asked how much for 30mg Vetoryl 30ct. They could not beat your price of $48.75; however, they still compound the Trilostane for any strength other than the 30mg and 60mg which is the dosage for Vetoryl that has been approved by the FDA. Their price for 100ct 29 or 31mg Trilostane is $60 plus $5 or $6 shipping. They ship anywhere in the U.S. and even to some countries overseas.

I hope this helps.

Glynda

[jrepac]

the various medications...lysodren, trilostane and anipryl, are not terribly expensive, particularly if you have a generic option available. The brand name versions are more pricey. The various testing is where it gets expensive. Keep in mind it is up to you to decide which tests you want to pursue and how often you want to test...it may not be truly critical to do all the tests all the time. It will partly depend on the treatment you choose and your dog's general medical condition.

Jeff

[purpledachshunds]

Hi Glynda and Jeff –

Thanks for the information. We really appreciate your responses! Even though we have been reading and researching about Cushing’s, the more we learn we find the more we need to learn! While I had read that different delivery systems for the cortisone for the ACTH exist, I had no idea the gel was less effective! I have been reading so much that maybe I read it and it just failed to sink in, but it did this time…so, thank you, Glynda, we will be sure to ask the vet when we go to see her before we adopt Bree exactly what cortisone delivery method her terrific price includes.

If we adopt Bree, we will keep Diamondback Drugs in mind. I will also contact them to inquire about medication for our epileptic dachshund, Tazmyn. She takes 2 different medications, one of which needs to be compounded. We recently had her compounded drug filled at a local pharmacy and it was $75.00 for 90 days and cherry flavored! (They wanted $90.00, but lowered it to $75.00.) In searching online for a cheaper solution, I stumbled across Center Pet Pharmacy, http://www.centerpetpharmacy.com, and when I called I actually spoke with the owner, Kenny Kramm. I was so impressed that the next time I need to order Tazmyn’s medication I will most likely use them. He talked to me for about an hour about the pitfalls of ordering online. He gave me a couple of websites to check out scam fraud, http://www.nabp.net (The National Association of Boards of Pharmacy) and http://www.nextag.com. He also said to check him out, so I did. I read “The Heart Of A Company” (just Google his name and it is the second link) and cried through a good portion of his family’s story. In a nutshell, he invented palatable flavors for children’s medicine when he had a daughter born with medical problems who refused to swallow her medicine. He then expanded the company into pet formulas. Finally, he sold the company, FlavoRx, and started Center Pet Pharmacy. It will be between 2-3 months before I need to order her medication and if I do order from Center Pet Pharmacy will post my experience on the forum. I almost skipped calling this pharmacy because there are no prices listed on his website. He does this purposefully because he wants his customers to call so he can get to know them and their pets. He says this is the closest he can come in this day and age to the face-to-face service he loves from years gone by.

Glynda, we commend you for taking care of 2 Cushpups! It is obvious why God sent JoJo to you. We are thankful he found such a caring, loving, and knowledgeable home!

Thank you again, Glynda and Jeff, for sharing your experience and advice with us. Roger and I are so thankful we found this forum and are very appreciative of the support, advice, and warm welcome we are receiving from everyone.

Myrna

[acushdogsmom]

Hi Glynda and Jeff –

Thanks for the information. We really appreciate your responses! Even though we have been reading and researching about Cushing’s, the more we learn we find the more we need to learn! While I had read that different delivery systems for the cortisone for the ACTH exist, I had no idea the gel was less effective! I have been reading so much that maybe I read it and it just failed to sink in, but it did this time…so, thank you, Glynda, we will be sure to ask the vet when we go to see her before we adopt Bree exactly what cortisone delivery method her terrific price includes.I only have a minute, but wanted to just explain that it's not a "cortisone delivery system" that is used in the ACTH stimulation test.

"Cortrosyn" and "ACTHAR gel" and another agent called "Synacthen" are actually synthetic forms of ACTH that when injected, stimulate the adrenal glands to release their reserves of cortisol into the blood stream.

There are many vets who use the gel, but the Cortrosyn or Synacthen do seem to be the stimulatory agents preferred by Internal Med Specialists, many of whom find the ACTHAR gel to be less reliable as far as getting consistent results is concerned.

Cortrosyn is very expensive though. And Synacthen, although less expensive than and considered just as reliable as Cortrosyn, seems to be used more in countries other than the USA. (My Internist here in Canada does use Synacthen).

In the Low Dose Dexamethasone Suppression test, however, it is a steroid that is injected (dexamethasone) rather than a stimulating agent.

:)

[purpledachshunds]

Thank you for the clarification...I am obviously still in the learning process. I also meant to thank Glynda for taking the time to ask questions when she called her pharmacy. It was very sweet and thoughtful of you to gather information for us...Thanks!

Myrna

[purpledachshunds]

We're still working on adopting Bree but he has had more issues come up. He has now been diagnosed with thyroid cancer. Does anyone have any experience with this diagnosis along with Cushings? We now have his lab results and we'll post his numbers soon. Thanks. Roger

[StarDeb55]

Roger, the following link should give you some good information about canine thyroid cancer.

http://www.dog-health-guide.org/thyroidcancerindog.html
http://www.furrycritter.com/health/dogs/Canine_thyroid_cancer.htm


What concerns me is the Cushing's diagnosis for Bree, in light of this cancer diagnosis. Thyroid issues can cause symptoms that mimic Cushing's which is why it's very important to rule out any type of thyroid problem. Do you know what was done to diagnose the thyroid cancer? Perhaps, a needle biopsy of the thyroid? IMHO, I would be asking some serious questions of Bree's treating vets as to the accuracy of the Cushing's diagnosis, now with a thyroid cancer diagnosis.

Debbie

[purpledachshunds]

Thanks for the links. This Wednesday Bree is going in to a teaching university for more tests on his thyroid cancer. They discovered it doing a biopsy. We did discover the same concern about the cushings diagnosis when we read an online medical journal article on the subject.

[muskyhusky]

My hats off to you for adopting a dog with these issues...Thank you so much.