Mypuppy:Princess (10 yr. old Lab on Trilostane) - has crossed the rainbow bridge

[mypuppy]

Hi everyone,
I know it's been quite a while since I've posted on Princess's thread, but here I am back on page 1--ughhhhhh. First, I hope you and your babies are doing as well as can be expected with this "dratted" condition or doing wonderfully great. I have been trying to read some of the updates over the last several months regardless of my absence. As for my Princess, she had a wonderful summer with absolutely no concerns---yehhhhhhh! Unfort. she has developed since yesterday some abdominal upset and had an accidental episode of diarrhea inside the house, and just walked in from the food store and found another accident. I put in calls to my gp and IMS, and I gotta ask myself and everyone "what is it with these doctors that you can never get them on the phone the moment you call them". ughhhhhh. why is it always a "call back" after their office hours are over? ughhhhh......So I have to hold on to the edge of my seat till much later to find out what I must do. I know Vetoryl can cause upset stomach and diarrhea, but I hope it doesn't mean she's heading for any crisis. She is still eating fine even though she has the diarrhea and seems to be acting pretty normal. Does anyone know if the Pepcid help with the diarrhea or merely just the upset stomach? Now I have to figure out if the Vetoryl is causing any of this and if I should stop it, which means Thursdays stim will probably need to be postponed. Never a dull moment huh! Thank you all, miss ya all....Tight hugs, Jeanette

[Rebelsmom]

Hi everyone,
I know it's been quite a while since I've posted on Princess's thread, but here I am back on page 1--ughhhhhh. First, I hope you and your babies are doing as well as can be expected with this "dratted" condition or doing wonderfully great. I have been trying to read some of the updates over the last several months regardless of my absence. As for my Princess, she had a wonderful summer with absolutely no concerns---yehhhhhhh! Unfort. she has developed since yesterday some abdominal upset and had an accidental episode of diarrhea inside the house, and just walked in from the food store and found another accident. I put in calls to my gp and IMS, and I gotta ask myself and everyone "what is it with these doctors that you can never get them on the phone the moment you call them". ughhhhhh. why is it always a "call back" after their office hours are over? ughhhhh......So I have to hold on to the edge of my seat till much later to find out what I must do. I know Vetoryl can cause upset stomach and diarrhea, but I hope it doesn't mean she's heading for any crisis. She is still eating fine even though she has the diarrhea and seems to be acting pretty normal. Does anyone know if the Pepcid help with the diarrhea or merely just the upset stomach? Now I have to figure out if the Vetoryl is causing any of this and if I should stop it, which means Thursdays stim will probably need to be postponed. Never a dull moment huh! Thank you all, miss ya all....Tight hugs, Jeanette

So sorry to hear this I know she was doing well. Any way she might have just gotten into something that upset her. Rebel threw up a couple times this week which had me concerned, but the 2nd time he had a small amount of grass in it. Maybe she found something outside that she liked but it didn't like her?? Sadie also had massive projectile diarrhea (tmi I know) a few months ago. With some antibiotics she was better in a few days. You know labs are constantly doing things they shouldn't be.. lol

I wish you all the luck and hope you find a simple answer this time.

Melissa

PS Has Princess ever had a obsessive chewing issue? Sadie finds a spot and won't leave it alone until it's a raw sore. We got her tail back to normal after months of cone wearing now she has found a spot on her foot. Her toenail looks like it could fall out and she is limping around. She is back in the cone, but I don't know what else to do to make her stop!!!

[gpgscott]

Hi Jeanette,

The pepcid does not help control diahrrea to my understanding.

While diahrrea is a sign to stop treatment and evaluate I think it is also important to take it in context. Is she other wise active, having a good appetiete and is the water uptake appropriate. Could just be a fleeting stomach issue and not low cortisol.

Scott

[Squirt's Mom]

Hi Jeanette,

Good to hear from you!

Two questions - 1) did it rain there just before she got sick, 2) are there other dogs close by?

When we were in TN, there were several other dogs in the neighborhood, back yard to back yard. Nearly every time it rained it seemed, Squirt got diarrhea that proved to be Spirochetes. The vet finally decided that one or more dogs above us had an infestation, would poop in their yard, it would rain and wash it all down in other yards. Squirt was more susceptible than the others for some reason, but all four of our babies there got them from time to time...always after a rain!

Just a thought!

Hugs,
Leslie and the girls :D - always

[Spiceysmum]

Hi Jeanette,

Good to hear from you but sorry to hear about Princess. I also think it might be something she has eaten or a bug of some sort. Whether you have to stop the Vetoryl or not I would just feed her boiled chicken and rice for a day or two as it is easier on their stomach. Brin had an episode of diarrhea last week while we were on holiday and he is on antibiotics and a light diet. He was staying at my daughters and a day later her dog had the same thing, I never knew dogs could catch bugs from each other like humans do.

Hopefully you won't have to delay the ACTH for too long.

Linda x

[mypuppy]

Hi Melissa,
Thanks, I don't believe Princess has gotten into anything in the yard. I am always out there with her and she is not far from my range. another thing is that she is not your typical lab where anything and everything goes to the mouth. She has never had any interest for stuff in the yard, wouldn't you know it, no even grass. Now that's an odd lab if you ever heard of one. I will continue to watch her closely and see if it will resolve itself. She is due for her stim this Thursday. I will let you know how she continues to do in the next few days. As for chewing lately, I do notice her licking her paws a lot, but she seems to have always done that from time to time. Vet says its allergies. Her eyes are dreadfully teary, dry and gunky...Yuck, so I rinse them twice a day to help her get some relieve. Thanks again for your post. xo Jeanette


So sorry to hear this I know she was doing well. Any way she might have just gotten into something that upset her. Rebel threw up a couple times this week which had me concerned, but the 2nd time he had a small amount of grass in it. Maybe she found something outside that she liked but it didn't like her?? Sadie also had massive projectile diarrhea (tmi I know) a few months ago. With some antibiotics she was better in a few days. You know labs are constantly doing things they shouldn't be.. lol

I wish you all the luck and hope you find a simple answer this time.

Melissa

PS Has Princess ever had a obsessive chewing issue? Sadie finds a spot and won't leave it alone until it's a raw sore. We got her tail back to normal after months of cone wearing now she has found a spot on her foot. Her toenail looks like it could fall out and she is limping around. She is back in the cone, but I don't know what else to do to make her stop!!!

[mypuppy]

Hi Scott,
So great to hear from you, thanks. I somewhat thought Pepcid would not alleviate the diarrhea, so I will watch and wait closely until I hear from one of my dr.s. sometime today. Hope you are well, and thanks again. Warm regards, Jeanette


Hi Jeanette,

The pepcid does not help control diahrrea to my understanding.

While diahrrea is a sign to stop treatment and evaluate I think it is also important to take it in context. Is she other wise active, having a good appetiete and is the water uptake appropriate. Could just be a fleeting stomach issue and not low cortisol.

Scott

[mypuppy]

OMG Leslie,
First, hi to you too and great to hear from you always, and second, YES, it started Sunday morning, 6 a.m. right after rain the night before, and YES, we share fences with our next door neighbor who have two dogs that obviously poop in the yard. Geez, but how do I confirm if this is in fact that spirochetes? I guess I would have to have her tested for it huh? Is it blood or through stool sample? And next question, how do they get rid of it if it is? Antibiotics? sorry for all the questions, but guess I need to get to the bottom of this. Princess has a stim this coming Thursday, do you suggest I have her tested for this parasite or whatever it is? I appreciate your comments so much, and thank you kindly. I hope Squirt is still swimming away---lol...too cute for words....Warmest regards and much love as always, xo (tight ones), Jeanette


Hi Jeanette,

Good to hear from you!

Two questions - 1) did it rain there just before she got sick, 2) are there other dogs close by?

When we were in TN, there were several other dogs in the neighborhood, back yard to back yard. Nearly every time it rained it seemed, Squirt got diarrhea that proved to be Spirochetes. The vet finally decided that one or more dogs above us had an infestation, would poop in their yard, it would rain and wash it all down in other yards. Squirt was more susceptible than the others for some reason, but all four of our babies there got them from time to time...always after a rain!

Just a thought!

Hugs,
Leslie and the girls :D - always

[mypuppy]

Hi there Linda,
Yeah, who would have know doggies get bugs from other doggies as well...haaa...I also read at my vets they give dogs flu shots as well. Wow! Hope its not the flu and Im too late. but anyway, I have already been giving her the rice and boiled chicken, so Im way ahead of you, but thanks anyway for the suggestion. I am waiting for any vet to call me back today and tell me what to do next. She is due for her stim on Thursday. I guess I will continue to give her her Vetoryl because if I don't it will mess up Thursday's stim. Again, she is eating, drinking and interacting just fine, so I don't get it. UGH...Got your email which I still need to reply to, sorry, but I promise I will soon. glad you are back from the holidays. Hope Brin is much better by now. Take care and talk soon...xo tight hugs, Jeanettes

Hi Jeanette,

Good to hear from you but sorry to hear about Princess. I also think it might be something she has eaten or a bug of some sort. Whether you have to stop the Vetoryl or not I would just feed her boiled chicken and rice for a day or two as it is easier on their stomach. Brin had an episode of diarrhea last week while we were on holiday and he is on antibiotics and a light diet. He was staying at my daughters and a day later her dog had the same thing, I never knew dogs could catch bugs from each other like humans do.

Hopefully you won't have to delay the ACTH for too long.

Linda x

[Squirt's Mom]

Hey Jeanette,

They do a stool sample...a smear, I think. Squirt would get anti-biotics and Metro....whatever it is for the diarrhea. :rolleyes::rolleyes: my memory! We also got this tube of stuff that looked like peanut butter to just keep on hand from the vet. It stayed in the fridge and kept fine for a long time...but can't remember what it was called; it was also for diarrhea.

The pool has been too cool for swimming lately. Our nites are finally cooling off! So we walk more now, much to the Queen's delight! :p

Hugs,
Leslie and the girls :D - always

[Rebelsmom]

Hi Melissa,
Thanks, I don't believe Princess has gotten into anything in the yard. I am always out there with her and she is not far from my range. another thing is that she is not your typical lab where anything and everything goes to the mouth. She has never had any interest for stuff in the yard, wouldn't you know it, no even grass. Now that's an odd lab if you ever heard of one. I will continue to watch her closely and see if it will resolve itself. She is due for her stim this Thursday. I will let you know how she continues to do in the next few days. As for chewing lately, I do notice her licking her paws a lot, but she seems to have always done that from time to time. Vet says its allergies. Her eyes are dreadfully teary, dry and gunky...Yuck, so I rinse them twice a day to help her get some relieve. Thanks again for your post. xo Jeanette

Rebel is closely monitored outside as well, he usually has an appetite for other animals poop! Gross I know. Weird thing is that he never ate grass before and I never saw him eat it. If she is otherwise acting normal it is probably just and virus of some sort which antibiotics should help with. I never found out what Sadie's was other than just some kinda stomach virus. I just spoke with the vet's office regarding her chewing on her feet. They want to see her but say it's just allergies (which I knew). She takes benadryl and Zrytec for them, she has the same runny eye problem and skin issues. Most resolved when we switched to the better food, but her feet seem to be an issue. I resorted to shaving her hair off her toe, cleaning with soap, adding neosporin and a bandage with the self adhesive wrap. Then I duct taped a sock over her foot and leg. It was quite comical but it worked at least for the day. She was extremely mad at me and wanted nothing to do with me for the rest of the day until I took it off.

[Rebelsmom]

I was also told by the vet that Imoduim AD can be given to them as well. This was told to me by my old vet, so who knows what you can trust there. Might be worth asking about though.

[jrepac]

U can use some Pepto for the runs as well....start w/one-half a teaspoon for a small dog

[Franklin'sMum]

Hi Jeanette,

Hey sweetie, I'm sorry Princess is having some tummy troubles :(. I remember something in Kim's thread for Annie about rice water. You boil some rice, and give the cooled down water from the rice. Just trying to think if it was for an upset tummy, nausea or diarrhea. Mental blank, sorry :o. It'd probably be back about 10-15 pages by now. I'll try and find it and get back to you.

Hugs to you all,
Jane, Franklin and Bailey xxx

[addy]

Hi,

I have had to deal with chronic diahrrea and colitis for 3 yrs. My Zoe will eat grass when her tummy hurts her. It is the only time she eats grass. If she has a runny stool but not more frequent squirty diahrrea I use pumpkin and rice instead of her food fo a meal or two. If she has squirty diahrrea I withhold food for 12 hours and then introduce small amounts of rice and pumpkin, Zoe weighs 18 pounds so I would feed 1/4 cup rice mixed with 2 teaspoons pumpkin, she would get this for 1 meal and then again six hours later until we can build up the rice to 1/2 cup with 2 teaspoons pumpkin. Slowly reintroduce her food as she could handle it. When that did not work, I had to bring out the metronidazole. Allowing their system to rest for 12 hours helps the most, I think. You can even go 24 hours but pump fluids then.

Hopefully, you won't need that:) Hoping things get better.

Addy







Addy

[Rebelsmom]

Hey Jeanette, how is Princess doing now? I know your ACTH test should be tomorrow. Did you have to reschedule?

[Spiceysmum]

Hi Jeanette,

Hope Princess is getting a bit better by now.

Linda x

[mypuppy]

Hi Jane, Linda, Melissa, Addy, Jeff and all,
Thanks so much for all your great suggestions. I kept Princess on the chicken and rice until today and I started to add a bit of her dry kibble as well (poor thing seems to be looking for more food with just the rice and chicken). So far she has tolerated it well and has not had anymore episodes of diarrhea since yesterday. I decided to keep her stim appointment as scheduled for tomorrow, as well as the nova stat profile--it's been a little over three months since her last stim so mommy needs to know what's going on inside at this point. I am hoping I will get her post by Friday if IMS cooperates. Thank you all once again for all your love and concern--right back at ya! Warmest regards. Xo Jeanette

[Rebelsmom]

That's great to hear Jeanette. I'm glad she's feeling better. Keeping my fingers crossed that her stim test is great.

[mypuppy]

Hi All again,
Don't have any stim numbers yet so I am guessing I will have to wait till Monday...darn....In the meantime, noticed Princess is back with her diarrhea episodes again, damn it. I have to ask, does anyone know if topical Baytril for ears can cause diarrhea, or tracolimus eye drops? I know it's a long shot, but I have been using these on her and thinking if this could be causing it? Also, I know I have read on forum I can give pumpkin for diarrhea. Can anyone tell me how much, a teaspoon, tablespoon and how often per day? Sorry for all the questions, seems I'm becoming a regular again--lol....Luv you all. xo Jeanette

[littleone1]

Hi my dear friend,

I don't about the meds, as Corky was on the oral Baytril. It didn't cause any problems for him. It actually helped him. I give Corky 1 tablespoon of pumpkin mixed in with his food. I really don't know how much to tell you to give Princess.

I hope everything will be better soon.

Give Princess big hugs and belly rubs from me.

Corkster and I love you bunches.

[Franklin'sMum]

Hi Jeanette,

Hoping Princess is feeling better. I've read people say they use either 2 tsp, or 2tbs of the canned pumpkin, but don't know exactly who, or the size of the pooch it was written about.

Here's Alison's post to Kim about the rice water for Annie (It was 24 pages back :))

If she is still drinking a bit then rice water might be the answer: http://en.wikipedia.org/wiki/Rice_water. Looks like you want to add about 1/2 teaspoon of salt to 2 cups of water. http://rehydrate.org/solutions/homemade.htm

Rice water is particularly recommended to stop diarrhea - which isn't Annie's problem. I suggested rice water because she might find it a lot more palatable than other rehydration solutions.
Alison

Other things that might be helpful are green beans or metamucil. They are some of the other magic diarrhea/constipation foods. The way they work is this, the fibre in the foods softens stools to help with constipation, but if diarrhea is the problem they soak up excess fluid in the intestines/bowels which firms up the poops.

Hugs
Jane, Franklin and Bailey xxx

[gpgscott]

Hi Jeanette,

I have not been one for waiting with diahreaa. I always used imodium at the advice of my Dr. and Moria was given the standard adult dose, one dose almost always did it.

Remember we were not giving cortisol lowering treatment.

Hoping she is better.

Scott

[Harley PoMMom]

Hi Jeanette,

I hope Princess is feeling better soon. Re; the tracolimus eye drops:


Possible Side Effects

Side effects are rare due to the very low
concentration of tacrolimus, and since
little of it is absorbed into the bloodstream.

If your pet experiences an allergic reaction
to the medication, signs may include facial
swelling, hives, scratching, sudden onset
of diarrhea, vomiting, shock, seizures, pale
gums, cold limbs, or coma.

If you observe any of these signs, contact
your veterinarian immediately.

http://www.drsfostersmith.com/Rx_Info_Sheets/rx_tacrolimus_ophthalmic.pdf


Sending healing thoughts for Princess and big hugs to both of you.

Love and hugs,
Lori

[mypuppy]

Thanks Scott. I was given an antibiotic and metradazinole for the diarrhea but have not used them yet. instead I gave her 2 tbsp of pumpkin with her brown rice and chicken since yest. She seems to be alright today.

On another note, I called my IMS to get her stim results. IMS is out till Monday but the results were available anyway. Here they are:
Pre Cortisol: 1.3
Post Corstisol: 1.5

Apparently, IMS left notes on chart stating her post is lower than she would want it to be and will follow up with me On Monday to discuss a dose adjustment. But if I am not mistaken isn't 1.5 within normal range for a cushpup. I realize it may be at the lower end of the scale, but My fear is we start messing around with dose adjustments again we risk a setback, and dealing with extra Stimson, etc.. Would love to get your comments anyone. Her chemistry panel was all Normal according to this dr. I spoke to today, but when I get a full copy I may post those just to make sure.

Best regards to all. Xo Jeanette

[mypuppy]

Thanks so much Lori,
I can't believe that. Wow. I need to give her the tracolimus daily for life but I guess to be on safe side will stop and ca
L vet on Monday to get an alternate eye drop. Ughhhh. how's Harley doing so far? love you lots. Xo Jeanette



Hi Jeanette,

I hope Princess is feeling better soon. Re; the tracolimus eye drops:



http://www.drsfostersmith.com/Rx_Info_Sheets/rx_tacrolimus_ophthalmic.pdf


Sending healing thoughts for Princess and big hugs to both of you.

Love and hugs,
Lori

[Harley PoMMom]

Hi Jeanette,

Dechra's Product Insert does say that a post between 1.45 ug/dl to 5.4 ug/dl, one is to continue on same dose. But if it were me and this was Harley having diarrhea episodes plus having a post on the low normal side, well, then I would hesitate continuing him on the same dose. Diarrhea can also be an indicator that cortisol is too low for that pup. Even though the stim numbers are saying it is within range the pup might need just a little more cortisol.

Love and hugs,
Lori

[labblab]

Oh Jeanette, I've gotta say that I agree with everything that Lori has just said. I know this will complicate things for you, because I'm thinking that right now Princess is taking 60 mg. capsules? And so a dosage change will mean a totally different capsule strength :(.

But Princess is right there at the "basement" as far as the therapeutic treatment range. And even if the diarrhea is unrelated, I'm thinking that at least a slight dosage decrease would be warranted...

Marianne

[mypuppy]

Dear Jane,
Thanks for the great tips. I have given her 2 tbsp of the pumpkin since yesterday, and she has not had anymore diarrhea today. in fact she did not have a poopy today at all. I'm guessing the rice and pumpkin binded her. I am going to start her on her dry kibble again tomorrow and see what happens. I will definitely keep your suggestions on hand for future problems. Thanks a bunch again. hope you and the little guy are doing ok. much love. Xo Jeanette

[StarDeb55]

Jeanette, I don't have a lot of time to go back through the thread, so is Princess on tacrolimus drops for dry eye, I assume? Was the dry eye diagnosed by a Schirmer's tear test? If so, the only alternative eye drop is cyclosporin. Normally, if dogs do have dry eye, they are put on cyclo drops first. If they have a poor response to the cyclo, they are moved to tacrolimus. Pups are also moved to tacro drops when the cyclo quits working for them. Both Harley & Chewy have been on cyclo drops, but then were moved to tacrolimus drops since the cyclo was no longer effective. Dry eye is an immune system disease, so both of these meds do have some degree of immunosuppression. From the link Lori provided:


Side effects are rare due to the very low
concentration of tacrolimus, and since
little of it is absorbed into the bloodstream.

I have a serious doubt that the tacro drops have anything to do with the GI upset that Princess' has been having trouble with, because the concentration of the drug is extremely low & not much is absorbed into circulation as the quote says. For instance, the concentration that Harley is using is .03%. Taking into consideration that he gets one drop in each eye twice per day, the amount of the drug that he is getting is literally infinitesimal.

I agree with everyone else that the basement numbers on her stim is what is causing the problem.

Hope this helps.

[Spiceysmum]

Hi Jeanette,

I agree with the others about the stim results. They are on the low side of normal and given that Princess went into remission before she could carry on going lower on the same dose. I know what a pain it is to keep changing and having to have further ACTH tests.

Hope the eye issues get resolved too, have you read Sas and Yunahs thread on 'Everything else'? It mentions another eye condition that Labs can suffer from. Probably nothing to do with what Princess has but its interesting.

Love,
Linda x

[littleone1]

Hi my dear friend,

I also agree with what others have said about Princess's dosage. If her cortisol level dropped that low, even though it is at the low end of the normal range, I know that I would consider a lower dose.

I'm glad the pumpkin and rice are helping her.

Give her a big hug from me.

Luv ya bunches.

[ktzndgs]

I was also told by the vet that Imoduim AD can be given to them as well. This was told to me by my old vet, so who knows what you can trust there. Might be worth asking about though.

I was also told by my IMS that I can give Imodium for diarrhea with Vetoryl. I wouldn't dare suggest a dose though. Best to check with your vet.

Kathy

[mypuppy]

hi everyone,
Well from all your comments it's seems like it's unanimous that I should consider a dose adjustment. geez! thank you all for that. My only doubt is that if a lot feel her diarrhea may have been based on her cortisol being low, why did she not experience diarrhea back when she was on the double dose (120mg), and her cortisol was even lower? her diarrhea has subsided and is acting just fine, actually has been. I am just so afraid of tampering again with dosing changes, more stims again, and the extra expenses. We are so tapped out, and it's not more the issue of the money here, it does make a dent but Im more concerned with setting her back and risk a relapse with returning symptoms. UGH. I will discuss with ims tomorrow and post accordingly on what is decided. Thanks again, and I said I would be a regular again didn't I? Xo Jeanette

[mypuppy]

hi Debbie,
how are you and the gang? Yes, Princess was put on the tracolimus for dry eye syndrome which was diagnosed through the schrimier test. That has been the only one she has been on, and her vet never put her on the other ones first. I guess I will call them tomorrow and ask for that one or maybe just keep her on the tracolimus. I wish over the counter Visine tears would do the job at this point. wonder if it could hurt to try. I mean they prescribe other human meds why not eye drops? Thanks again for taking time to write. best regards. Xo Jeanette

[labblab]

Hey again, Jeanette. I just wanted to clarify that I don't think her diarrhea is necessarily related to the cortisol level. (This is because after owning three Labs who find and eat ANYTHING gross, I am used to seeing barfing and diarrhea on a fairly regular basis...:eek:). But I think the low ACTH result -- in its own right -- is reason enough to consider a slight dosage decrease.

A couple of thoughts in that regard, though. If your current trilostane is in capsule form, maybe you could find a local compounding pharmacy that would "repackage" the contents into a different dosing strength. And secondly, even though I am usually a stickler about urging people to perform ACTH tests soon after any dosing change...I'm thinking that maybe you could wait a while to retest again, as long as Princess' symptoms seem to remain under control. If you decrease her dose a bit, you shouldn't have to worry about her cortisol dropping too low. And as long as her symptoms don't rebound, you can figure that you've found a good "zone" for her to be in. I don't mean waiting forever to test again. But maybe not for another month or even two, as long as she is looking good. At least maybe something to talk over with your IMS...

Marianne

[StarDeb55]

Jeanette, OTC drops such as Visine will simply help with symptoms, redness, build up of mucus, etc. The prescription drops are a must. This is because dry eye is an immune system problem where the immune system is attacking the lacrimal glands, slowing or stopping the production of tears. The prescription drops will help to suppress the immune system, allowing the lacrimal glands to do their job.

Debbie

[Rebelsmom]

I know everyone is referring back to the stim numbers, but is it possible that she has some kind of stomach bug and need the anitibiotics? I know you said you got some for her, did they test a stool sample? I think as long as she is feeling well other than th poop I would rule out other things before messing with her dose. Just my 2 cents.

Melissa

[mypuppy]

thanks Melissa,
Princess has not had any more diarrhea, and no we have not tested her stool at this point since she seems better. As you said, maybe a little bug???. Spoke to IMS today and she wants to lower her dose to 30mg which has me on edge right now. This just never gets any easier. Talk soon. Xo Jeanette

[mypuppy]

Hi again everyone,
Finally spoke to my IMS today, and her recommendation is to lower Princess's dose to 30mg. Whaaaaaaatttttt? I am having extremely mixed emotions/doubts about this option. Now we are going to half the dose, and what if that sets her back with returning symptoms? I am so torn here as to that drastic dose decrease, but feel these vets have got us by the gonads (pardon my vulgarity), if I don't agree to this, she will either say go find a new IMS and I cannot get any refills on Princess's Vetoryl. So again, damned if I do, damned if I don't. Sorry for the venting moment here, as much as I realize it is always best to be on the conservative side, I can't help but wonder if this will be like starting all over again. Ughhhhhhhhh. Warm regards. Jeanette

[labblab]

Jeanette, had Princess previously been on 60 mg. once daily? If so, I agree with you that cutting the dose in half does seem like a big drop...:o Are you using compounded trilostane or brandname Vetoryl? Even if you are using Vetoryl (which I know is only available in more limited dosage strengths), you could still combine 30 mg. and 10 mg. capsules to arrive at a more incremental decrease. Although, by the same token, you can also use the same strategy in reverse -- go ahead and drop to 30 mg. and if the symptoms rebound, start adding back 10 mg. at a time. Of the two "evils," maybe your IMS is just really worried about Princess dropping two low since that has happened previously. And she figures you can increase again later on if the symptoms reappear. Just babbling here -- but I do understand why you are feeling "iffy" about a big decrease.

Marianne

[mypuppy]

I hear ya Marianne,
Right now I 'm in the "what to do" mode here? Honestly I should feel blessed it's a decrease and not an increase, if anything, but a lot of other personal issues, my IMS being an hour away doesn't help much either and just the financial aspect takes a toll at times. I want to do the right thing and rest assured, I won't give up on my pup no matter what it takes, but it does get terribly draining at times, as you well know. I will sort this out when Im in the right frame of mind and continue on our journey. BTW, this is the first time Princess had been on the 60mg since the 120mg dose, and she is on the Vetoryl brand, not compounded. Thanks again for "babbling", and don't ever stop doing so, ya here. Xo Jeanette

[mypuppy]

hi again Debbie,
Spoke to gp today regarding the eyedrops, and apparently reason they never put Princess on the Optimmune drops before the tracolimus is because they have proven the tracolimus is more effective for the kcs than the other drops, and so their practice only supports/prescribes the tracolimus. I also asked regarding the possibility of diarrhea as a side effect and he said it was highly unusual unless ingested. this is it for now. Thanks again for your concern and feedback. Xo Jeanette




Jeanette, OTC drops such as Visine will simply help with symptoms, redness, build up of mucus, etc. The prescription drops are a must. This is because dry eye is an immune system problem where the immune system is attacking the lacrimal glands, slowing or stopping the production of tears. The prescription drops will help to suppress the immune system, allowing the lacrimal glands to do their job.

Debbie

[littleone1]

Hi my dear friend,

I understand what you're saying. You can vent all you want.

Even though Corky's cortisol level keeps rising, when this happens, there are definitely signs that appear, but they are in no way as drastic as when he had the full blown symptoms. They are very mild as compared to what they were, but you'll be able to tell if Princess's cortisol level is rising.

Take care.

[Franklin'sMum]

Hi Jeanette,

Sending hugs and thinking of you.
Jane, Franklin and Bailey xxx

[mypuppy]

Thank you so much Terri and Jane,
I am still sleeping on my decision to lower Princess's dose. Gosh, she is doing so wonderful I hate to mess it up. My gutt says stay the course but it will complicate matters if I do anyway. I feel so stuck. Thanks for your support always. love you both and those babies. Xo Jeanette

[Franklin'sMum]

Hi Jeanette,

Honey, you are such a good mum, and we know you'll consider every possible angle before you do anything. Whichever way you decide to move forward is what's right. Princess could not possibly be in better hands.
Big Squeezy Hugs,
Jane, Franklin and Bailey xxx

[mypuppy]

Awwww Jane,
That means so very much. We can only do so much right and God knows it's never enough it seems. Thank you kindly. We love you bunches. Xo Jeanette and the Princess

[Squirt's Mom]

The Queen is wondering how the Princess is doing today? :p

[mypuppy]

Haaaaaaaaaaaaaaaaaaa,
Hi Leslie,
Please tell the Royal Queen that her precious Princess is doing wonderful, thank you. I placed the order for her lower dose of Vetoryl (30mg) and will start her in a couple of days. I hope my IMS know what she's doing here. How are you and the Squirt? Warmest regards and Tight ones. Xo Jeanette

[Rebelsmom]

Glad to here she is still doing well Jeanette. I hope everything works out with the 30mg. That would so scare me to be changing again. Call me if you need anyting.

Melissa

[Spiceysmum]

Hi Jeanette,

I'm sure you will quickly notice if the new dose is too low and can adjust it back up gradually. I know how hard it is to make these decisions, not just from a financial point but because you want it to be right for Princess. I'm sure she will be fine, she's got the best Mum, sorry, Mom ha ha!! Sending best wishes to you both.

Love,
Linda x

[mypuppy]

Hi everyone,
just received Princess's new Vetoryl (30mg) and will be starting her tomorrow morning. Please keep everything crossed that this will be a positive change for her. in the meantime, I have her chemistry results and want to make sure they seem normal to you. I appreciate any comments and thank you sooo much. Xo Jeanette

ALT. 55. Ref. Range. 12-118
AST. 30. Ref range. 15-66
BUN/ creatine ratio. 13. Ref range. 4-27
Total T4. 1.5. Ref range. 1.0-4.0
Alkaline phos. 61. Ref range. 5-131
Creatinine. 1.1. Ref range. 0.5-1.6
Bands. 0. Ref range. 0-300
Eosinophils. 616. Ref range. 0-1200

[Roxee's Dad]

Hi Jeanette,

Very Nice, all the numbers seem to be within the reference ranges :D:D:D Keeping all fingers and paws crossed here for Princess on her new dose. :)

[labblab]

Yup, just what John said about those numbers! :)

Listen, kiddo, I definitely understand your discomfort with dropping Princess clear down to 30 mg. I would have wished for a different recommendation, myself. But just remember that your vet can always prescribe some 10 mg. capsules to add in the event that Princess starts showing some symptoms again. :o

In the meantime, fingers crossed that she'll do just fine on the 30's, though!!!

Marianne

[Squirt's Mom]

Hi Jeanette,

Everything looks good but one thing did catch my eye. The T4 is getting pretty low. We know that hypothyroid can cause the same signs so that reading made me wonder if perhaps her thyroid is acting up. Of course, sick euthroid syndrome might be a consideration as well. :rolleyes: Don't mean to cause you concern! Remember I am NOT a medical person but am just putting my thoughts out here for consideration. Some of our more knowledgeable members will have better insight on things. ;)

The values we associate with Cushing's look really good! :D

Hugs,
Leslie and the girls :D - always

[mypuppy]

Thanks John, Marianne and Leslie,
I feel more at ease now that I received your comments.

Leslie, thanks for pointing out the t4 seeming low, however if Princess was experiencing any thyroid issues would I not be seeing the symptoms that go along with hypothyroidism? I had asked my IMS specifically on the t4 because back when she was going through the initial diagnosis testing her gp suggested she was borderline hypothyroid due to a low t4 also. In turn I asked my ims's 2nd opinion and she said she was not hypothyroid. UGHHHHHHHH. I left it that when I read several times about the sick euthyroid theory, which I still do not understand fully. What other symptoms would I be seeing if Princess was hypothyroid? Hope all is well and thanks for your concern. I don't mind you pointing out anything that seems unusual. Luv ya all. Xo Jeanette

[StarDeb55]

Jeanette, the only way to determine sick euthyroid is to have a free T4 by equilibrium dialysis done. If that comes back normal, it's sick euthyroid. I have an understanding with the boys GP that anytime a T4 is done & it's low, he adds on the free T4 to confirm.

Debbie

[gpgscott]

Hi Jeanette,

It is my understanding that the t4 needs to be interpreted along with tsh (thyroid stimulating hormone) a low normal t4 with a normal tsh is OK but a low normal t4 with an elevated tsh is indicative of hypo thyroid. The main symptom which led to our checking Moria's thyroid function was larengeal paralysis but there are a host of other symtoms. I would ask why a tsh was not also done.

Hoping the dosing change works out well.

Best to you and Princess. Scott

[Harley PoMMom]

I left it that when I read several times about the sick euthyroid theory, which I still do not understand fully.


Euthyroid sick syndrome (ESS), also known as sick euthyroid syndrome, refers to the condition in dogs in which concurrent nonthyroidal illness (NTI) causes suppression of serum concentrations of circulating thyroid hormone without true pathology of the thyroid gland. Decreased concentrations of T4, and to a lesser degree fT4, with ESS can be misleading and result in an erroneous diagnosis of hypothyroidism. Although the exact mechanism of this syndrome is unknown, it is believed to be a protective mechanism of the body during NTI to decrease cellular demands by slowing metabolism.

Euthyroid sick syndrome can be associated with endocrine disorders such as hyperadrenocorticism, hypoadrenocorticism, and diabetes mellitus, as well as any significant organ disease, particularly renal failure and liver disease. Cardiac failure, hemolytic anemia and infectious disease are also etiologies of the ESS.

http://usa.leventa.com/Vet/euthyroid.asp

Hope this helps. :)

Love and hugs,
Lori

[mypuppy]

Thanks Debbie, Scott and Lori,
Wow, all this brings me back to October '09 when Princess had the free t4 and cTSH which is when my gp suggested Princess to be hypothyroid but IMS said not necessarily. Scott based on your recent comment regarding the lower/normal free t4 with an elevated tsh which seems to have been Princess's results from Oct. '09 I am wondering if perhaps my IMS overlooked her results and Princess is in fact hypothyroid. I feel as if I have wasted an entire year without treating her. Ugh. I will post those results from October '09 again here in the hope that someone can shed some light. Thanks again.

Free T4-Ed (ng/dL). 1.2. Ref range: 0.7-3.7 ng/dl
Free T4-Ed (Pmol/L). 15.4. Ref range: 9.0-47.4 pmol/l
CTSH. 0.45. Ref range: 0.05-0.42 ng/ml. Flag: High

Comments:
increased canine tsp values may occur in dogs with untreated primary hypothyroidism. Sick euthyroid dogs are expected to have low normal tsp concentrations. Secondary or tertiary hypothyroidism (pituitary or hypothalamic lesions) are reported to occur in less than 5% of hypothyroid dogs.

[gpgscott]

Jeanette,

I do not have Moria's report at hand but from my memory these numbers look similar to me and Moria benefitted greatly from the thyroid supplementation.

Scott

[labblab]

OK guys, I'm probably being really dense here, but as long as Princess is not exhibiting any symptoms consistent with hypothyroidism and her most recent T4 is within normal range and basically still at the same point as the testing back a year ago (1.2 then and 1.5 now)...why are we worrying that there is a problem?

Jeanette, hasn't Princess been doing really well recently? Or is she still having some unresolved issues?

Marianne

[labblab]

Jeanette, I just went back to the point in your thread where you had posted these results last year, and this is a response that Glynda offered at that time:


...I dug through my paperwork on interpreting hypothyroid testing and I found a paper by Michigan State University Diagnostic Center for Population and Animal Health. They stated that they were aware of a few circumstances of normal thyroid hormone concentrations with elevated thyroid stimulating hormone. There are possibilities they have probably yet to learn but they state:


Spurious elevations in TSH are occasionally seen both as a laboratory artifact and as a non-repeatable physiological anomaly. These two possibilities are identified by submitting a repeat sample for analysis. Physiologic explanation for this pattern of test results include recovery from significant non-thyroidal illness when that illness had been associated with low serum thryoid hiormone concentrations, and recovery from a reversible sulfa-drug-induced hypothyroidism. In these instances, elevated serum TSH concentrations are observed as the pituitary encourages the suppressed thyroid glands to return to function. A similar finding might follow withdrawal of prolonged thyroid medication from a dog which had normal thyroid function."

I goes on but basically but the best approach to this type of result is to retest at a later date.

I freely admit that I know next-to-nothing about thyroid testing, but if you do still feel concerned about Princess' thyroid function, maybe you'd want to ask your IMS whether the more complete panel should be repeated one more time? But maybe she'll say "no," as long as her T4 is still within normal range and she isn't having any problems...

Marianne

[mypuppy]

Marianne,
You are far from being dense lady. I am in agreement with you, if Princess is not exhibiting any symptoms that would point to hypothyroidism why should we be digging for more? That's where all this gets totally confusing and frustrating. However, for that peace of mind perhaps I will redo the Ft4 and tsh again with my gp and see what we come back with. Thank you for extracting Glyndas info. From a while back, everything helps. Greatly appreciate your help. Tight ones. Jeanette

Thanks again Scott. I understand about the results and I have read also if t4 is low and tsh elevated it points to hypo. However, as Marianne pointed also Princess's t4 one year ago was slightly lower than the most recent t4, and according to ims it falls within the normal range. I am curious if there was a way for you to post Morias results if they are readily available of course. Thanks again. Xo Jeanette

[lulusmom]

I was able to find one of Moria's test results in an archived thread; however, the reference ranges were not available. Using the reference ranges you posted for Princess, the Ft4 is low and the TSH is high which is consistent with a diagnosis of hypothyroidism.

T4=1.0
TSH=1.64
Free T4=8

[mypuppy]

Hi everyone,
oh boy, maybe I am reading too much into things since I switched Princess's dose, but geez, Princess gave me the strangest, scariest look yesterday as if I was one big tasty steak or something. Yikes! And today after dinner she kept coming around her bowl and licking it, something she has not done in quite a while. Everything else is the same, but I will be watching closely. Geez! Xo Jeanette

[mypuppy]

Glynda,
So sorry, I meant to thank you for posting Morias thyroid results. UGHHHHHHHHHHH:(:mad: One more thing to add to this madness. Luv ya Baby Doll. Xo Jeanette

[mypuppy]

Hi there to all my very special k9 family and their babies,
Some of you may have been wondering how we are doing since my puppy's thread has been a bit quiet. I have been trying to keep up with some of the threads regardless, and also wanted to briefly update on Princess's status. She has been doing great on the lower dose so far with no return of symptoms. She is scheduled for her next stim on Nov. 3rd. that will be the real test. I am hoping for a better post than last in order to continue the path we are on. For now I am extending my warmest love to you and your babies and alwAys pray for their continued good health. I love you all. Tight hugs. Jeanette and the Princess

[Harley PoMMom]

HI Jeanette! :)

We have missed you and hearing about Princess, I am very happy that your update is a good one. Will be keeping everything crossed that Princess's stim results are within range too.

With much love and (((hugs)))
Lori

[labblab]

I just want to "second" Lori's well-wishes!! I'm so glad to get this update, and I too will be beaming positive thoughts for a perfect stim test next week...:) :) :)

Marianne

[Franklin'sMum]

Hi Jeanette,

Sending best wishes and good thoughts for you and Princess. Will be keeping an eye out for updates.
Lotsa love,
Jane, Franklin and Bailey xxx

[mypuppy]

Hi everyone,
Just got Princess's stim results. Good and normal results, however I wish I would be a more enthusiastic but can't because just yesterday I noticed several round, bald patches on Princess's back and not sure if she's losing her hair due to the cushings or something else. of course I thought of ringworm but have never seen it or know what it would look like so she is scheduled for a vet visit tomorrow. My other logical theory is a slow thyroid. I have a friend who strongly feels I should get her thyroid checked again considering she has developed new symptoms pointing to hypothyroid. Her eyes are awful and mucous filled and red all the time even with the eye drops, she has developed acne or sores under her jaw, has put on some weight and now these sudden hair patches. hoping for some light as to what this it. but anyway her pre cort was 1.2 and post was 2.3 on the 30mg of Vetoryl. hope you are all well and the babes also. tight hugs Jeanette

[Squirt's Mom]

Hi Jeanette,

Good to hear from you and nice numbers! :)

When was Princesses last CBC? It might be worthwhile having that done if it has been a while.

Here is some info on ringworm in canines:

http://www.marvistavet.com/html/body_ringworm.html

http://www.peteducation.com/article.cfm?c=2+1557&aid=471

http://www.newmanveterinary.com/Facts%20About%20Ringworm.html

Let us know what the vet has to say today!

Hugs,
Leslie and the girls :D - always

[Spiceysmum]

Hi Jeanette,

Glad to see the numbers have gone up a bit since the dose change, great results! Sorry can't help with the other problems but hoping you get some answers soon, poor Princess, one step forward two steps back!

Love,
Linda x

[mypuppy]

Hi again everyone,
Took Princess to vet today for the new hair loss issue. She has developed more lesions. vet diagnosed it as pyodermia and gave cipro oral antibiotic for 14 days and a special shampoo twice a week. luckily it was not anything more serious or ringworm. vet said she could have picked up the bacteria at groomers or vets. geez I hope she didn't pick up yet a new one at today's visit. Yikes. So this is it for now. Leslie thanks from the bottom of my heart for all those links you posted on ringworm--you are a doll. And Linda, thanks for your concern as well. I know I owe you an email--been crazy as usual. Your are all in my thoughts always. I love ya. Xo Jeanette

[clydetheboosmom]

Hi there -

I'm sorry that Princess has developed a bacterial infection issue, but glad its not ringworm!

Hope all is well with you!!

Lynne, Clyde & Bailey

[Sabre's Mum]

Hi Jeanette

Great that the vet has diagnosed the pyoderma. Just a warning ... if it doesn't go away you may need to get a culture and sensitivity test as some may be resistant to certain types of antibiotics. When Sabre had pyoderma we had to give him two strong antibiotics to knock it on the head ... however he did have a deep pyoderma!

This is from the Merck Veterinary Manual


The primary treatment of superficial pyoderma is with appropriate antibiotics for ≥21 and preferably 30 days. All clinical lesions (except for complete regrowth of alopecic areas and resolution of hyperpigmented areas) should be resolved for at least 7 days before antibiotics are discontinued. Chronic, recurrent, or deep pyodermas typically require 8-12 wk or longer to resolve completely.

So my personal advice would be not to stop the antibiotics too soon ...

All the best
Angela and Flynn

[mypuppy]

Hi All,
Wanted to post results for Princess's last stim which was yesterday. IMS has recommended lowering her dose again now to 10mg/day from 30mg, and stim in 2 weeks. Does anyone feel Princess may be sensitive to Vetoryl since I know from her past history her post cortisol number has always resulted on the lower end of the scale? Any thoughts would be kindly appreciated. Thanks and Luv you all...xo Jeanette

Here are her numbers:

Pre Cortisol: 1.2
Post Cortisol: 1.5

[labblab]

Hi Jeanette!

How is Princess behaving these days? How are her Cushing's symptoms, and how does she otherwise seem to be feeling?

Also, just to remind everyone, her most recent previous ACTH testing was in early November, and the results then were 1.2 and 2.3, right?

Marianne

[mypuppy]

Hi Marianne,
Nice of you to comment, thank you. Princess is quite fine which is what is mind boggling about her and cortisol. Eating, pooping, peeing, playing fine, and no cushings symptoms. And yes, her last stim was in November, 2010 with pre of 1.2 and post of 2.3 on the 30mg of Vetoryl.

This is always fun, isn't it? Thanks again. xo J.

[zoesmom]

Hi Jeanette -

Given how Princess is doing - acting well and showing no symptoms - I probably wouldn't drop the dose from 30 to 10 mg. Maybe to 20 or 15 mg. would be better? It's a crap shoot many times. Do you use the vetoryl brand or do you use compounded? If compounded, that would make it even easier to drop to 20 or 15 mg. Otherwise, guess you'd have to give two 10 mgs. if you wanted to do that. Personally I always liked having a combination of strengths on hand so that I could 'tweak' Zoe's dose up or down if needed. Of course, Zoe's dose was so high that a little 'tweak' wasn't a big deal. With a low dose like Princess is on, not that much wiggle room. You'd have to do it with 10 and 5 mg caps. Glad she's doing so well though, especially with those sorta low numbers! With the 1.0's, I'd definitely be hesitant to keep her at 30 mg. for too much longer. Sue

[labblab]

Thanks for this additional info, Jeanette. I do realize that your IMS doesn't want Princess' cortisol to drop any further, but since Princess is doing so well with a cortisol level at this range, like Sue, I also worry about cutting clear down from 30 mg. to 10 mg. daily. The drop over three months from 2.3 to 1.5 doesn't seem like an enormous one to me, so I'd be thinking that you'd want to be tweaking the dose downward instead of dropping it so significantly. But if it turns out that the 10 mg. doesn't control her sufficiently, then you can always go back up to 20 mg. If the 10 mg. does end up working adequately, then great.

I'm just really pleased to hear that Princess is doing so well. And although it is frustrating, I don't think it's that unusual for dosing changes to continue as dogs remain on trilostane over time. Just one of the joys of treatment :o...

Marianne

[mypuppy]

Hi Marianne and Sue,
Everything you both said makes a lot of sense to me. The challenge will be getting it to make sense to my IMS. I left a message for her, but won't hear back till Monday as she is out till then. Thank you both so much for your inputs. Are we having fun yet? :mad: LOL. I will post again next week after my IMS and I come to some mutual agreement, but in the end, she rules I suppose.

Love ya. xo Jeanette

[Spiceysmum]

Hi Jeanette,

Here we go again! It's so hard to know what to do isn't it, especially when Princess is doing so well. As you know, when Spicey's post result dropped to 0.9 and she went into remission she was acting fine and there was no way we would have ever known without the ACTH test. For that reason only I probably would drop to 10mg because I know the last time Princess went into remission, from what I remember, she didn't show any outward signs of being too low either. Sorry to confuse the issue! I know between you both you will decide which is the best way to go.

Love to you and Princess,
Linda x

[littleone1]

Hi Jeanette,

I can understand why your IMS wants to lower Princess's dosage. Dropping 20mg a day does seem like alot, but they wanted to increase Corky's by 20mg a day. The 10mg might work well for Princess. Since Princess is going to have a stim test done in 2 weeks, that should give you a good idea how she is doing on the 10mg.

Love ya bunches. (((HUGS)))

Terri and Corkster

[mypuppy]

Hi there Linda,
Yes, here we go again, and you don't confuse me at all. I know exactly where you are coming from. And right you are again. When Princess dropped too low we would not have known it had it not been for the stim. As Sue mentioned in her earlier post this is a total "crap shoot". Just when you think things are a bit under control, here come more decisions to make--ughhhhhh. I am still amazed that for Princess's weight and size, we are at 10mg. Wow! Will let you know what is decided on Monday, but chances are I will go conservative again and go down to the 10mg. Hope all is well, and please know there's an email in the works--lol. Luv ya. Xo Jeanette

[mypuppy]

Hi Terri,
A 20mg drop does seem a bit much. I just get worried about setting her back with returning symptoms, but as I mentioned in my last post I guess it is better to take the conservative approach and work up than risking worse. I really wasn't expecting to stim her so soon--the expenses are adding up, but I know it must be done. Just wish these tests were not so expensive considering they are done so frequently. Maybe someone will come out with some type of at home stims and put these vets out of business--lol. Thank you for your advice. hope you and Corky are doing well. luv ya both. Xo Jeanette

[mypuppy]

Hi again Sue,
Forgot to mention Princess is on the Vetoryl brand. Thanks again. Xo Jeanette


Hi Jeanette -

Given how Princess is doing - acting well and showing no symptoms - I probably wouldn't drop the dose from 30 to 10 mg. Maybe to 20 or 15 mg. would be better? It's a crap shoot many times. Do you use the vetoryl brand or do you use compounded? If compounded, that would make it even easier to drop to 20 or 15 mg. Otherwise, guess you'd have to give two 10 mgs. if you wanted to do that. Personally I always liked having a combination of strengths on hand so that I could 'tweak' Zoe's dose up or down if needed. Of course, Zoe's dose was so high that a little 'tweak' wasn't a big deal. With a low dose like Princess is on, not that much wiggle room. You'd have to do it with 10 and 5 mg caps. Glad she's doing so well though, especially with those sorta low numbers! With the 1.0's, I'd definitely be hesitant to keep her at 30 mg. for too much longer. Sue

[mypuppy]

Hello friends,
Just wanted to update quickly on Princess. She started on the lower dose of Vetoryl (10mg) this past Saturday. I finally spoke to my IMS, and wanted to share some information we discussed which I have never come across on tis forum. My IMS mentioned the possibility if Princess's cortisol continues to drop in the near future and since Vetoryl does not come in a lower dose, we may have to skip her Vetoryl 1-3 days in between and even consider stopping it altogether. WOW! It is clearly obvious what a dramatic drop Princess has made since we started her treatment (from 120mg to 10mg). I find it amazing and at the same time worrisome. Does anyone here agree? Thanks to all for your continued support. I find myself repeating this one too many times but "Princess and I wouldn't be here without you" I Love you all for that and so much more. tight hugs. Xo Jeanette

[lulusmom]

Hi Jeanette,

In my opinion, you aren't going to have to worry about dropping the dose again or discontinuing treatment. I'm betting that the opposite will happen. I think the cortisol will increase and you'll have to increase the dose. I am baffled as to why your IMS felt it necessary to drop the dose by 2/3rds. As Marianne had already mentioned in a prior post, the drop in cortisol from 2.3 in November to 1.5 in February is not a huge drop nor a worrisome one. I'd be a lot more worried if that drop happened in only 10 to 14 days and/or if the basal cortisol had also dropped. It didn't drop and stayed static at 1.2 ug/dl.

Apparently your IMS does not treat tiny dogs because if she did, she'd know that their meds are routinely compounded due to their wee size. Not that I think you'll need a smaller dose but I believe you can get whatever dose of "Vetoryl" you need from a veterinary compounding pharmacy. Diamondback Drugs in Scottsdale, AZ is one of many compounding pharmacies that can do this.

[Spiceysmum]

Hi Jeanette,

I have just read (very quickly, obviously too much time on my hands!) through your entire thread and can see a pattern emerging again! In September you were worrying about having to half the dose again. It seems like when Princess has been on a new dose for a few months her results go really low. I hope she stabalizes on the 10mg dose but it wouldn't surprise me if she goes into remission again. That might be a few months down the line yet but whichever way it goes I know you will decide what's best for her, with a little help from all of your friends here!

Linda xx

[Franklin'sMum]

Hi Jeanette,

Nothing to add except more hugs and support for you and Princess :)
Jane, Franklin and Angel Bailey xxx

[clydetheboosmom]

Hi Jeannette -

I finally am starting to get caught on on people again, and wanted to check on you, and saw your most recent posts. I want to share something with you -

Bailey is an AmStaff Terrier and she has been on Vetoryl. She started off at 120, then went down to 90, then 60 then 30 and then 30 every three days, and now she is on "prn" Vetoryl. Tufts IMS/Endocrinologist told me that there is not enough research sometimes to know how dogs will do on long term use...Bailey has been using Vetoryl since first diagnosed. She went Addisonian three times, possibly four, with the Trilo.

So, I guess I just wanted to tell you that "stuff" can happen that is off the track....I watch her and her cortisol levels carefully, but so far (knock on wood) she is still on "PRN" use.

Hugs to you and God Bless -

Lynne, Bailey and Angel Clyde

[mypuppy]

Lynne,

So glad to hear from you again, and thanks for checking in. I do remember you saying about your baby having gone into Addisons several times. What dose was that on if you don't mind my asking? also sorry for my ignorance but what does "prn" Vetoryl mean? So far Princess is doing ok on the 10mg, but it hasn't been two weeks yet so time will tell. Will keep you posted. I hope you and your babies are doing well on your end, and it's been a while but Im sending you some of those very tight hugs. luv ya, Jeanette

[mypuppy]

Awww Jane,
Thanks for adding your hugs and support as always. That's all one can wish for. You are so dear. I hope you and your precious button nose Franklin are doing well these days. Tight hugs and much love. Xo Jeanette

[StarDeb55]

Jeanette, in medical lingo, prn means when needed or as necessary.

Debbie

[mypuppy]

Debbie,
Nice to see you back- you just couldn't stay away huh--lol. Thanks for defining that term. maybe Princess will be one of the lucky ones to go that route. Warm regards to you and the gang. Xo Jeanette

[mypuppy]

Hi friends and furbabies,
Princess is doing well on the lower dose of Vetoryl (10mg). I have been keeping up to date with all your babies, and still keeping you and them in my prayers.

I also thought it was time to update some pics, so I have created a new album for your viewing. Enjoy and love you all.

xo Jeanette and the Princess

[Squirt's Mom]

Hi Jeanette,

I keep up with all your posts, too, but there just aren't enough of them for me! ;)

Even tho I am the world's worst at keeping in touch with folks, you and Princess are on my mind often and in my heart always. It is ALWAYS good to hear from you. And it is especially good to hear that Princess is doing well! :D

Hugs,
Leslie and the gang

[labblab]

Oh Jeanette, it's great to hear from you and Princess!!!! :) :)

I'm so glad that she's doing well, and I love the new pictures. :D :D

It's always so good to get an update from you, and it's especially good to get a "good" update! :p

Many hugs to you and your big, beautiful girl ~
Marianne

[mypuppy]

Awwww Leslie,
Don't say another word...I know exactly what you mean--we wish there were more hours to our days. You and the babes mean the world to me. Thank you for your sweet thoughts always.

Lots of love...Jeanette

[mypuppy]

Marianne,

How dear to hear from you. You are always there to cheer me on, and make my girl feel so special--it means sooo much to me. I am so glad you enjoyed the new pics. Wish I could see some of yours.

You are the sweetest!
Love ya...Jeanette

[labblab]

Jeanette, I finally do have a few pics uploaded to my own album now. :)

It took me forever, but I finally got it done! :o

Marianne

[Roxee's Dad]

Hi Jeanette,

Really good to hear from you and very happy that Princess is doing well. Love the new pictures and I can feel the love emanating from them. :)

[Truffa's Mom]

Yeyyyy good to know our pretty Princess is doing OK. Always thinking of you... time to sleep around her but for sure I'll go get "my fix" later on Princess new album, and for sure I'll have to follow your good example uploading pics of my Truffa.
Tons of smooches

[mypuppy]

Dearest Marianne,

I simply loved your album--I was in Lab heaven:). Please recap For me, are Peg and Luna still with you and which one is your cushpup? Sorry, brain dead here. BTW, I think a chocolate lab would make a wonderful and colorful addition to your Lab assortment---LOL.

Love you and your babies, all three of them. RIP Sweet Barkis.


Xo J

[mypuppy]

Hi John,

Great to hear from you as well--it's been a while. Glad you enjoyed my pics, and you could not be more correct--that Princess sure does get her fair share of sheer love around here and then some. What can I say, she is so hard to resist. They all are, aren't they? Hope you and your babes are doing well yourselves.

Xo J.

[mypuppy]

Marcela, thanks so much.

Would love to see some of your precious Truffa. Can't wait. I think of you often as well. Xo J.

[Rebelsmom]

Great pictures Jeanette. So glad to hear Princess is doing well.

Hugs and belly rubs from us.

[labblab]

Dearest Marianne,

I simply loved your album--I was in Lab heaven:). Please recap For me, are Peg and Luna still with you and which one is your cushpup? Sorry, brain dead here. BTW, I think a chocolate lab would make a wonderful and colorful addition to your Lab assortment---LOL.

Love you and your babies, all three of them. RIP Sweet Barkis.


Xo J
Jeanette, thank you so much for asking about my babies! Sweet Barkis was my Cushpup. He was diagnosed in late 2003 and had several good months after starting trilostane treatment. Unfortunately, we subsequently lost him to what we assume were the effects of a rapidly enlarging macrotumor. Our hearts were broken, but one month later, baby Peg was born in the fall of 2004. We were not even thinking about getting another puppy at the time that she was born. But by the time she was ready to leave her mom right around Halloween that year, things in the universe just worked out and we were lucky enough to bring her home with us. :)

Two years ago, we decided she needed a baby sister, and that's when Luna joined our family, too. Neither Peg nor Luna are Cushpups, but you better believe that I've always got my eyes open watching them and every other dog I see for possible Cushing's symptoms :o. Once you've joined the Cushing's family, I think you're a life-long member! (But that's also a really good thing, too, considering the incredible friendships that I've made along the way. ;) :))

And you'd better hush about adding a chocolate to the mix, 'cuz hubby has already started lobbying to add a brown boy to the family pack! But mom is not ready for another new baby quite yet!!! :eek: :eek:

Tons of hugs to you and to beautiful Princess,
Marianne

[mypuppy]

Oh Marianne,
How sad for Barkis and your family. It is heartbreaking to say the least. I give you and so many others here so much credit for getting right back on that horse and having the heart and courage to bring another fur baby into your lives after losing another. The way I feel at this moment for my Princess it seems as if I will never be able to love another. All I can think of is that I will try to compare and obviously that would not be fair to another baby. I know I shouldn't think of this right now and I honestly never did, but after the cushings diagnosis it has been difficult to focus on the positive all the time. Like I once said in one of my very earlier posts, it is walking on eggshells. Nevertheless, I do count my blessings every single day and thank God for gracing me with my Princess's life in mine, and feel Strongly this is what was meant to be. I am hoping I will love again after her but maybe not for awhile. I'm sorry for your sweet Barkis. I truly am, and I know you will forever hold him dear to your heart. Peg and Luna are irresistible together--just too cute for words. You must have so much fun watching them play and romp around together--so priceless. As for that chocolate addition, I totally hear ya, maybe way down the road you will be ready. Went to my local shelter today and wouldn't you know it there was a Princess up for grabs. unfortunately and sadly enough she has a lot of aggression issues, and I can tell from the moment I approached her. My heart simply dropped because here I have the sweetest and kind natured lab at home, and because of some bad owner this other has to suffer for his dumb ignorance--it is so unfair. unfortunately with a very active little human one at home, it is not a challenge or risk I would be willing to take at this point, but I still left there extremely saddened. Sorry it took awhile to get back to you, oh and btw, I would love to hear more on all your babies, are you kidding me, if and when you ever have the chance.

take care of you and please give those precious labs lots of kisses from aunt Jeanette and some licks from cousin Princess.

I love you all. Tightest hugs. Xo Jeanette

[mypuppy]

thanks Melissa,
I'm guessing Rebel is doing great as well. hoping Sadie's problem will soon be resolved too. Let's text soon.

lots of luv. Xo J.

[mypuppy]

Hi friends,
Nothing to update, other than Princess has become a bit finicky about her dry kibble or canned food, but put a nice, big, juicy steak in front of her and well you all know what happens next--lol. I was curious if anyone here has been feeding a raw diet to their pup, and if so which one and if your pups encountered any problems with it, ie, stomach upset, diarrhea or intestinal parasites? I have been hearing so much on this diet and how well dogs do on it, and how much better it is to solve food allergy issues, which I believe Princess may be having, the constant red ears and red and teary, gunky eyes. I also heard there are some dog food distributors out there who also offer a canned homemade food. If anyone has any experience or info on any of these and has time to comment I'd appreciate it so kindly.

And as alwAys sending warm regards and love to you and your babies. Xo Jeanette

[StarDeb55]

Jeanette, I fed Primal raw to both Harley & Chewy for around 1 1/2 years. Harley, my finicky eater, would even eat it pretty well as long as it was one of the poultry flavors & not beef or something similar. I know Glynda feeds her whole pack Primal, & absolutely swears by it. Unfortunately, I had to quit using it when I realized I was spending about $125 monthly for dog food. It's not cheap by a long shot, & I'm thinking, "Holy cow, the dogs are eating better than the human!" I'm now feeding Chewy Orijen senior formula formula kibble as it's 100% grain free, & has quality protein + carbs. Chewy has pretty bad allergies, & I wanted him off all grains, so decided to try this one. On dogfoodanalysis.com, most Orijen foods have a "6 star" rating.

I dont' know if I've asked you previously, but when it comes to Princess" gunky eyes, it's possible that it may not be allergies. Has she ever been checked to make sure she doesn't have dry eye? It's a very simple test, Schirimer's tear test that takes less than 5 minutes to perform. A dog with dry eye must be on eye drops permanently to help them make sufficient tears to protect their eyes. Long term untreated dry eye can lead to corneal scarring & permanent blindness. This is what has happened to Chewy as the eye vet & I figure that he was never treated for dry eye until he got into rescue. Dry eye is not uncommon in dog's with severe allergies as it's an immune system issue, too. Barkley, Harley, & now Chewy all had dry eye. 2 of them of course were cushpups, 2 had severe allergies. The immune system is so important that it can really cause serious problems when it's not firing on all cylinders.

Debbie

[mypuppy]

Hi Debbie,
Thank you for your prompt reply and all the great information on dog food. I hear ya on how expensive the high quality foods are. Princess has been on Merrick for over 6 years now, and for some reason she always had a sensitive stomach and Merrick has been the only food that she can tolerate without throwing up, but now she is starting to get tired of it I guess (can't blame her). Would you be able to comment a bit more on the Primal raw you fed your pups. Is there anything special to do to it before it is fed? Does the raw food need to be mixed with a dry kibble or will it provide all the dogs nutritional value if fed alone? Did your dogs experience any stomach discomfort or diarrhea or vomiting on it? And lastly I guess did you notice your pups allergy issues resolve after starting the new diet? I'm sorry for all the questions, but I felt the need to do my homework before I take the plunge and start messing with diet changes. I will also try to pm Glynda and try to ask more info from her. I almost forgot, thank you also for pointing the dry eye condition. We did discuss a while back, but I know it is hard to keep track at times. princess does suffer from it and is on the tracolimus twice a day. I find at times it doesn't seem to do the job because of the gunk coming out of it. at some point I think she will need an eye specialist, but again thank you so much again for posting.

Warm regards to you and the pups. Xo Jeanette

[StarDeb55]

There is absolutely no need to supplement the Primal with anything, even kibble. I did not transition either dog to the Primal, pretty much made the switch "cold turkey", & really didn't notice any problems. I can't say that it helped with Chew's allergies a whole lot, but who knows. When it comes to cost, it is considerably more expensive than Merrick's. Depending on what type, a 4 lb. bag of frozen nuggets will run $20-$25. I was feeding little guys compared to Princess, & using 4 1/2 bags a month.

When it comes to the dry eye, have you tried cyclosporin eyedrops for Princess? With the gunkiness in her eyes, she may not be responding to the tacrolimus. IMO, it sounds like a repeat tear test is in order to check this. When I first adopted Chew, he was on cyclosporin eyedrops which appeared to me to not be terribly effective. The first time I took him to the eye vet, my suspicion was confirmed, his tear test in both eyes was horrible. That's when he got moved to tacrolimus eye drops. He is also on an antibiotic + steroid eyedrop, now, too. The steroid is to see if some of corneal scarring will thin down to where he might regain a little vision. Even if he could tell light vs. dark, it would help.

Debbie

[lulusmom]

Hi Jeanette,

I researched the heck out of the commercially prepared raw food diets to make sure whichever one I chose was going to be complete and balanced. There are some raw foods out there that are to be used to supplement the dog's normal food. I never understood why anyone would want to do that. The last thing I wanted to do was be grinding up organs or throwing chicken necks at the dogs. :D I like easy and the foods like Primal and Natures Variety couldn't be any easier. Put breakfast in the fridge the night before to thaw out, wake up and serve. Then I put dinner in to thaw at breakfast time. I do nuke it for just a few seconds to take the chill off.

My dogs went cold turkey with no transition. My fosters go on Primal the minute they walk through the door and I've never had one bout of loose stools because of it. They get anything but high quality in the shelter so they come home quite often with soft stools but they firm up within 24 hours. Buster's allergies cleared up almost immediately as did his colitis; however, his tear staining and foot chewing has gotten worse in the last couple of months.

I hope this helps.

[mypuppy]

hi again Debbie,
Princess has never been on the cyclosporine eye drops. The tracolimus was the only eye drop prescribed when they did the dry eye test. i will take your advice and will have her eyes retested and ask to try the cyclosporine. As for the steroid drops, would it be advisable for me to put Princess on any steroid with the cushings?

Getting back to the raw diet, I went into the Primal website and used their feeding guideline calculation, and it seems Princess would have to consume 32 of their nuggets---yikes!!:eek::eek: Wonder how much that will run me a month, but it is peace of mind if she does well on it and enjoys the flavor? Will let you know what I decide. Again, thank you sooooo much for your help.

Xo Jeanette

[Eskimo'sMom]

I am in your exact situation" Exactly. Wish I could help more but just wanted to let you know.... I know exactly how you feel. Overwhelmed, what meds, do I med, and crying. Eskimo was diagnosed just last Thursday. I have yet to meet with her vet who is away for ten days.

[Rebelsmom]

Hey Jeanette, I changed Rebel and Sadie over to Acana pacifica a year ago. It has been a blessing, Sadie had really bad allergies. From runny eyes, stuffy breathing to scratching herself raw. Since changing to the pacifica it has all gone away for the most part. Sometimes she still requires a benadryl here and there but nothing like she was. It costs me around $60 a month for the 2 of them.

[mypuppy]

Hi Eskimo's mom,
Thank you for your recent post, but please fill us in a little more on what is going on with your puppy. I will have to go directly to your thread and read up a bit. I am so sorry for Eskimos cushings diagnosis. My pup was diagnosed over a year and a half ago, and as you was overwhelmed, crying hysterically all day and night and depressed. after joining this forum with such loving, knowledgable, caring, dog loving human beings, I did a 360 for the better and realized I had to face this head on and learn as much as possible in order to treat my baby, and fortunately my baby has been treated successfully for over a year now. thank God for these people--you will find out for yourself exactly what I mean. Please do not despair as hard as I know it is to keep it together. Stay on and ask questions And I promise things will start falling into place for your Eskimo. be patient with all this and with yourself. I won't paint a pretty picture and tell you this is one easy ride because it is far from that, but it is certainly NOT the end for your baby if you take the proper measures to educate yourself and proceed with caution. I am sure the others have already posted a world of valuable info on your thread to lead you to your dogs treatment. thank you for your support and I hope you accept mine and the others here. the beauty about this forum is the wonderful people behind it. We try to help one another because we are all in the same position or have been at some point. Hang in there and God Bless you and your precious pup.

some tight hugs as well. Xo Jeanettw

[mypuppy]

Hi Melissa,
How are you and the kids--lol? I remember when you switched over to acana (the smelly fishy one right?)--lol. I think at this stage I am looking into the raw diet for Princess. I really think if I try another dry kibble, no matter how wonderful it is, she may turn away from it. I know there are so many great quality kibbles out there but I just think she needs more substance and variety and the raw diet seems as if it may satisfy this goal. right now it looks like I will try her on Natures Variety also called Instinct. I hope it will be an easy transition as I am going to try it cold turkey. she has become very finicky lately and it is becoming a very stressful chore. I need to nip this before it gets worse, specially for Princess. Hope you and the pups are doing well. How is Sadies leg doing? Take care and warm and tight hugs to all of you. Xo Jeanette

[Rebelsmom]

Hi Melissa,
How are you and the kids--lol? I remember when you switched over to acana (the smelly fishy one right?)--lol. I think at this stage I am looking into the raw diet for Princess. I really think if I try another dry kibble, no matter how wonderful it is, she may turn away from it. I know there are so many great quality kibbles out there but I just think she needs more substance and variety and the raw diet seems as if it may satisfy this goal. right now it looks like I will try her on Natures Variety also called Instinct. I hope it will be an easy transition as I am going to try it cold turkey. she has become very finicky lately and it is becoming a very stressful chore. I need to nip this before it gets worse, specially for Princess. Hope you and the pups are doing well. How is Sadies leg doing? Take care and warm and tight hugs to all of you. Xo Jeanette

Pups are doing ok. Sadie has an appt on Saturday to get some more information on her leg. Took them to beach on Sunday, great for them mentally but not so good on the leg. Rebel is a trooper, can't complain except he is a little finicky too. He just thinks that if he eats I'll leave, so I have to sit with him and act like I'm just chilling and he eats! Spoiled brat is what he is. I saw commercials for natural wet food that's in the dog isle and I saw it at walmart. A little refrigerator at the end of the isle with food and treats. I bought some of the treats and the pups love them! Let me know how it goes.

[mypuppy]

To ALL my dear and very special friends and fur babies,

After much consideration and due to some time conflicting personal circumstances it comes with great regret to inform you I will be leaving the forum indefinitely. It goes without saying that is is certainly not a final goodbye for I know I my heart will always be guiding me back here and checking in on all of you and my very special fur babies who have made such a huge, special and life long difference in my and Princess's lives. I know Cushings brought us together as one, and I know we will ALWAYS be connected in the same way. I have been so blessed and touched deeply by all of you and your babies, and each and everyone of you have enriched my life with your deep love, compassion, concern, encouragement, sincerity and friendship toward me and my Princess. I will forever hold each of you and your babies way deep in my heart. I love you all so very much. Take care of yourselves and please give those babies many sweet belly rubs from their auntie. Thank you everyone again for
the gift of life for my Princess. God Bless. Xo and tights hugs.

Jeanette and Princess

[labblab]

Oh Jeanette, we will miss you and Princess very much while you are away. But I do hope that you will return soon. And I also understand that sometimes we all need to take a break from our "internet families" so that we can devote important time and attention to our "in-house families"...:o :o

I truly hope that there is nothing going on that is a problem for you and your loved ones. But instead, that you just need some time to yourself right now. We'll be here waiting and watching for you, whenever you have the time and opportunity to check back in. I hope it will be sooner rather than later, because you will be sorely missed!!

In the meantime, many, many hugs to you, Princess, and the rest of your family. :) :) :)
Marianne

[Spiceysmum]

Jeanette,

I too will miss you here and hope that it is nothing too serious keeping you away. You have been a good friend to many here, including myself. We will always be here if you need any advice for Princess. Hope she is still doing well. Love to all.

Linda x

[mypuppy]

dear Linda and Marianne,

You are both just so sweet, why it makes it so much harder to break away from here. I appreciate your support, and promise to keep in touch either way. Love you gals so much. All my love.

Xo Jeanette

[Franklin'sMum]

Oh Jeanette,

I too hope that you just need some time and space, and that nothing is seriously wrong with you or your family.
Hugs to you my friend,

Jane, Franklin and Angel Bailey xxx

[mypuppy]

happy easter to all my special friends and babies....

I am praying for the blessing of good health for all our pups and peace for those who have gone before us...

Tight hugs. Xo

jeanette, princess £ family

ps: Me, stay away? So much for that. :)

[Harley PoMMom]

Dear Jeanette,

Happy Easter to you and your family! Sending huge and loving hugs your way.

Love and more hugs,
Lori

[addy]

Dear Jeanette,

I hope everything is okay. We will miss you.

Hugs,
Addy

[Spiceysmum]

Hi Jeanette,

Happy Easter to you all too. Lovely to see you back!

Love,
Linda x

[mypuppy]

Hello friends,

I take the opportunity to update on Princess's stim yesterday.

Pre: 4.5
Post: 5.3

As much as I know the post no. Is within Dechras range (slightly), unfortunately Princess symptoms have gradually returned. I was unable to speak to my IMS today but she informed the tech we do not need to do anything because her no. Is normal. However, I suppose she neglected to take into consideration that I told her Princess had returned symptoms:confused: This is where AGAIN we get into the issue which for some reason with Princess seems to be pattern, do we treat the numbers or symptoms? I asked vet to leave message for my IMS to call me next week to discuss further. At this point my heart is leaning toward adjusting her dose considering Princess seems a bit uncomfortable, specially at night.

Everyone, hope you and all your babies are holding your own and well. You have all been greatly missed while I have taken a bit of time off, but not glad to be on this ride again.

Take care of you and those precious bandies.

Tight hugs. Xo Jeanette and Princess

[labblab]

At this point my heart is leaning toward adjusting her dose considering Princess seems a bit uncomfortable, specially at night.

Hi Jeanette!

Remind me, is Princess being dosed once daily right now? With an acceptable ACTH result but a rebound of symptoms especially later in the day, it might be the case that she would be a good candidate for twice daily dosing. In that event, it's not so much that she needs a significant increase in her once daily dose, but rather that she would benefit from having the medication spread out more throughout a 24-hour time period. Here's the relevant quote from Dechra's U.S. Product Insert (http://www.dechra-us.com/files/dechraUSA/downloads/Product%20inserts/Vetoryl.pdf):


However, if clinical signs are not controlled for the full day, twice daily dosing may be needed. To switch from once daily to twice daily dosing, increase the total daily dose by 1/3 to 1/2 and divide the total amount into two doses given 12 hours apart.

Can you tell us how much trilostane Princess is taking right now? And also a bit more about the type and timing of her returning symptoms?

Thanks!
Marianne

[lulusmom]

Hi Jeanette,

Marianne was reading my mind when she posted so as usual, she's saved me lots of key strokes. :D Your thread is scarey long for a slow reader with comprehension challenges like me but as luck would have it, I only needed to go back a few pages to find what I was looking for. Last month you mentioned that Princess was getting finicky with her kibble and canned food. Cushdogs with high cortisol don't usually become finicky so can you tell me what symptoms are you seeing right now?

[littleone1]

Hi my dear friend,

I am also inclined to go along with Marianne's suggestion of the possibility of twice daily dosing. Corky's dosing schedule has been modified twice now since his symptoms weren't being controlled throughout the day. Hopefully, you will be able to get some answers from your IMS.

We all need to get off of this roller-coaster ride for awhile.

Lots of hugs and belly rubs.

Luv ya bunches,

Terri and Corkster

[mypuppy]

Hi Marianne, Glynda, Terri, and glad to get your inputs--they help me get a bit prepared for when I speak to my IMS, who usually seems to have a different plan in mind.:rolleyes:

Princess has been on 10mg once a day since February 26 and was doing fine without any symptoms up until about a week ago when I started noticing more water consumption, then looking for more food, although what dog doesn't look for more food huh? Haaaa, and of course my dead give away something is off with her is her sneaking out of my bedroom in the middle of the night to lay on dining room cool floor and drinking more water. Glynda, you are right, close to a month ago she became very picky with her kibble and even her cooked chicken. at that point that is when I stArted seeking alternatives as to a different diet altogether., ie, raw, grain free kibble, home cooked, etc. She wanted no part of raw--:(, so I successfully switched her to Orijen grain free and I cook some meats for her each night just to entice. She is doing fine now but I'm also guessing it's because of symptoms.

i will discuss twice daily dosing next week with my IMS, but in the event she agrees, what dose per day are we looking at according to Dechra? Sorry, not good with calculating this stuff:eek:. I was thinking going to 20mg (10 in the am and 10 pm).

The question is will my ims go for it? So this is it. Thanks again for your help, and yes, get me off this dang ride for a while please. Lol.

Xo Jeanette

[labblab]

Thanks for this additional info. We know from past experience that Princess has a history of bottoming out on her cortisol, so I do think you want to be cautious about upping her dosage prematurely. If these changes have only been going on for a week, you may want to wait it out for a little longer in order to maker sure that this is a genuine pattern for her. But if so, then I think trying twice daily dosing would make sense.

Since 10 mg. capsules are what you have on hand, I know it would be easiest for you to add another 10 mg. at night. But I would be afraid of doubling her total daily dose -- once again, especially because of her past history. Per Dechra's published recommendation, I don't think you'd want to go any higher than adding another 5 mg. to the total daily dose. Maybe you could stick with your 10 mg. in the morning, but add another 5 mg. at night. Or you might want to just start slowly with 5 mg. both morning and evening. I can't remember if you are using brandname Vetoryl. If so, you are stuck in that they do not make a dosage unit that small. So you would have to either order a compounded trilostane product, or find a compounding pharmacy that will repackage Vetoryl into smaller doses for your use.

As far as talking with your IMS about the dosing question, perhaps she would be interested/willing to discuss twice daily dosing with Dechra. I can't remember if you've already had occasion to speak with Dr. Tim Allen -- he's a vet who serves as a technical representative in Dechra's Kansas office. A number of us have spoken with him over time, and I'm sure he'd be happy to consult with you or your IMS about Dechra's dosing recommendations and how they would apply in Princess' case. Since twice daily dosing is a published option of Dechra's, I would hope that your IMS would be willing to give it some consideration. Here's contact info for Dechra:

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

Marianne

[Squirt's Mom]

Hi Jeanette,

Good to see you around more!

Please be sure to have her blood sugar and thyroid levels checked as well. Needing to entice a cush pup to eat is just not the norm - tho we do have babies that seem to like to do just the opposite of what they are supposed to! :rolleyes::) Thyroid and blood sugar irregularities can affect appetite so have those checked before increasing her dose.

Hugs,
Leslie and the gang

[littleone1]

Hi Jeanette,

I personally wouldn't want to double Princess's dosage. When Corky went to Bid with Trilo, his dosage was only increased by 6mg a day.

I would get in touch with Dr. Allen and get his feedback on it. When Corky went to TID, Corky's IMS spoke with Dr. Allen, and they decided on what the dosage increase should be.

It's better to be safe than sorry.

(((HUGS)))

[mypuppy]

Thanks everyone. I appreciate all your great advice. It all makes sense, but of course very difficult what to decide on this end. I actually contacted Dr. Allen after your replies, and his suggestion was to consider doubling her dose to 20mg BID. Princess has always been on the brand Vetoryl so as Marianne pointed out, I guess Im stuck since they do not make anything less than 10mg. Blehhhhhhhhhhhh! Tune in for more next week as to what we decide.

Leslie, when you suggested to have her blood sugar and thyroid are you trying to r/o diabetes and hypothyroidism since symptoms are very similar? Just asking:eek: As for having to persuade Princess to eat, she has always turned her nose up for dry kibble, this is why I have always had to mix a little something in with it. But I throw a piece of plain old steak in her bowl, she would not have a problem devouring it, cushings or not. She loves her people food for sure.

Thanks again everyone. Talk soon Im sure.

Xo Jeanette

[Squirt's Mom]

Hi Sweetie,

What I am thinking is that blood sugar and thyroid imbalances can affect the appetite - whether too high or too low, the desire to eat can be lowered. It is rare for a pup who's cortisol is high NOT to be driven to eat - anything, everything, all the time. There are always exceptions to the rule but before increasing, and certainly before doubling, her dose I would want to be sure those values were normal.

I had always said that Squirt was such a Miss Piggy that I would never be able to rely on her appetite as a guide. Man! Was I wrong! :eek: When her signs started kicking in, there was no doubt THIS was what a cush appetite looked like. She was not just wanting more food when her bowl was empty or another treat, she cried at the door to go out and search for things to eat - this was after spending hours scrounging inside for the merest crumb. She gulped her meals down with barely breath between bites and then would get frantic when it was gone. She would charge Moe, who outweighs her by 40 lbs, if she even thought he had something edible. The look in her eye was heart-breaking; as if she blamed me for trying to starve her and she couldn't understand why. :( There was no question in my mind that her cortisol was rising to an uncomfortable level.

If her problem that she simply doesn't care for the kibble and wants human food - well, that is a whole new ballgame! :p That means she suffers from the same affliction as mine - the dreaded SR, Spoiled Rotten! :p

Hugs,
Leslie and the gang

[mypuppy]

Hi Leslie,
Your posts certainly always make me laugh. I hear ya on that cushings appetite, and Squirt takes the grand prize for that. Wow! That Squirt sure has the appetite of 100 cushings dogs put together. Haaaaa. And btw, I can definitely contribute Princess's pickiness to the SR syndrome. :D. The name Princess suits her finely, trust me.
On another note, I understand what your saying related to the other tests. I think I need to act quickly because her symptoms seem to be progressing. I don't think I should wait too much longer before considering a dose increase. Will keep you posted. In the meantime give those babies some belly rubs from auntie, and please take a great, big hug for yourself.

Xo Jeanette

[Spiceysmum]

Hi Jeanette,

Sorry you are in this position again, trying to decide which way to go. Perhaps it will be ok going to 10mg twice a day as she was on 30mg when she went low so somewhere in between might be enough to keep the symptoms at bay, let's hope so.

Thinking of you often so it is good to hear from you even though it is for the wrong reason!

Linda x

[mypuppy]

Thanks my dear Linda,

I've missed you much also. I'd knew in my heart I would be back but as you said for the wrong reasons, but it is what it is, as you and all the others well know here. I spoke to Dr. Allen and he too highly suggested going up to 20mg BID, but now I have to convince my IMS. Without her agreement I get no pills:mad:. UGHHHHHHHH. I will keep you informed soon. I hope you and your loved ones and Brin are doing great. I miss and love you.

Tightest hugs. Xo Jeanette

[labblab]

Jeanette, if Dr. Allen has given you the green light to add a 10 mg. evening dose, then I truly hope your IMS will be willing to talk to him about Princess. She may have reasons of her own for wanting to pursue a different course, but Dr. Allen is such a great resource that it seems a shame for her to disregard twice daily dosing without at least discussing it with him.

Marianne

[mypuppy]

Marianne,
I agree. I am hoping my IMS keeps and open mind when I speak to her on Monday, because as I mentioned earlier she decided on not taking any action based on Princess's numbers and seems to be disregarding her symptoms.

Thanks for your support. Xo Jeanette

[mypuppy]

Hi friends,

Just spoke to IMS, and discussed Dr. Allen's suggestion on doubling Princess's dose. As I suspected she is not convinced and point blank said she will not change her mind based on Princess's normal stim......UGHHHHHHHHH. :mad::mad::mad: She recommends a urinalysis to rule out anything else, so off to get some pee:D. in the meantime Princess is very miserable with symptoms. I hope we can stabilize her again real soon.

Are we having fun yet?

Warmest regards and love, Jeanette

[labblab]

Since I am not a vet, I feel uncomfortable criticizing the decisions of vets. But I am really puzzled as to why your IMS is choosing to disregard twice-daily dosing as an option. It is not a novel approach, by any means. Virtually every current researcher and protocol with which I am familier discuss twice daily dosing in a situation like this, when a dog's 4-hour ACTH results are within the desirable range but symptoms are rebounding later in the day. We already know that it is an option that Dr. Allen (representing Dechra) would recommend. Additionally, here is a summary about the approach used at the UC Davis veterinary school (found on page 3 of the following article):

http://veterinarynews.dvm360.com/dvm/article/articleDetail.jsp?id=460965&sk=&date=&pageID=1



The UC-Davis current recommendation is to initiate trilostane therapy at 1 mg/kg once daily. That dose is continued for about one week until a veterinary re-check can be completed.

Owners are instructed to collect a small urine sample from their dog before leaving home the morning of the scheduled re-check prior to trilostane administration. Trilostane should then be given and the dog should be seen by the veterinarian two to three hours later.

The goal of therapy is an owner who is completely pleased with the response. As aids in achieving this goal, both urine and blood tests are indicated. The urine should be checked, at a minimum, for specific gravity, glucose and urine cortisol-to-creatinine ratio (UCCR). An ACTH stimulation test should be started at the time the dog is seen, again about two to three hours after trilostane administration.

The UCCR result should be within the reference interval and the post-ACTH serum cortisol concentration should be between 1.5 and 5.5 mcg/dl.

If the serum-cortisol concentration is within that goal and the UCCR is abnormal, the medication should be given BID [twice daily]. If the serum-cortisol concentration is too high, the trilostane dose should be increased. But if the serum-cortisol concentration is too low, the dose should be decreased.

This approach should be used at each re-check until the dog is doing well.

Since your IMS is interested in testing a urine sample, perhaps she'd consider running a UCCR (urine cortisol:creatinine ratio), as discussed in the UC Davis article. This test (on a urine sample obtained first thing in the morning before the daily trilostane dosing) can provide a clue as to whether a dog's cortisol level is rising too high during the latter part of a 24-hour cycle -- hence, the need for twice daily dosing. We've been told that the accuracy of this test can be improved by testing a pooled sample of urine specimans collected (and refrigerated) over a three-day period.

I can understand how frustrating this situation is becoming for you, seeing Princess in discomfort. And I truly do not understand your IMS's resistance to trying twice daily dosing, given its acceptability among the Cushing's veterinary community...:(

Marianne

[Squirt's Mom]

Hi Jeanette,

I am so sorry your vet is not willing to be more open-minded or listen to you concerning Princesses signs in spite of the numbers. That certainly makes more difficult for you. :(

I like Marianne's suggestion of the 3-day UC:CR - IF your IMS will consider that. If not, maybe someone else would. ;) I would find out before I collected the urine tho just in case it doesn't need to sit for long - not too well versed on things like that. :o

You are a great mom and I know you will do whatever it takes to make sure our Princess is getting the best of care. If it will help, you can tell her IMS that Queen Squirt said she better get it right - that's a royalty she is dealing with! :D

Many hugs,
Leslie and the gang

[mypuppy]

Thanks Marianne and Leslie,

I'm just as dumbfounded with my IMS, and very upset. I have agreed to do the urinalysis as per her suggestion, and if that comes back normal, I will suggest the UCCR or bring up Dr. Allen's opinions once again. If she won't listen then, I will be seeking an alternate IMS.

Xo Jeanette

[littleone1]

My dear friend,

I wish you were closer so you could take Princess to my IMS. When Corky went to BID, she is the one that suggested it. When I asked her about TID, she conferred with Dr. Allen. She is always willing to go the extra mile and do what's best for Corky.

I'm hoping that you will be able to get things resolved.

Give Princess lots of belly rubs from me.

Luv ya bunches.

[LacubriousDogs]

I haven't read through this entire thread (90+ pages!) but in seeing how Princess is turning her nose up at dry kibble, I wanted to mention that my Baby did the same thing when we first started the Trilostane. I of course thought it was a reaction to too much, but my smart DH tried wetting her food and she ate it. she basically refused ALL hard food and treats and that's when we figured out that her ears were infected! All that crunching must have been painful. So we treated that and now she is accepting the hard kibble again. Just a thought...

[mypuppy]

Hello All,

Princess and I just got back from gp visit for a urinalysis. They found small trace of blood, and was prescribed Simplicef 200mg once a day for 14 days. Here are some other results from today.

nitrite - negative
Urobilinogen - normal
Protein - negative
Ph - 6.5
Blood - trace (10) small
Specific gravity - 1003
Ketone - negative
Bilirubin - negative
Glucose- negative

Microscopic exam:
RBC's - 5-10
Epithelial cells - 3-5

The gp's main concern was the small trace of blood and her specific gravity. Any comments while I hear back from my IMS? Thank you anyone. Xo Jeanette

[Harley PoMMom]

This is JMO! Blood in dog urine is most likely due to an simple infection that can be treated with antibiotics but I believe antibiotic therapy should be based on culture and sensitivity testing.

Hoping the UTI clears up fast.

Love and hugs,
Lori

[lulusmom]

I agree with Lori. With a USG of 1.003, Princess is not concentrating her urine which means the white blood cells are probably going to be diluted out. This is a common thing in cushdogs and a urine culture should be done to determine the full extent of infection as well as which bacteria is involved so that the appropriate antibiotic can be prescribed. If the urine specimen was collected by free catch, the sample could be contaminated or have microscopic debris in it. Did you collect the urine yourself or did the vet?

[mypuppy]

Hi Lori,
So nice to hear from you. I hope whatever this is will be resolved with the antibiotics, otherwise, back to the drawing board...:mad:

I did start Princess on her antibiotics today, and I will keep everyone updated on her progress, God willing.

In the meantime, I hope you find yourself well these days.

luv you dearly...xo Jeanette

[mypuppy]

Hi all,

I just received a very disappointing call from my IMS based on Princess's urinalysis results today. Without jumping the gun, she mentioned the possibility Princess may have developed DI (diabetes insipid us), and will have to be tested for it if her symptoms do not resolve on the antibiotics by next Monday. Truth is, I am quite devastated to hear this right now. Makes me wonder if this is only the beginning of what lies ahead for my Princess. I don't want to seem as if I am overreacting, but I can't help but feel quite disillusioned about my baby's quality of life now. I ask for your prayers in that this is a simple infection which will resolve.

Thank you friends for all your support and friendship.

Xo Jeanette

[Squirt's Mom]

Hi Jeanette,

Of course, you have all the support I can send your way!

I admit I don't know a lot about DI but I am wondering why she suspects it? Is it because of the accidents?

Keeping you in my thoughts,
Hugs,
Leslie and the gang

[lulusmom]

Hi Jeanette,

DI is a very rare condition and in my opinion, until you rule out lack of control of cortisol throughout the day, which is a more likely suspect, it is too early to pursue a DI diagnosis. I am intimately familiar with DI and have researched the heck out of it as Jojo has the kind that does not respond to treatment. He has sucked up water and peed buckets since the first day I brought him home. I was really disappointed that the PU/PD never resolved with treatment but everything else did and he was much happier. Most dogs with DI do respond to treatment so what Jojo has is even more rare. If Princess actually has DI, she would probably respond to treatment and her quality of life would be fine so please don't assume the worst. Did your IMS explain any of this to you?

[labblab]

Jeanette, can you be as specific as possible about the symptoms that have returned for Princess? Are they limited to excessive thirst and urination, or are you seeing a return of other problems that had previously been controlled by the trilostane? Also, can you tell us more specifically about the timing -- is she thirsty and peeing throughout the day, or mainly only in the afternoon/evening/night?

If the problem is limited to thirst and urination (throughout the day), then a UTI definitely seems plausible. And as Lori and Glynda have said, unless your vet obtained a sterile urine sample in order to culture for the type of bacteria, I'm not seeing how a UTI can be ruled out even if Princess does not respond to the Simplicef -- it may just not be providing the right antibiotic coverage for her "bug."

However, if the thirst/urination is rebounding mainly late in the day and if you are also seeing a return of any other Cushing's symptoms, I'd still be wondering about ineffectively controlled cortisol as opposed to leaping ahead to DI. Keep in mind that even if it were to be DI, it can be effectively treated. We've had other members here whose Cushpups also suffered from DI. So please try not to feel downhearted about this. I really do believe that things will improve once the real source of the problem is identified!

Marianne

[mypuppy]

Hi Marianne,

I started to gradually notice Princess drinking a bit more during the evening. This onset began close to one week and a half ago to possibly two. As I said it slowly moved on to more drinking and skipping out of the bedroom during the night to drink and be let out. Notice her looking for more food here and there and her scrounging around the yard. She doesn't want to lay in her bed or carpet, only hardwood. She has always loved her bed, specially during the night when her symptoms were controlled. Up to the present moment, she does drink all day and night. I truly feel it is a cortisol issue but with that normal range it has been close to impossible to convince my IMS. however, seeing this trace of blood in her urine, I am not 100 percent positive it is cortisol related. I'm thinking could it be related to me messing with her diet changes, trying raw and she may have some infection from feeding raw??? Sorry for perhaps sounding a bit ignorant. I truly wish I was had the extensive knowledge as most of you on all these issues so that I can firmly speak up for my dog and make demands to best treat her.

I think I will try communicating with my IMS via phone or email sometime today and express all the concerns you and the others have brought forward without jumping to DI. i thank you from the bottom of my heart for being so quick to help and support me on this journey. Xo Jeanette

[Squirt's Mom]

Hi Jeanette,

I am so glad to see Glynda and Marianne's post this morning. My first thought when you said the IMS was thinking DI was, well, not very charitable toward her - I thought "she is determined to find SOMETHING so that Jeanette won't be right about Princess needing twice a day dosing."

You are dealing with a KNOWN (Cushing's) and a POSSIBILITY (UTI) that both can cause excess urination and drinking. It makes much more sense to me to first rule out the KNOWN as the cause and then confirm the POSSIBILITY of the UTI via sterile sample than to go looking for a third, and rare, UNKNOWN.

My position is this - my doctors and my babies vets work for me not the other way around. ;) I respect their experience and education but I also demand that they respect me and my knowledge of my body and my babies - because NO ONE knows those things better than I. A few years ago, I went to see a new doc who proceeded to tell me he didn't believe in hypoglycemia so I could not have that condition - I was diabetic! HUH?!?! :confused: Needless to say, I never darkened his door again.

Sending you strength, hope and love!
Hugs,
Leslie and the gang

[mypuppy]

Leslie,

I am very accepting of strength, hope and love right now, thank you darling. I can't believe that doctor!:eek: He obviously didn't study your chart prior to your visit with him. I too would run for the hills...LOL...:eek:

I completely agree regarding Princess's IMS. I am making it my goal to change that situation soon, but need to stick it out a little while longer, God willing.

Sending you and the babies tight hugs and belly rubs..

Love you too....xo Jeanette

[addy]

Sorry for perhaps sounding a bit ignorant. I truly wish I was had the extensive knowledge as most of you on all these issues so that I can firmly speak up for my dog and make demands to best treat her.

Oh Jeanette, I have been following along and when I read this part, I just wanted to reach out and give you the biggest HUG!!!!!!

I think you are doing a wonderful job and I think I know how you feel about tangling with an IMS you know you need at the moment:(

Anyway, I am here to just give you moral support and THE BIGGEST HUG because you sound like you need one!!!!

Hugs,
Addy

[littleone1]

I am sending positive thoughts and prayers that Princess does not have DI.

I'm glad we had a chance to talk yesterday. I don't blame you for wanting to find another IMS.

(((HUGS)))

[Spiceysmum]

Hi Jeanette,

I think all of the symptoms are more likely to be because of Cushings or an infection too. Hope you can convince the IMS of this.
We are off to the seaside in the caravan (lol) for a few days so will catch up when we get back.

Thinking of you all.

Linda x

[mypuppy]

Awwwww Addy,

You are so very sweet. That BIG hug was heartfelt, thank you so kindly. I will get through this somehow for my Princess's sake.

Love you dearly and thanks again.

Xo Jeanette

[mypuppy]

Hi Linda,

You are always here behind the scenes to cheer me on. I too strongly believe this is all cortisol related. We will get to the bottom of this, I promise.

Enjoy your (RV)--LOL mini vacation with your lovely family. We shall plan on an email upon your return.

Love you much alwAys.

Xo Jeanetts

[mypuppy]

My dearest Terri,

it was lovely to hear your voice yesterday, and to learn you are one of our new forum hosts. :).

Keep Princess in your prayers in that she will beat the odds with this new possibility of having DI.:(

All my love to you and my Cork.

Xo Jeanette

[mypuppy]

Hello to all my dear friends and babies,

I am sorry it seems it has taken a while to update on my Princess, as I am sure a lot of you have been wondering how she is doing. Princess just ended her two weeks on Simplicef and 7 days on the ddavp trial injections. We performed another urinalysis yesterday, and we still found some trace of blood, but her USG went up from 1.003 a week ago to 1.012 yesterday. Spoke to my "lovely" IMS today:D, and her plan was to continue on the injections and perform a cysto. I had a different plan:D. I insisted on having her stimmed and perform a mini blood chemistry panel. To my surprise, she agreed:eek: Therefore, before I proceed with any more injections, perhaps unnecessarily, Princess and I are off to get stimmed tomorrow. I feel a whole lot better knowing more on the cortisol at this point, even though its only been 2 weeks from her last stim, but her symptoms are ridiculous and can't bear to watch her so uncomfortable a second longer. Does my plan make sense to anyone?

Sorry I havent been much support to most here lately--I have been a bit overwhelmed/worried/exhausted with all this, but I hope this finds you and your babies well these days....

Luv to all, xo Jeanette

[labblab]

Hi Jeanette,

I hate hearing that our sweet Princess is still miserable! :(:(

I'm going to throw out an idea that probably won't be approved by your IMS :o, but I'm wondering if there would be value in scheduling Princess' stim test for the end of the day tomorrow, rather than the usual 4-6 hour post-trilostane window. I am still stuck on wondering whether her problems are caused (or at least exaggerated) by an early drop-off in the effectiveness of her once-daily trilo dose. Since you had a 4-6 hour stim performed just two weeks ago, I think it would be interesting to now see what her ACTH response is later in the day. If it has rebounded to an unacceptably high level, that would give credence to adding in a second daily trilo dose.

Marianne

[Harley PoMMom]

Hi Jeanette,

If Princess symptoms are drinking and urinating a lot then I would definitely have the cysto done and have the culture and sensitivity testing performed also.

Hoping sweet Princess is feeling better soon.

Love and hugs,
Lori

[mypuppy]

Thank you for your feedback Glynda, Lori and Marianne. This has been all too overwhelming and difficult for me in deciding which path to take. Honestly, I am at a loss for words as to what is going on with my precious girl. My gut tells me "cortisol" but I can't say for sure. Unfortunately, my IMS cannot run the uccr tomorrow and I cannot get to her later in the day for the stim, so I will leave it at that and just do a regular early stim with the blood panel and take it from there.

Thanks once again for your thoughts.

Luv, Jeanette

[lulusmom]

Hi Jeanette,

Is there any way you can reschedule the stim test when the IMS can also do a UC:CR or reschedule it for the time frame Marianne mentions. The results will be a whole lot more meaningful. There is the possibility that the post stim result will be identical to the results of the stim two weeks ago and you won't know any more than you do right now. Just my two cents.

Glynda

[mypuppy]

Glynda and Marianne,

I am not opposed to having the stim performed later in the day if my IMS agrees to it. If she does, I must ask a couple of things: does anything change in how they perform the stim since it is later in the day? Do they still take 2 draws (pre and post)? What time would you recommend to begin the stim?

Thanks. Xo J.

[jrepac]

I hope you get to the bottom of this Jeanette...

I've dealt with diabetes or Cushings in each of my Aussies and the symptoms are incredibly similar. It's a challenge to figure out what's what. Not to mention UTIs coming into the mix, which is typical when a pup has high cortisol. Hopefully you can get to the bottom of it by process of elimination.

Best of luck

Jeff & Angel Mandy

[labblab]

Hi Jeanette,

I'm sorry I did not have the chance to get back to you earlier re: your question. But by now, the testing will have been completed, and you will be awaiting results! For future reference, the procedures for the ACTH testing are exactly the same no matter what time of day the test is performed. And as for the timing, if you were ever to go the route of testing later in the day, I'd try to have it done as close to the 12-hour mark after dosing as is possible. That's because I'd like to know what the cortisol level is at the time that a second daily dose would be given (if it seemed warranted).

If later in the day is not an option, then another possibility might be to have the testing done in the morning right BEFORE giving Princess her once daily dose. I believe that testing at the 23-hour mark was Dechra's original recommendation in terms of determing what a dog's true "trough" level is when being dosed once daily, and they may still be recommending that testing time frame when a switch to twice-daily dosing is being considered. Once again, Dr. Allen at Dechra would be well-versed re: the pros and cons as to alternative testing times. I so wish your IMS would consider talking to him.

Marianne

[mypuppy]

Oh it's ok Marianne and thank you for replying. I did go ahead with her stim yesterday and in fact just go off phone with a backup IMS with results, which do not surprise me in the least and which I suspected for a while.
Pre: 9.5 (high)
Post: 13 (high)

Her chemistry panel was normal, except for liver values which were high, but which I understand is expected with cushings??? I was given the ok to increase Princess's Vetoryl to 20mg per day. The only doubt I had was that I was given the option of doing once a day or BID, so not sure which way to start her off on the higher dose? When I initially spoke to Dr. Allen, he recommended doing the 20mg BID, however, I did speak to him again yesterday, and he now recommends splitting the 10mg to twice daily. Wow! How does all this stuff change overnight? I wish I could just get straight answers for once. As for the liver values, I do not have the actual numbers in front of me, but will post all actual results when I receive them. Should I be concerned with the high liver values? I don't know what to say, other than, I feel a tiny bit more relieved to learn her cortisol is on the rise, and am hoping this will close the DI chapter for now, God willing.

I want to thank you all for your patience, particularly Glynda and Marianne--who have walked me through this and held my hand so generously and caringly--I love you all dearly.

xo Jeanette

[Spiceysmum]

Hi Jeanette,

So glad that you are getting some answers at last. Sorry I haven't posted before but we have had a few family problems and I have been feeling stressed to say the least. We are off on the family holiday for a week in the morning but I promise I will email when we get back. I will be thinking of you all.

Love,
Linda x

[littleone1]

Hi my dear friend,

I'm so glad that you got the results you were looking for. I'm glad you stuck to your guns and went with your gut feeling. You know Princess the best.

BID and splitting the 20mg into 10mg twice daily is the same thing.

I'm interested in knowing what your IMS said, since you were right.:D

Love you and Princess bunches Lil Sis.

[mypuppy]

Hi Linda,
So sorry to hear of your personal conflicts and your worry over it:(. I hope it's not something you can't handle. Thanks for commenting, and please take care of you and your family. We will have an opportunity to talk I am sure, just stay well.

I love and miss you dearly.

Xo Jeanette

Ps: rubs to Brin :D

[mypuppy]

Hi again my friend,

I am extremely anxious to get Princess started on her dose increase, and hoping to see some improvements with symptoms. And you are absolutely right, We know our babies best and that gut feeling somehow never fails us.

Funny you mention, I too am curious to hear what my ims has to say on Monday (I spoke to a back up ims today). I am sure she will offer me more injections:eek: OMG, I am running for the hills from this one. I know she will not admit any wrongdoing and the fact that she has wasted my valuable time and money and delayed my baby from feeling better. it totally bites, but at least we are finally getting somewhere. I am a bit concerned with the high liver values. I was instructed to start giving Denamarin for liver support. I believe it's a combo of milk thistle and Sam-e? I need to look up any side effects. other than that, I am a bit more at ease. thanks for being there for me and my Princess through this--means a whole lot. Will let you know how Monday goes. :eek:

Lots of love always to you and my Cork
Xo Jeanette

[mypuppy]

Hi all,

has anyone here ever used Denamarin, and if so, did you notice any unusual side effects on your babies while on it?

Thanks and warmest regard,

Xo Jeanette

[littleone1]

I'm still here my dear friend. When the cortisol level is up, the liver values also have a tendency to be higher. On one of our Cork's test results, there was one liver value that was elevated. Once his cortisol level got lower, that liver value did go back into the normal reference range.

Corky has taken both Milk Thistle and SAM-e, and he never had any side effects. I'm really hoping that Princess's issues will finally be resolved.

Luv ya bunches,

[logans mom]

Logan has been taking Denamarin for a year now with no side effects. They even come in chewable tablets now.


Debbie

[mypuppy]

Hi Jeff,

This is definitely a challenge, and hope we are starting to "get to the bottom of it".

Hope you are well.

Best regards. Xo Jeanette

[labblab]

Oh it's ok Marianne and thank you for replying. I did go ahead with her stim yesterday and in fact just go off phone with a backup IMS with results, which do not surprise me in the least and which I suspected for a while.
Pre: 9.5 (high)
Post: 13 (high)

Her chemistry panel was normal, except for liver values which were high, but which I understand is expected with cushings??? I was given the ok to increase Princess's Vetoryl to 20mg per day. The only doubt I had was that I was given the option of doing once a day or BID, so not sure which way to start her off on the higher dose? When I initially spoke to Dr. Allen, he recommended doing the 20mg BID, however, I did speak to him again yesterday, and he now recommends splitting the 10mg to twice daily.
Wow, I am really surprised that Princess' cortisol has increased this much in two weeks' time. I really was not expecting to see much change at all! So thank goodness you followed your own instinct about this.

Just to clarify, are you saying that when you talked with Dr. Allen yesterday, he backed off from an earlier recommendation of increasing her to a daily total of 20 mg. (given as 10 mg. twice daily) to instead suggesting that you stick with a daily total of 10 mg. (given as 5 mg. twice daily)? If so, I am guessing that he had revised his recommendation prior to knowing about this big increase in cortisol, and he was thinking that the issue was not so much that she needed more medication in total, but rather that it would be more effective for her if it was spread out throughout a 24-hour time period. But of course, I cannot speak for him.

Given these new ACTH results, I do agree with the need for a dosing increase. As you say, the question is whether to administer it once daily or to split it up. And I think you'd find support for either approach. If it is easier for you to stick with once-daily dosing, I think the argument could be made for doing so. My big "pitch" for shifting to twice-daily dosing was based on the assumption that Princess' 4-6 hour ACTH result was showing that her cortisol was being well controlled, early in the day, by the 10 mg. dose. But that is no longer the case. So I think it would be reasonable to see whether or not her symptoms resolve simply by increasing the once-daily dose, if that is a regimen that is easier for you.

I realize that, either way, you will now be doubling her dose. Given the fact that she is a big girl, 20 mg. total does not seem like a lot of medication for her. But we also know that, at the beginning, she seemed to be very sensitive to dosing increases. So, as always, I know you will remain very vigilant as to how she is doing. And even though both Dr. Allen and your IMS are advocating for her to remain on brandname Vetoryl, it may turn out that she may need a compounded dosage if 15 mg. turns out to be a better option for her. But that is an issue that may never need to be addressed.

Do let us know as to what you decide to do!

Tons of hugs to you and our Princess,
Marianne

[lulusmom]

Marianne, I looked at those results and almost fell out of my chair. I couldn't believe how much cortisol had risen in two weeks....that was until I remember that Jeanette had told me that the IMS, without her permission, gave Princess a DDAVP injection right before doing the stim test. She asked me if I had any idea if that could affect the results of the stim test and by golly, a quick bit of research revealed that DDAVP increases cortisol production in dogs with PDH. I found this bit of information in an abstract of a study done at the University of Vienna, Austria

The desmopressin stimulation test in dogs with Cushing's syndrome
http://www.domesticanimalendo.com/article/S0739-7240(07)00101-4/abstract


Desmopressin was injected as an i.v. bolus of 4μg and serial blood samples were collected before and after 30, 60 and 90min. Desmopressin significantly stimulated cortisol release in dogs with PDH (median 51%, range −24 to 563%; p<0.0001), whereas no increase was seen in dogs with AT (median −12%, range −44 to 5%; p=0.063) and in controls (median +7%, range −36 to 196%; p=0.131).


I believe this would explain the drastic increase in cortisol in just two weeks. I also believe it is very likely that the results of this stim test were artificially exaggerated by the DDAVP, rendering it useless for much of anything. Thank goodness Jeanette is asking questions because making any change in dosing based on this stim test is not a good idea. And thanks to Jeanette, we all learned something new about the effects of DDAVP on cortisol.

I still believe Princess will benefit from twice daily dosing and think that Dr. Allen's suggestion to put her on 10mg BID is a good one.

[labblab]

I believe this would explain the drastic increase in cortisol in just two weeks. I also believe it is very likely that the results of this stim test were artificially exaggerated by the DDAVP, rendering it useless for much of anything. Thank goodness Jeanette is asking questions because making any change in dosing based on this stim test is not a good idea. And thanks to Jeanette, we all learned something new about the effects of DDAVP on cortisol.

I still believe Princess will benefit from twice daily dosing and think that Dr. Allen's suggestion to put her on 10mg BID is a good one.
Wow! Great catch, Glynda!!! As you could tell, I too was stunned by the cortisol increase but could think of no reasonable explanation.

But if this is the case and the ACTH was artifically elevated, then it seems as though there is still a question mark as to the dosing. Because switching to 10 mg. BID represents a big dosing increase -- doubling her total daily dose. I am wondering whether Dr. Allen was backing away from that (prior to hearing these most recent ACTH results), and was instead suggesting that Princess' existing 10 mg. dose be split into 5 mg. twice daily. Jeanette, can you clarify for us what Dr. Allen recommended in his most recent conversation with you?

Marianne

[mypuppy]

Dear Glynda and Marianne,
Ive been doing a bit of digging of my own, and try to make some sense for Princess's recent stim numbers. Glynda, I analyzed the info you found in the abstract from Univ. of Vienna, and a light bulb went off for me, and that doesnt happen very often with me when it comes to this :D. So I got to thinking if the amount of desmopressin administered to the dogs in that study is more, less or equal to what Princess received the day of her stim??? Furthermore, does it make a difference that this study was performed via IV, where Princess received a fine insulin syringe? I actually placed a call to my IMS pharmacist in the hope they can shed some light and possibly help with conversion of units injected in Princess against the study and we can differentiate between the two? Are there any geeks here who can help with this???? :D. Princess received 5 units of 0.01% ddavp acetate per syringe the day of her stim. Just food for thought here, because if Princess possibly received a much lower dose against the study, maybe it did not have a bearing on her stim after all. Let's remember, those full blown cushings symptoms are there, and her numbers were already rising from her February stim which was in the 1's at the 30mg, to 5.3 in May and post of 13 three weeks thereafter. Does this make sense to you at all or am I in denial? :eek:

As for Dr. Allen, I have a follow up to call him on Monday wherein we will discuss Glynda's study and the effect of desmopressin during an acth, and we will discuss dosing changes as well based on the latest stim numbers which I did not have available at the time of our last conversation. I am guessing he may switch his recommendation back to the original 20mg BID against the 10mg BID. I will let everyone know the outcome of our conversation, and I think I will hold out a couple days longer until we clear up all these issues. UGHHHHHHH is all I can say.....

I love ya gals...xo J.

[labblab]

I am guessing he may switch his recommendation back to the original 20mg BID against the 10mg BID.
Jeanette, I think we're being confused by a terminology issue here. Because when you write "20 mg. BID," that literally translates to "20 mg. given twice daily" (for a daily total of 40 mg.). Likewise, "10 mg. BID" translates to "10 mg. given twice daily" (for a daily total of 20 mg.).

Right now, Princess is only taking 10 mg. once daily. So at most, I am assuming that you're talking about doubling her dose by giving 10 mg. twice daily (or 10 mg. BID). And at the least, Dr. Allen was talking about splitting the 10 mg. into two doses of 5 mg. each (or 5 mg. BID)?

Marianne

[mypuppy]

Oops! Sorry and thanks. What I meant is 10mg BID for a total of 20mg daily. That was Dr. Allen's first recommendation based on the 5.3 post but with rebounding symptoms. But I do not understand why he changed to 5 BID? What will he recommend now with an even higher post of 13? I am not sure if I feel the 5 BID will hold her over, and why I think I will consider the 20mg total daily, just not sure if I will do twice daily or just once? Glad we cleared this up. Any comments as to the desmopressin? Just curious.

Xo jeanette

[lulusmom]

The recommended dosing for DDAVP injectable is anywhere from 1 to 2 ug (micrograms) for a dog to 4 ug (microgramsj) for dogs weighing more than 15kg. I believe the latter was the amount used in the study. You say that Princess got 5 units but unfortunately, I don't know what a unit is. If it's ug, which is the same as mcg (microgram), then it's possible Princess received more than was used in the study. Now the study did administer IV so if your IMS injected IM or subcutaneously, I don't know what the difference would be.

I did not forget about the Princess' returning symptoms nor that her post stim had gone up slowly since the prior two stims; however, her prior post stim had only risen 3 or 4 points over a few months period as opposed to the now 7 points in two weeks. Plus, you said Princess isn't really nervous at the vet's office and aside from her initial stim prior to treatment, I don't recall her basal cortisol being above the normal range. This time it's more than 3 points above normal.

[labblab]

Oops! Sorry and thanks. What I meant is 10mg BID for a total of 20mg daily. That was Dr. Allen's first recommendation based on the 5.3 post but with rebounding symptoms. But I do not understand why he changed to 5 BID? What will he recommend now with an even higher post of 13? I am not sure if I feel the 5 BID will hold her over, and why I think I will consider the 20mg total daily, just not sure if I will do twice daily or just once?
It will be great for you to talk directly with Dr. Allen again on Monday so that he can explain his thinking to you. But I am wondering whether he was just feeling antsy about going so far as doubling Princess' total daily dose when her May post-ACTH result was only approx 5. Here's an earlier comment of mine about Dechra's published recommendation in a situation like that:


With an acceptable ACTH result but a rebound of symptoms especially later in the day, it might be the case that she would be a good candidate for twice daily dosing. In that event, it's not so much that she needs a significant increase in her once [total] daily dose, but rather that she would benefit from having the medication spread out more throughout a 24-hour time period. Here's the relevant quote from Dechra's U.S. Product Insert (http://www.dechra-us.com/files/dechraUSA/downloads/Product%20inserts/Vetoryl.pdf):


However, if clinical signs are not controlled for the full day, twice daily dosing may be needed. To switch from once daily to twice daily dosing, increase the total daily dose by 1/3 to 1/2 and divide the total amount into two doses given 12 hours apart.
And we've heard other specialists say that dogs being dosed twice daily may actually end up needing a SMALLER overall daily dose than dogs being dosed once-daily. The problem is, you would not be able to make any of these kinds of small dosing changes if you stick to 10 mg. brandname Vetoryl capsules. So that's a separate issue. And of course, the bigger issues is: what are her accurate ACTH results?????

All-in-all, I'm so sorry that this has turned out to be such a confused mess for you!!!!!!!!! You and Princess so deserve a break, and I surely hope that Dr. Allen can help you make sense of all of this on Monday.

Marianne

[mypuppy]

Thanks again Glynda and Marianne,

Yes, Dr. Allen and I have a lot to discuss tomorrow. Princess is not being controlled at all at this point on the 10mg, even during the day and after taking her morning dose of Vetoryl. She has also started stealing food from my little one's plate, and is looking at mommy as if Ive some piece of juicy steak:eek: In all honesty, whether the last stim results were altered or not with the dang desmopressin injection, I think I am comfortable with the 10mg increase, just need to figure out if I will do once or twice daily.

Warmest regards, love and tight hugs,

Jeanette

[lulusmom]

She has also started stealing food from my little one's plate, and is looking at mommy as if Ive some piece of juicy steak:eek:

Better to think you have a piece of steak than thinking you are a piece of steak. :p:p:p

[mypuppy]

Oh I know that look all too well by now, and she looks at me like I am steak not just holding a piece of steak. I know it's funny but if you only saw it you'd think the same way. She is unbelievably hungry 24/7. I can't stand it because I don't actually understand what may be going on inside of her. it breaks my heart, so she has been getting some extra treats daily. Can't wait to have her sleeping back in my room and in her own comfy, therapeutic bed--she doesn't even enjoy that, and it's an awesome bed--I find my 6 year old lounging there many a times--haaaaaaa

Xo Jeanette

[lulusmom]

Hi Jeanette,

Uncontrolled cushdogs are hungry all of the time because excess cortisol has a dramatic effect on the metabolism. It is a catabolic steroid and it chews through protein like nobody's business so a dog is hungry all the time. This is also why a dog with cushing's should be on a higher good quality protein diet. If you've ever known anybody with asthma whose been on prednisone, they'll tell you how hungry they are.

[mypuppy]

hi friends,

As promised, here is first update after my phone conversation with Dr. Allen, and unfortunately for my Princess and myself it's not favorable in the least. I gave him Princess's latest post stim results, and he considered those to be good numbers to increase her dose to 10mg BID (20mg total daily). I was satisfied with that suggestion up until the moment I mentioned Glynda's study on desmopressin. consequently, Dr. Allen had no knowledge desmopressin may increase cortisol during an ACTH?? needless to say, and since we do not kmow for sure if these last stim nos. Are accurate or not, he recommended not increasing her dose at all until Princess receives another stim. OMGGGGGGG:(. unfortunately, the possibility of expensing for another stim right now is pretty slim. :(:( with having to stim her again in two weeks after any dose increase. I am so torn as to what to do here now bearing all this in mind. Sorry everyone for ranting as usual. My heart tells me to go ahead with the increase and hope for the best. I do have pred. On hand. I just want what we all want here--make our babies better. Still waiting on call back from IMS:mad: with her plan. Will update again.
Thanks all. Xo J.

[lulusmom]

Hey Jeanette,

I think part of your IMS' plan should be to either reimburse you for the cost of the stim or do another one for free. Plain and simple, you shouldn't have to pay for her ignorance and more importantly, Princess shouldn't have to endure the stress of being poked and prodded for a test she screwed up.

[mypuppy]

Glynda,

My IMS admit being wrong and throw in a stim on her dime. You have heard "when pigs fly", "when hell freezes over". :D. It's like beating a dead horse. But thanks for the encouragement.

Xo J.

[lulusmom]

It's one thing for your IMS to dismiss your opinion as to why Princess has symptoms and pursue an unlikely cause, rather than the obvious elevated cortisol, but it's another thing to flat out render a test useless because of her ignorance. I'd not only beat a dead horse, I'd beat her about the head and neck with a dead horse until she admitted she screwed up and made me whole.

[Squirt's Mom]

I'm with Glynda all the way, Jeanette. :mad: You will get arrested just as fast if you are ignorant of the law you break as you will if you KNOW the law. Same should certainly hold true when it is the vet who was ignorant. It is their responsibility to stay on top of developments in their fields and Princess, nor you, should have to pay for their failure.

So sorry you are having to deal with this on top of everything else. :(

Hugs,
Leslie and the gang

[mypuppy]

Very true Leslie, amd thank you so kindly my dear friend...Tight ones and licks to Squirt, Trinket and Brick from the royal Princess who has been promoted to "your Highnesss " :D

Glynda...ROFL....you are too much....:D xo

Jeanette

[mypuppy]

Hi all,

finally spoke to IMS this morning. I confronted her regarding the possible desmopressin interaction with Princes's stim, and she is adamant in stating the ddavp injection did not raise the cortisol. At that point, I no longer wanted to pursue this issue since it is truly a waste of more time, as much as of course I am burning up inside:mad: She upped the dose to 20mg total daily which I already started this morning. I am so praying and hoping this will be the right dose for her in order to see some fast improvements. Wish us luck and prayers. Thank you all for seeing me through this and your encouraging words.

Much love, xo Jeanette

[Harley PoMMom]

Sending huge and loving hugs with a lot of positive energy! ;):)

[lulusmom]

Jeanette, I do understand your exasperation with your IMS and your desire not to beat a dead horse but I do hope you will at least print out the abstract from the study done in Austria. Be sure to hand it to her with a comment like "I guess desmopressin only stimulates cortisol in dogs living in Austria. Silly me for thinking my American dog would have the same reaction." :D At the very least, it might stop her from making the same mistake twice. Ya know, I readily admit that if I don't quit eating like there's no tomorrow, I am not going to be able to get my fat butt through the doorway but somehow I don't think I will ever have as big a problem as your IMS must have getting her big fat head from one exam room to the next. Honestly, have you ever dropped to your knees in front of her and waved your arms up and down while chanting "I'm not worthy, I'm not worthy?"

[labblab]

Hi Jeanette, are you giving the 20 mg. once daily, or are you splitting it into two doses?

Marianne

[mypuppy]

Hi Marianne,

I am giving the total 20mg once daily in the morning--Princess was not being controlled any longer on the 10mg even during the early part of the day. I sure hopes this works for her, but I welcome any comments or concerns you may have.

Thanks dearly. Xo Jeanette

[labblab]

Sounds good to me, Jeanette. You've got to start somewhere, and this is the easiest change to make. I've got EVERYTHING crossed that you'll soon see improvement!!!!!!!!!!

Marianne

[mypuppy]

:)Marianne:)

[mypuppy]

Hi everyone,
Some of you are probably wondering how Princess is doing on her new dose of Vetoryl (20mg) once daily. Unfortunately symptoms have not resolved on this dose, and seems hungrier than she has ever been--:(. I have scheduled her stim for next Thursday, and am hoping this one will show a more accurate reading than last months which we suspect may have been altered with the desmopressin injection--:mad: I will let you know what happens. For now, off to fill the water bucket for the Princess:D.

Warmest regards and love to all of you and your babies.

Xo Jeanette

[Spiceysmum]

Hi Jeanette,

Sorry to hear Princess has not improved on the higher dose. I wish she could get a break from this high and low cycle. Hope you get some answers from Thursday's stim. I will be waiting for the results with you!

Love,
Linda x

[labblab]

Jeanette, I am also so sorry to hear that Princess is not doing better! Are you noticing any pattern in her symptoms that would lead you to believe that twice-daily dosing might be helpful, or is she just bad all through the day?

Marianne

[mypuppy]

Thank you so much Linda and Marianne.

Marianne, Princess is not being controlled even in the morning after taking her 20mg of Vetoryl:(disappointing and makes me wonder if anything else is going on? I'm also concerned if it is cortisol and we bump her up to 30mg again, she may drop too low and risk my ims lowering her to 10mg again and start this all over again:mad: I wish we can find the right dose for her and stick to it for a while. This constant up and down with dosing is certainly frustrating and very costly. I am also wondering if there is a slight possibility that the Vetoryl may not be suitable for Princess any longer and may have to switch her to lysodern? Just a thought?

Tight hugs to all. Xo Jeanette

[mypuppy]

Hi All,

Finally heard back on yesterday's stim results:

Pre: 5.7
Post: 6.7

Didn't speak to my regular ims, but backup ims has recommended to stay the course on the 20mg for another 2-3 months and not increase dose now for fear of Princess bottoming out again, which was my concern as well. She said if we can allow her more time and possibly lower her in the 4's and her symptoms have not resolved, we can then consider increasing to possibly 25mg. At the same time she mentioned that other factors and hormones can contribute to the possibility that Princess may just be one of those dogs whose pu/pd may never really resolve:(.

I know these are great numbers and should be ecstatic:), but the symptoms are still there sooooo:mad:

Thank you all for your kindness and patience with me over my impatience, for all Ive been wanting is to help my sweet girl. I have faith we will get her there.

love you all dearly. Xo Jeanette and Princess

[lulusmom]

Those numbers aren't bad at all but with symptoms still unresolved, twice daily dosing may be the answer. So your IMS wants you to continue dealing with overt symptoms for two or three more months before making a decision? :confused:

[labblab]

Under the circumstances, I've got to agree with Glynda that I believe I'd lobby for going ahead and shifting Princess to a twice-daily dose rather than leaving her so uncomfortable for another couple of months. Since you're using 10 mg. capsules anyway, it would be easy to try 10 mg. twice daily rather than 20 mg. once daily. Isn't that what Dr. Allen originally suggested back in May? Since you wouldn't be altering the overall daily total, maybe that would be an acceptable compromise to your IMS...

Marianne

[mypuppy]

I agree with both of you Glynda and Marianne, however, before I consider BID on 20mg, have a couple of questions when it comes to her next stim. Considering the 2nd dose is given in the evening or preferably 12 hours after her first dose, how does that affect the stim results if the post pill stims are performed within 4-6 hours post pill? With BID don't we risk not getting an accurate post since the previous evening's dose may be out of her system by the morning? I DO NOT know much on twice daily dosing, but do my questions make sense to both of you or perhaps you can add more valuable info to make me make sense of it--lol...Glynda I know you mentioned at one point it would be nice to up her dose to 25mg divided to twice daily. Do you still feel the same after getting such a good post? I guess my main concern here is if I do go to BID, will the 10mg hold her out in the morning considering the 20mg is not right now? I am again, curious if something else may be going on that we are missing? Blehhhhhh. Is this a good time to go back and do a cysto? Do I check her thyroid? So many doubts, so many paths to take, but don't know where to start?

Luv ya'll, xo Jeanette

[littleone1]

Hi Jeanette,

If you go BID, you shouldn't have any problems with the results on a stim test. Corky's taking his Trilo every eight hours, and has been on TID for 5 months. I've never had a problem with his test results.

You might want to consider having Princess's thyroid level checked since she was borderline before. When Corky had his tests done this time, they also did a T4, as it was a possibility that his symptoms could have been a combination of his higher cortisol level and his thyroid level being too low.

I really hope that you'll soon be able to get some resolutions to Princess's symptoms. Hang in there my dear friend. You're doing a great job.

Corky and I love you bunches.

[mypuppy]

thank you so much Terri,
So much yet to learn with cushings and other health issues, but I guess one thing at a time. As for thyroid, I know there is always the possibility, but I think that one time her vet at the time said she was borderline was prior to having the cushings diagnosis, and her cortisol was off the charts at the time, so we never really knew for a fact. Either way it doesn't hurt to check. thanks again. Hope you and Corky are hanging in there as well. Not fun.

Another thing for anyone else who cares to comment, and this may be a long shot, but approx a momth or so ago we had company over and the kids were rough housing with Princess, and to my shocking surprise Princess began to hump my little girl :eek: (sorry for the visual, I have no other way of interpreting the event). What on earth could have prompted her to do this? Princess has been spayed since she was 6 months old. Could there be a possibility Princess may be having issues with her intermediate hormones which may be causing her symptoms? Perhaps I should consider an adrenal panel. In the event she did have issues with other hormones, how do they address that problem?

Again, a long shot of speculation, but it's all Ive got.

Xo J.

[labblab]

Jeanette, I have actually been wondering myself whether intermediate hormones could be playing any role in Princess' symptom rebound. However, I was more suspicious of that at the time of her May ACTH when her cortisol was closer to falling within the ideal therapeutic range. Since her cortisol is now even higher on a doubled trilo dose, I agree with Glynda that your first priority is getting her cortisol level lowered, rather than focusing on the intermediates. We know that elevated cortisol causes Cushing's symptoms -- the effects of elevated intermediates are not so certain.

That is why I would first want to give twice-daily dosing a try. If Princess does end up with a truly therapeutic stim result on twice-daily dosing (post-ACTH less than 5.4) and STILL exhibits symptoms, at that point I might personally opt for a full adrenal panel in order to assess her intermediates. Depending upon "if" and "which" intermediates were actually causing a problem, then the likely recommendation would be to switch to Lysodren. But this is purely speculative, and definitely putting the cart ahead of the horse.

One other idle thought that I've entertained is whether Princess could possibly have an adrenal tumor rather than a pituitary tumor. As I recall, her ultrasound left some questions unanswered because her right adrenal gland could not be viewed clearly. And her LDDS results were right on the borderline as to being consistent with PDH. I am no expert on adrenal Cushing's, but I wonder whether her up-and-down cortisol levels could result from inconsistent hormone production on the part of an adrenal tumor. I dunno -- maybe others with more knowledge about that can comment.

Anyway, long story short, I'd still start with twice daily dosing to see if that brings down the cortisol and better controls the symptoms.

Marianne

[labblab]

I just wanted to add two other quick thoughts that I forgot to write earlier. The first is that the humping may be an expression of dominance and not have anything to do with hormones. Both of my girls were also spayed at an early age, but one frequently humps the other one, especially when they are "sparring" with one another.

Secondly, I know you are worried that 10 mg. in the morning may be too low a dose to control Princess' symptoms. And that may turn out to be true. But noted endocrinologist Dr. David Bruyette has told us that dogs dosed twice daily often require a lower total daily dose than those dosed once daily. I don't know for certain, but I assume this is because the cortisol level never gets as high at any time throughout a 24-hour time period -- you are giving the second dose while a "tail" may still remain on the first dose, if that makes sense.

[mypuppy]

Hi All,

Just got the green light from my ims to switch Princess to twice daily dosing (20mg daily).

Hoping for some resolution of her symptoms on this new path--"WE ARE WORTHY"---haaaaaaa:D

Wish us luck. Love you and your babies.

Xo Jeanette

[littleone1]

Corky and I are keeping everything crossed that this will really help Princess.

Lots of love and hugs for both of you.

Terri and Corkster

[mypuppy]

Thank you dearly big sis. How are matters on your end, and how is Corky? Any news on him yet?

Love you both much.

xo J.

[Squirt's Mom]

Hi Jeanette,

I am so glad the vet was willing to listen and try this approach. Hopefully, this will do the trick for our Princess!

Keep up the good work!

Hugs,
Leslie and the gang

[lulusmom]

WE ARE WORTHY

Yes, we are!

[Harley PoMMom]

Sending positive energy your way, Great job, Jeanette!!!!

[marie adams]

Hi Jeanette,

We are sending positive vibs your way also!!! Hang in there!!!:D:p:)

[mypuppy]

awwwww, thanks to all my friends, Glynda, Leslie, Lori, Marie....

We definitely need all the positive energy we can get right now.

I will let you know how my girl makes out.

tight hugs. Xo Jeanette

[mypuppy]

Hi all,
Starting Princess on her twice daily dosing today. Is it okay to give her 2nd dose a few hours before the recommended 12 hours? I gave Princess's 1st dose at 7 a.m. and since she eats her dinner early, 4 p.m., and iit is suggested to give Vetoryl with a full meal, I would like to give 2nd dose at 4 p.m. against 7 p.m.

Thanks. xo Jeanette

[linda126]

How long did it take for your dog to get back to her old self. My dog has been on trilostane for 2-1/2 months and although the excessive thirst, panting is gone, he is so lethargic. Has about 2 active periods during the day and sleeps the rest of the time. I heard it may take up to 4-6 months and was wondering how it was for you.

[mypuppy]

Linda,
I sent you a private message. Hope you got it?

Xo Jeanette

[labblab]

Hi all,
Starting Princess on her twice daily dosing today. Is it okay to give her 2nd dose a few hours before the recommended 12 hours? I gave Princess's 1st dose at 7 a.m. and since she eats her dinner early, 4 p.m., and iit is suggested to give Vetoryl with a full meal, I would like to give 2nd dose at 4 p.m. against 7 p.m.

Thanks. xo Jeanette
i know that the ideal is to give the trilo as close to twelve hours apart as possible. But I understand why you are wanting to give the second dose along with Princess' dinner. I wouldn't worry about any danger of overdosing her, since you were previously giving her 20 mg. all at one time. If this is the schedule that works best for you, I'd say to go ahead and give it a try. But if she wakes up in the morning being really symptomatic, then that may be an indication that you do need to wait and dose her later on in the evening, along with at least a small snack.

Marianne

[addy]

Hi Jeanette,

I have been following along and want to wish you all the best for Princess starting twice day dosing. I hope it does the trick for her.

Hugs,
Addy

[mypuppy]

Sounds great Marianne. I will see how Princess wakes up tomorrow morning since I already gave her second dose with her meal tonight. the only reason I was asking if it would be okay is because I understand it is recommended that vetoryl be given with a full meal so it can be better absorbed, and so to avoid an upset tummy, but I don't have any problems waiting till the 12 hours, will do so tomorrow.

Tight hugs. Xo Jeanette

[mypuppy]

Oh Addy,
You are so kind and sweet to think of us behind the scenes. I've been trying to keep up also, but I feel Ive fallen behind with so many new members. I am wishing you and Zoe both the same and some progress soon. I think I would have cried also if Id see Princess go up and down the stairs after not having done so in so long--wow! That is so awesome! Good for Zoe.

Take care of you and warmest regards and much love to both of you.

Xo Jeanette

[labblab]

Sounds great Marianne. I will see how Princess wakes up tomorrow morning since I already gave her second dose with her meal tonight. the only reason I was asking if it would be okay is because I understand it is recommended that vetoryl be given with a full meal so it can be better absorbed, and so to avoid an upset tummy, but I don't have any problems waiting till the 12 hours, will do so tomorrow.

Tight hugs. Xo Jeanette

Jeanette, I think you can stick with the earlier dose for a few days if you want to in order to give it a good test. I wasn't clear in what I wrote earlier. I meant that if she consistently wakes up symptomatic after trying your dosing scheme for a few days, then I'd make the change to a later dose.

[mypuppy]

Hello my dear friends,

It's only been 2 weeks since Ive updated, (it sure seems longer than that), but wanted to say a brief hello to all, and to let you know how we are doing on the twice daily dosing. Princess is finally starting to show some improvement throughout the evening, and is not wanting to drink or be let out during the night while mommy, daddy and sisters are asleep :). Wow! That is GRAND right there. During the day she is still drinking more and wanting to go, and well the appetite has not changed at all--still can eat a cow if she had one in front of her :eek: She has also developed 2 bleeding sore spots (one on her elbow and one on her paw), but I think it is due to her favoring to lay on the hardwood floors all the time in order to stay cool. Her IMS suggested to get elbow pads and try to keep her off the hard floors. Sure, that will be easy--LOL. So my friends, although this is going slower than Id want, Ill take it!

Please give the babies a gentle belly rub from me and take some tight hugs for yourselves.

I love you all fondly. Xo Jeanette and the Princess

[Spiceysmum]

Hi Jeanette,

At last some improvement, even if it is only small. Perhaps the next stage will be to go to 20mg in the morning and 10mg at night, depending on her ACTH results of course. Enjoy your sleep!

Linda xx

[Squirt's Mom]

Hi Jeanette,

I know you are hoping for more improvement, but remember that baby steps forward is still progress. You are doing a fine job. Starting low and slow may be the key with Princess and Trilo, and Trilo is easy to adjust either way. ;) So keep the faith and keep up the good work!

Hugs,
Leslie and the gang

[mypuppy]

Test test test test test

[Spiceysmum]

Hi Jeanette,

Not sure whether you're testing to see if your posts appear or if you're fed up of tests! Either way it's good to hear from you. Hope Princess is still doing better on the 2x day dosing, she must be due a stim soon. Hope you get some good results and they are going in the right direction.

Linda xx

[mypuppy]

LOL my dear friend Linda,
I had what I thought was a little computer glitch or losing my mind:D. But at the same time, thanks for checking in on us since I do agree with you, life is one test after another. So sorry haven't emailed. Trying to keep girls busy and from bickering while they are on summer vaca. Lol. Princess is holding her own for now, and to my surprise ims does not want to stim until October:confused: Im guessing it's perhaps because we didn't change the mg?:confused: So as long as she acts well, I will hold her to that date. We both need a break anyway. Hope you and the family are doing well, and Brin as well. Will try to write soonest my little one gives me some mommy alone time--lol.

love you lots always, stay well. Xo Jeanettw

[mypuppy]

Hello friends and newbie friends and fur butts,

I find it amazing how long it's been since we last communicated, but it has been quite a nice break for all of us, mainly my sweet Princess. however, as we all have learned this ride with our cushpups is never ending, and seems to lead us back to setbacks. Well I suppose the last few days we have had a setback. I knew all that bragging about how great she has been doing on her 10mg BID would come to bite me in the :eek:....Long story short, Princess had one bout of diarrhea this week, didn't want her regular food or treats, seemed lack of enery. Stopped her Vetoryl immediately, put her on chicken and rice for 24 hours, following morning she threw up, by lunch time she was ready to eat and wanted to play and fetch, and so she did. Seemed fine for the rest of the two days, and so I reintroduced her evening dose of Vetoryl with no problems. She threw up again yesterday, but no diarrhea etc. Stopped meds again. Last night I did not sleep a wink listening to Princess's stomach gurgling all night and very loudly. Decided to take her to vet today and we did a chemistry profile with electrolytes and the electrolytes were normal. However, vet mentioned her lipase was high and could be an onset of pancreatitis. OMG:(. I have read several posts here that cushinoid dogs are more prone to it and they should have a low fat diet, which I think Princess is. She gets high protein grain free dry with boiled chicken breasts. Don't know if her high protein dry food has triggered this recent episode and should switch her back to grains?. Quite the confused one here all over again. Consequently Princess is due for her stim this coming Monday, but now this changes everything and not sure if I should stim since I am scared to start up her Vetoryl again?? Can anyone recommend a special diet to prevent a full blown episode of pancreatitis? Do I need to lower her protein and go back to grain, and which is a high quality grain dry food? I am adding here the out of range results from today's blood work, perhaps someone can shed some light on the pancreatitis theory according to these numbers? Any help, however small is greatly appreciated. Stay well and as always sending tight. Hugs and warm regards to all of you and your precious babies.

HCT: 56.8. (37.0 - 55.0). - High
HGB: 19.7 g/dl. (12.0 -18.0). - High
PLT: 587 k/ul. (175 - 500). - high
GGT: 9 u/l. (0 - 7). - high
LIPA: 4733 u/l. (200 - 1800). High

Xo Jeanette and my girl Princess

[Harley PoMMom]

Hi Jeanette,

It is so good to hear from you and sweet Princess! Although there are numerous things that can elevate the lipase, pancreatitis is definitely one of them and should be considered especially when vomiting is ocurring. I suggest having a spec cPL test done to either rule in or out pancreatitis.

Dog's that have pancreatitis should be fed a very low fat, moderate high quality protein dog food. The fat content should be no more than 10% even lower if possible. Small meals spread throughout the day should be offered and plenty of water.

Just curious if her liver enzymes were in the normal ranges.

If I can help in any way, please do not hesitate to ask.

Love and hugs,
Lori

[mypuppy]

Thank you so much Lori. It's always nice to come back to all my friends, but of course wished it would be under better circumstances.

Princess is on an 80% protein dry food (Orijen) and I incorporate some boiled chicken breast with it as she is very picky and wont touch the dry without anything in it...Other than that, she does get a slice of ham everyday with her Vetoryl, because it is the only way I can get it in her. Could the ham be triggering something? I may just have to shove the lousy capsule down her throat?? I will ask my IMS on Monday about the Cpl test to r/o or confirm pancreatitis.

In the meantime, her gp today did not discuss anything on her liver enzymes but here they are for your taking:

ALT: 72 u/l ( 10 - 100)
ALKP: 56 u/l (23 - 212)
AMYL: 532 u/l (500 - 1500)
====================
others: (normal range)

BUN: 14mg/dl ( 7 - 27)
CREA: 1.0 mg/dl ( o.5 - 1.8 )
BUN/CREA: 14
PHOS: 4.3 mg/dl ( 2.5 - 6.8)

Thanks again and love to you, Bear and the bad cat...

xo Jeanette