Truffle - 12 y/o Border Terrier (Need vet in SE Michigan)

[Truffle's Mom]

Hi Everyone,

My 12 year old Border Terrier, Truffle, was diagnosed with Cushing's and we have begun treatment with Anipryl. I understand from reading that it may take a month or two to see if the drug is working or whether we may need to consider an alternate method of therapy. I was curious if any of you are currently using or have used Anipryl in the past and what your experience was/is.

She is currently at 15 pounds and has all the clinical signs of Cushing's; increased appetite, water consumption and urination, pot belly, thin coat, flaky skin, lethargy and panting, although the panting is not so much of an issue.

I do not have the results of her tests in front of me but I will post them later. Let me know if there is any other information that might be helpful.

Thank you for allowing me to be a part of this group.

Truffle's Mom

[littleone1]

Hi Truffle's Mom,

Welcome to to a wonderful group. Everyone is very supportive and caring.

I don't have any experience with Anipryl, but there are others that will be along to give you more information.

Corky has been taking Trilostane for 32 days. He is doing very well on it.

I know that you will be asked to post the test results that you have. This helps everyone to get a better understanding of what is actually going on.

I hope things go well for Truffle.

Terri and Corky

[gpgscott]

Welcome to you and Truffle.

I can't think of one current member who is currently treating with Anipryl. We do have at least one who did previously, it is Leslie a Forum Host. I am sure you will be hearing from her.

Would you please post a history of symtoms, testing, diagnosis, to date.

Cushing's is difficult to diagnose and in an elder there can be many issues which mimic Cushing's.

The Anipryl probably won't hurt, but it also probably will not help.

Please let us know more.

Best to you and Truffle.

Scott

[Harley PoMMom]

Hi Truffle"s Mom,

Welcome to you and Truffle from me and my boy Harley. We do have one member here, Jeff, who treats his pup Mandy with Anipryl, and I am sure he will be along soon to share his advice/opinions.

When you post the tests could you also post the units (ug/dl, nmol/L, etc.) and the reference ranges that the labs used. Did Truffle have a CBC and/or Chemistry blood test done? If so, could you post anything on there that is marked high and also post the units and reference ranges too. Is Truffle on any other herbs or supplements? Did Truffle have an ultrasound?

I know this cushings journey can be a frustrating and scary one but we are here to help you through it, ok. When my boy Harley was first dx'd with cushings I was terrified but these wonderful, amazing and knowledgeable people here took my hand, guided me and taught me so much about this cushings disease that now I don't feel so alone and afraid anymore. Please remember you are not alone on this journey, we are here for you and Truffle.

We are so friendly around here and "hey you" is so impersonal, if you wouldn't mind, could you tell us your name, please? :)

Hugs.
Lori

[MiniSchnauzerMom]

Truffle's Mom and Truffle,

I've never treated with Anipryl so have no advice to give but did want to drop by and say "hi and welcome". As Scott and Lori have both stated Leslie and Jeff are familiar in treating their babies with Anipryl and I'm sure they will be by to give you their input.

Glad you found us and will be watching for your post with Truffle's test results. Welcome to our family!

Louise

[Squirt's Mom]

Hi and welcome to you and Truffle! :)

I'm Leslie and my Squirt is the pup who took Anipryl (Selegeline); glad to meet ya! :D One thing you need to understand, Squirt was originally diagnosed with PDH but her signs were mild and intermittent. As it turns out, she had a splenic tumor that caused her tests to return positive for PDH when she may not actually have that form. Anipryl helped control the signs she did have until her surgery and she hasn't needed it since as her cortisol has returned to normal.

She was on Anipryl for about 7 mos. and did quite well on it, even tho I was told to expect to transition to Lysodren in a few months. In spite of the current question as to the validity of her original diagnosis, I remain one of few supporters of this drug for Cushing's treatment. :p However, even I realize it isn't for all cush pups and in fact works for very few as far as actually treating the condition and not just the signs. Anipryl is effective in 25% or less of the 85% of cush pups that have pituitary dependent hypoadrenocortism (PDH). That's because it works only on those pups who have the tumor in an area of the pituitary called the pars intermedia. It will have no effect on adrenal tumors, or ADH. Anipryl is most often used for pups with canine cognitive disorders and it is usually more effective there than with Cushing's, but I firmly believe it has it's place in treatment. ;)

To the best of my memory, the side effects for Squirt were mild and mostly digestive - indigestion and nausea, which we treated with Pepcid AC first and then with Tagamet, and it seems that occurred mostly at night. I was told to expect some nervousness/restlessness at first, but she just gained some energy and stamina it seems like; I know she wasn't lethargic like before but she wasn't speeding her butt of either, just perkier. :p It went to work quickly it seems like.

I'm not at home right now and don't have her journal, but when I return I will be able to give you a bit more specific info about her days on Anipryl if needed, and send you some links about it. I know Jeff will be along to offer his experience with it as his Mandy is currently on Anipryl.

I'm glad you found us and hope to learn much more about you and Truffle soon. There will be bunches of questions as the days go by...just do your best and we will keep hounding you til we get the info we need. :p:D The most important thing for you to know right now is that ya'll aren't alone on this journey. We will be here with you to help in any way we can...all you gotta do is holler! ;)

Hugs,
Leslie and the girls

[Roxee's Dad]

Hi Everyone,

I do not have the results of her tests in front of me but I will post them later. Let me know if there is any other information that might be helpful.
Thank you for allowing me to be a part of this group.

Truffle's Mom

Hi Truffle's Mom,

Welcome to you and Truffle. There is some info in our resources section, if you haven't found it yet you can click on this link and it should take you there.

http://www.k9cushings.com/forum/showthread.php?t=224

My pup was on Anipryl for the first few month's after diagnosis (2006). It seemed to make her more restless at night and she did grow "some" hair back on her tail but it didn't last long. It did'nt do anything for her panting, apetite or thirst. Actually, she seemed to pant more while on Anipryl.

I do hope your Truffle will be part of that 15% that it helps. :) Looking forward to hearing more about Truffle's diagnosis.

[Franklin'sMum]

Hi Truffle's Mum and Truffle,

Hi and welcome from me and my sweet child Franklin.

Our (limited) experience is with Trilostane, so I can't help with anything Anipryl related.

The people here on the forum are incredibly friendly, knowledgable
and helpful. I'm sorry for the circumstances that brought you here, but glad you found the forum.:)

Take care,
Jane and Franklin xx
________
Zq8 (http://www.chevy-wiki.com/wiki/ZQ8)

[Truffle's Mom]

Thanks everyone for the warm welcome.

Truffle has been exhibiting the increased thirst/urination/appetite for well over a year. We have treated her for possible UTI even though her urine's did not reflect bacteria with little effect. We also have tried changing food to see if her symptoms were possibly from a food allergy and with herbal sedatives (Happy Traveler) to see if possibly it was related to behavorial. Again these did not affect any of her symptoms. Over the last several months or so the symptoms have worsened.

We had a CBC done in April 2009. Here are the results:

Total protein results: 7.3 Reference Range: 5.0-7.4 Units g/dL
Albumin " : 4.2 " : 2.7-4.4 " g/dL
Globulin " : 3.1 " : 1.6-3.6 " g/dL
A/G Ratio : 1.4 " : 0.8-2.0
AST (SGOT) 27 " 15-66 IU/L
ALT (SGPT) 30 " 12-118 IU/L
Aklaline Phosphatase 101 " 5-131 IU/L
GGT 11 " 1-12 IU/L
Total Bilirubin 0.1 " 0.1-0.3 mg/dL
BUN 17 6-25 mg/dL
Creatinine 0.8 0.5-1.6 mg/dL
BUN/Creatinine Ratio 21 4-27
Phosphorus 3.3 2.5-6.0 mg/dL
Glucose 111 70-138 mg/dL
Calcium 10.5 8.9-11.4 mg/dL
Magnesium 2.2 1.5-2.5 mEg/L
Sodium 148 139-154 mEg/L
Potassium 4.3 3.6-5.5 mEg/L
Na/K Ratio 34 27-38
Chloride 108 102-120 mEg/L
Cholesterol 369 92-324 mg/dL
Triglcerides 186 29-291 mg/dL
Amylase 309 290-1125 IU/L
Lipase 340 77-695 IU/L
CPK 167 59-895 Iu/L



Complete Blood Count
WBC 8.8 4.0-15.5 1000/ml
RBC 7.3 4.8-9.3 "
HGB 18.1 12.1-20.3 g/dL
HCT 56 36-60 %
MCV 77 58-79 fl
MCH 24.9 19-28 pg
MCHC 33 30-38 g/dL

Differential Absolute %
Neutrophils 6864 78 2060-10600 /ml
Lymphocytes 1056 12 690-4500 /ml
Monocytes 616 7 0-840 /ml
Eosinophils 264 3 0-1200 /ml
Basophils 0 0 0-150 /ml
Platelet Estimate Increased
Platelet Count 596 170-400 1000/ml

T4 2.6 1.0-4.0 mg/dL


At this time our regular vet also did a complete urinalysis which came back negative and a x-ray. X-ray revealed some inflamation of the large intestine and some dark spots.

To be continued....

[Roxee's Dad]

Hi Truffle's Mom,

Do you have any results from any cushing's diagnostic test such as an ACTH Stim test or LDDS test?

ETA: Looking at the CBC results, I don't see anything out of range. Typically our cush pups have some high ALK numbers, but I'll leave the analysis to our expert's.

[Truffle's Mom]

Here is kind of a time line based on our vet visits:

3-7-2008: Saw vet for excessive thirst/urination. Total health plus T4 done along with urinalysis chemstik. Treated with Clavamox tabs 125 mg. wt 18 lbs

8-9-2008: same symptoms. Complete urinalysis.Treated with Cranvet and Cephalexin 250 mg. weight 17 lbs

11-3-2008: same symptoms. Complete urinalysis done. Treated with Happy Traveler for possible behavioral issue. 17 lbs

04-11-2009: Same Symptoms. Total Health Plus T4 and Complete urinalysis. X-Ray also done. Treated by changing food to IVD Canine Rabbit for possible food allergy. 17 lbs

04-30-2009: Emergency surgery for bloat . Sent home with Canine ID and Cephalexin 250 mg. 16.8 lbs

05-16-2009: Complete urinalysis

10-24-2009: Visit to Specialty vet-Internal Medicine
Ultrasound: Normal- Adrenal glands appear similar size

Urine Culture & Susceptibility
Source: Urine-Cysto
No-Growth

Urine Cortisol/Creatinine
Urine Cortisol 18.8 ug/dL
Urine Creatinine 74.6 mg/dL
Urine Cortisol/Creat Ratio 79

Urine Cortisol:Creatinine ratio <13.5 rules out hyperadrenocorticism
Urine Cortisol:Creatinine ratio > 13.5 indicate elevated serum cortisol but may be adrenal or non-adrenal illness.
Additional testing using LDDS or ACTH Stim is recommended for further identification of hyperadrenocorticism.


Vets notes: raised UCCR no other abnormalities
Next steps three view *not sure what the word is here-waiting for vet
LDDS

Collective findings to date consistent with PDH

Leptospirosis Panel also done- negative

Talked with vet about results and asked about Anipryl. He agreed and prescribed Anipril 7.5 mg once a day with follow up in six weeks. No additional test were done.

As soon as I hear from the vet or his tech on that missing word I will let you all know.

Thanks so much!!

Melanie and Truffle

[jrepac]

Hi there! I'm the other Anipryl (selegiline) user...I have been using it since Sep '08 and have been relatively pleased. It is controversial in terms of ability to treat Cushings....it either works or it doesn't. And, there is no way of telling beforehand. You just have to try it and see. Plus, over time, you may have to switch to another med; again, it just depends how well your pup responds to it.

My Aussie, Mandy, exhibited all of the classic cushings signs as early as late 2007 and then into spring 2008, but the diagnosis was not quite confirmed. It was "borderline" or maybe pre-cushings, if there is such a thing. As her symptoms were mild, I asked to try anipryl, as opposed to putting her on lysodren (when frankly, the diagnosis was not confirmed, that seemed kind of extreme to me). Anyways, the anipryl, combined with various other supplements (for UTIs, liver maintenance, etc.) has been my treatment protocol for some time now. About 3 weeks into treatment, I noticed it was having an effect...ultimately, improved sleeping patterns, less eating, less drinking, and less peeing. Improved skin and coat as well. No more UTIs or ear infections, either, so it was all good for us. For some, I am told it can take up to 2 months to see a change, but if not by then, forget it and move on to something else.

This year, finally got a "firm" diagnosis of cushings + atypical cushings (thanks to UTK test). For the moment, sticking w/the anipryl, plus melatonin & flax (lignans) and monitoring progress. So far, so good, but we'll see what our check ups bring.

I hope this info. is of help to you; the other thing to keep in mind is that anipryl is very safe, it has very few side effects, so there is no real harm in trying it. If it works for you great, if not, you can try one of the alternatives.

good luck!

Jeff

[jrepac]

Hi Melanie, just saw your latest post on test results after I posted. Has your vet suggested getting an ACTH or LDDS test? The UCCR test is a good screening device...and here it is suggesting Cushings. High ALK and high cholesterol are also indicators.

Again, the anipryl likely wont hurt, but you may want to be sure you are dealing w/cushings as opposed to something else.

A lot of conditions can produce cushings like symptoms (thyroid, diabetes, and god knows what else)

Jeff

[Truffle's Mom]

Just spoke with my vet his notes to my vet:

Next steps: three view of thorax (to rule out any stressors that might be causing elevated cortisol)

LDDS

When he and I spoke, we thought it couldn't hurt to try the Anipryl without the LDDS to see if she showed any improvement but we would need the LDDS before he would try either the Lysoden or Trilostan.

I'm beginning to second guess myself already and have asked his office to let me know how much the LDDS test will cost. Money is somewhat of an issue and we are already at 1000+ but I want to do what is best for Truff.

My vet was leaning more towards Diabetes Inspidis but the specialist is relatively certain we are dealing with PDH.

[jrepac]

I'm sure others can tell you what an LDDS costs, I have not done one, but I understand it is a little more expensive than an ACTH test. Prices on that also vary widely....I've seen as low as $180, but others getting prices in the $300s...sometimes, it pays to check around on pricing.


and certainly, the anipryl can't hurt, but am thinking the vet would take Truffle off of it prior to the LDDS. In some testing of Anipryl done in Canada, it was found to positively influence the LDDS results.....so, I'd think you'd need to come off of it for several days prior to testing...see what your vet says...

[Truffle's Mom]

Just got the quote for the LDDS...$430.00...:eek: That's for the office visit, Dex Supress, IV and Hospitalization.

Another 326.00 for three views of the thorax...:eek::eek:

Have a call into the doc to find out if not doing the xrays will affect treatment if the LDDS come back positive.

[SasAndYunah]

Hi Melanie and Truffle,

welcome to this board from me as well :)

I don't have much to say or add about treatments and such but I wanted to share some alternative testing with you. I am from The Netherlands and the way Cushings is diagnosed there, is a bit different and more then likely a lot cheaper. So I just wanted to let you know that you could ask for another way of testing which would cost you a lot less...

Of course the clinical signs ( for example drinking/peeing lots, insational appetite, panting, etc) and the bloodpanel (for example elevated Alk Phos levels) are part of diagnosing Cushing's. But then the diagnosing protocol here is a lot different from the USA. Here they do a cortisol/creatine ratio test first. This goes as follows. You collect first urine samples during 3 days, one sample each day. If the average value of all 3 samples of the cortisol/creatine ratio is greater then 15 x 10 (to the 6th) µmol per liter then the diagnosis is hyperadrenocorticism.

Then, to differentiate, they use the same method, you collect the first urine during 2 days, and after collecting the second urine sample (on day 2), you give the dog 3 high dose dexamethasone tablets orally, one every 8 hours. The third day you collect the third and last urine sample (the sample after the dog has been taking the high dose dexamethasone tablets). If the cortisol levels in the third sample have dropped by 50% or more, you're dealing with PDH. If the drop in cortisol levels is less then 50%, it can be either PDH or ADH.

This method of diagnosing is a lot less expensive and lot less stressfull on the dog. So I think that if money is a problem, you could always ask for this method of diagnosing and/or differentiating between PDH and ADH. In The Netherlands this is the standard procedure to diagnose Cushing's, so I don't see why it would be less accurate or why a vet would not want to use this method :)

Anyway, just an idea....to still get a thourough diagnosis but to safe quite a bit of money and stress on the dog.

Best of luck,

Saskia and Yunah,
The Netherlands :)

[littleone1]

Hi Melanie,

Corky had an LDDS test done last month. The total cost for everything was $350.00. He didn't have to stay all day, as we only live about 6 minutes away from his IMS. I was able to bring him back every four hours for his blood draws. I don't know how close you are to your vet. You might want to ask if this would be possible. That would help to cut down on your expenses. I don't know anything about the thorax. Corky didn't have to have any x-rays.







I wish you the best.

[acushdogsmom]

Just got the quote for the LDDS...$430.00...:eek: That's for the office visit, Dex Supress, IV and Hospitalization.


He didn't have to stay all day, as we only live about 6 minutes away from his IMS. I was able to bring him back every four hours for his blood draws. I don't know how close you are to your vet. You might want to ask if this would be possible. That would help to cut down on your expenses.Same here, sort of. We brought our dog in for the first blood draw, then went to sit with him in a nearby park for a while and also spent some time in the car listening to music until it was time for the second blood draw. Went back inside the clinic for the second blood draw, then did the same thing until it was time for the third blood draw. So our LDDS price did not have to include a charge for "hospitalization".

Also, I don't know why there would be any charge for an IV. The LDDS test requires a blood draw (taking a blood sample), then one injection (of dexamethasone) and then two more blood draws. My Vet never had to place an IV to do an LDDS test ...

[gpgscott]

Another 326.00 for three views of the thorax...:eek::eek:

Have a call into the doc to find out if not doing the xrays will affect treatment if the LDDS come back positive.

I am not getting this. I am not a Dr. but I do know that xray is not a good method to diagnose soft tissue issues, and why the thorax. Does the Dr. suspect an esophogeal issue?

If the Dr. suspects some medical issue which is causing elevated cortisol the way I understand it is that that issue should be diagnosed and treated first. Cushing's brought on by other medical issues or medical treatment is called iatrogenic and the first course of treatment is to address the underlying treatment/issue.

Assuming there is no treament or condition causing the symtoms I would take this course. I would want the UC:CR first, and the tests to rule out diabetes should not be costly. If the UC:CR is in the postive range for Cushing's and the diabetes tests are negative the next test I would want is the full adrenal panel from UTK. I am not a believer in LDDS, it can be ambiguous.

We see many members whose pups are put through the diagnostic mill and the pup suffers unnecessary tests and the owners empty their pockets. Not good.

Scott

[labblab]

I am guessing that the vet is suggesting the thoracic (chest) x-rays in order to rule out any obvious problems with Truffle's heart and lungs, including the presence of tumors. Information such as this can always be helpful, but given the financial worries (as well as Truffle's classic Cushing's symptoms), maybe the vet would not see them as being essential right now. I don't believe we ever had any chest x-rays performed on Barkis at the outset. They were ultimately recommended when he started to have problems that could have been associated with a tumor, but that was much farther down the road. But then again, his initial Cushing's diagnostics seemed more clear-cut, with lab abnormalities, bilaterally enlarged adrenals on ultrasound and a sky-high ACTH. In this case, where Truffle's labs and ultrasound were essentially normal (aside from the UCCR), maybe it would seem more important to "leave no stone unturned."

Marianne

[littleone1]

Hi Melanie,

I gave you the amount I paid for Corky's adrenal panel. His LDDS test was only $203.25.

Terri

[gpgscott]

Melanie,

Sorry I missed that you have had a UC:CR and that is is in the range suggestive of Cushing's.

You mentioned an exploratory surgery for 'bloat'. Did that turn up anything and could Truffle be having some type of chronic infection.

Scott

[jrepac]

Hi Melanie and Truffle,

welcome to this board from me as well :)

I don't have much to say or add about treatments and such but I wanted to share some alternative testing with you. I am from The Netherlands and the way Cushings is diagnosed there, is a bit different and more then likely a lot cheaper. So I just wanted to let you know that you could ask for another way of testing which would cost you a lot less...

Of course the clinical signs ( for example drinking/peeing lots, insational appetite, panting, etc) and the bloodpanel (for example elevated Alk Phos levels) are part of diagnosing Cushing's. But then the diagnosing protocol here is a lot different from the USA. Here they do a cortisol/creatine ratio test first. This goes as follows. You collect first urine samples during 3 days, one sample each day. If the average value of all 3 samples of the cortisol/creatine ratio is greater then 15 x 10 (to the 6th) µmol per liter then the diagnosis is hyperadrenocorticism.

Then, to differentiate, they use the same method, you collect the first urine during 2 days, and after collecting the second urine sample (on day 2), you give the dog 3 high dose dexamethasone tablets orally, one every 8 hours. The third day you collect the third and last urine sample (the sample after the dog has been taking the high dose dexamethasone tablets). If the cortisol levels in the third sample have dropped by 50% or more, you're dealing with PDH. If the drop in cortisol levels is less then 50%, it can be either PDH or ADH.

This method of diagnosing is a lot less expensive and lot less stressfull on the dog. So I think that if money is a problem, you could always ask for this method of diagnosing and/or differentiating between PDH and ADH. In The Netherlands this is the standard procedure to diagnose Cushing's, so I don't see why it would be less accurate or why a vet would not want to use this method :)

Anyway, just an idea....to still get a thourough diagnosis but to safe quite a bit of money and stress on the dog.

Best of luck,

Saskia and Yunah,
The Netherlands :)

I really like this method; only drawback is the pee-catching part!

I plan on doing a UCCR soon using a multi day sample, just as a sort of check up to see where things are at.

I think ACTH & LDDS tests are a bit stressful and I hate putting an older dog thru that unless it is really necessary...

[jrepac]

Just got the quote for the LDDS...$430.00...:eek: That's for the office visit, Dex Supress, IV and Hospitalization.

Another 326.00 for three views of the thorax...:eek::eek:

Have a call into the doc to find out if not doing the xrays will affect treatment if the LDDS come back positive.

$430 is high; I seem to recall my vet quoting $300...but we went w/just the ACTH anyways....he felt it was more reliable than LDDS...tho some consider LDDS to be the gold standard.

[jrepac]

S My Vet never had to place an IV to do an LDDS test ...

When I had my last ACTH test done, which went to UTK, my vet used an IV...$42 for the IV! He said it was safer/better to do it that way. I was wondering if that was a recommended UTK protocol, as never had an IV on past ACTH tests with my current Aussie nor my last one. Eh, sometimes, you really have to question if the vets are trying to rack up the charges (unfortunately). Just looking at the VAST range of prices here is eye opening...

[Harley PoMMom]

Hi Melanie,

Would you mind giving us details about the emergency surgery for bloat that was performed on Truffle: ie; why it was performed, did they find anything, was this the first time Truffle bloated, etc. Any details you can think of may help us, ok...thanks.



04-30-2009: Emergency surgery for bloat . Sent home with Canine ID and Cephalexin 250 mg. 16.8 lbs

Melanie and Truffle

Hugs.
Lori

[Truffle's Mom]

Spoke with the tech who assists our doc...doc is not comfortable treating Truffle without doing an upper chest xray to make sure their aren't any underlying issues in the heart or chest. Does that sound right?

Here is how it's showing the breakdown:

Exam.Consult, brief: 57.25
IDEXX Dex Supress. (Pre/2 Post): 238.99
Injection/IV: 72.09
Dexamethasone SP 4 mg/ml inj (per ml): 2.63
Hospitalization, Internal Medicine: 60.43
Radiographs, 3 views & Interpretation: 326.39


And if the test proves positive, then there is follow up visits, re-testing and medicine. Our budget will not support this so at this point I will continue to use the Anipryl and say lots of prayers that it helps her. I am in SE Michigan so if anyone on the board here is aware of a vet that is familiar with Cushings that is more reasonable I'd be grateful for a referral.

[Truffle's Mom]

Regarding Truffle's bloat...

She got into her dog food. My husband who is disabled, discovered this when he woke up. He is not nearly as familiar with dogs as I am and called me. When I came home I found Truffle's tummy was tight as a drum. She also was unsuccessfully attempting to vomit and she was unable to bring up any food.

I called our vet who told us to bring her in immediately. Our vet attempted to pump her stomach but the food was so packed in, she was unable to. Three hours later, she had extracted over a pound of food from her tummy. Truffle seems none the worse for having gone through it. I did question the vet if she noticed anything while she was in there but she said she wasn't really able to due to the length of the surgery.

[Harley PoMMom]

Hi Melanie,

According to the The Border Terrier Club of America, this breed is prone to heart issues.

http://www.btcoa.org/health/health_main.html

Did your vet ever check Truffle for a heart murmur?

Hugs.
Lori

[labblab]

Spoke with the tech who assists our doc...doc is not comfortable treating Truffle without doing an upper chest xray to make sure their aren't any underlying issues in the heart or chest. Does that sound right?

Hi again, Melanie!

I cannot say that it is unreasonable to perform chest x-rays on Truffle under these circumtances. But it sure does seem as though your vet is not cutting you any breaks whatsoever in terms of the pricing of your tests...:( :( Is this your regular vet, or the internal medicine specialist?

By any chance, are you anywhere near the vet school at Michigan State? Unfortunately, I'm thinking that E. Lansing is more central than southeastern. But our experience here is that vet schools are often more reasonably priced when it comes to diagnostic procedures than are private practices. You would need a referral to be seen at MSU for a consultation, but I'm guessing your vet would be willing to do that for you.

Also, I don't know whether any of the links on this thread would be helpful to you, but maybe you might qualify for some financial assistance through one of these programs:

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

If nothing else, you might very well qualify for "Care Credit." This program does not relieve you of your responsibility for vet bills, but it allows you to space out the payments over time without having to pay any interest. We have had a number of folks who have benefited from this program.

I'll do some more thinking about this, and reply again later on if I have any brainstorms!

Marianne

[Truffle's Mom]

Thanks Marianne... I will check out the links and see if there might be something we qualify for. The vet who is giving me these prices is an internal medicine specialist.

I do have a line of credit with Care Credit...2500.00 of which 1000 is already gone but I do have that resource. I just want to use the dollars as efficiently as possible. Our regular vet does not take Care Credit not sure how wide spread that might be in regular vet offices.

We are in Michigan so MSU might be an option for testing however it is 2 hours one way which for intial testing wouldn't be an issue. I am more concerned on how to manage the follow up care once we begin treatment. Can your regular vet do that or do I have to take her back to MSU?

[SasAndYunah]

Hi Melanie,

I am going to be very unconvential here...:) First of all, let me say I was shocked at those prices! I can't compare the prices for the LDDS os HDDS test since they are not performed here. But the price for a consult, for example...a consult here costs 16,75 euro, a lot less then you are being charged.

Okay, now for the unconvential part :D

Unless there are suspicions (coughing, breathing difficulties, etc) that Truffle is having some heart/lung problems, I don't see why she needs those x-rays, and certainly not 3. If I were you (financially) I would have the Cushing's diagnosed through the urine/cortisol test and perhaps have it differentiated by another 3-day urine test as I described in an earlier post.

And then, instead of treating with either Lysodren or Trilostane, I would look into the "complete destruction of the adrenals". (don't know the word in English :) ) This requires a lot less testing afterwards and is cheaper in the needed medications that will need to be given for the rest of Truffle's life. In other words, make her go Addisonian by purpose...that's cheaper (and easier) to treat. It's very unconvential overthere in the USA but done regularly overhere in The Netherlands. The way it is done is as follows:

The first 5 days you give the Lysodren daily...divided into 3 or 4 doses a day (easier on the GI tract). After the fifth day, you give the Lysodren every other day for the next 40 days. (so out of the 40 days you give the Lysodren 20 days). On the third day of the Lysodren therapy you start with the replacement therapy containing hydrocortison, fludrocortisonacetate and NaCl (salt). The doses will change once the Lysodren therapy has ended... But this is the general procedure how they will do this procedure.

Just an (very unconventional) idea...you can discuss it with your vet and ask about the costs involved if you were to go this route. At least that way, you can compare.

Best of luck,

Saskia and Yunah :)

[Truffle's Mom]

Saskia,

Thanks so much for the "unconventional" info....a couple of questions for you:

Would I not need to verfiy through an LDDS test that she does indeed have Cushing's? From what I'm reading it seems that we only have 2 indications of Cushing's; 1) clinical symptoms 2) increased UCCR and Cholesterol.

Isn't forcing her body into Addison's what we avoid trying to do with a Lysodren?

[SasAndYunah]

Hello Melanie :)

Yes ofcourse, you would first need to have a confirmed Cushing's diagnosis. If you scroll back at page 2 of this thread, you'll find an alternative way to diagnose Cushing's... the "Dutch/European way" :D Would be a lot cheaper then the LDDS test as done in the USA.

About the Lysodren and trying to avoid a dog going Addisonian, (and there are many that are much more able to explain this a lot better then I can..) yes, when one treats a dog for Cushing's and uses Lysodren, you try to have the Lysodren dose so that it erodes just the "outside layers" of the adrenals and therefore keeping the cortisol levels in the right range. If "overdosed", the dog will go Addisonian, meaning, too much or all of the adrenals stopped functioning and that's precisely what one would like to avoid. But, with the treatment I describe, it is the purpose to make the adrenals stop functioning all together, so...a kind of "guiding the dog into Addison's. The dog will not go Addisonian the same was as a dog that was accidentally overdosed on Lysodren. With this method, you start the replacement therapy during the time you make the dog addisonian on purpose. Meaning, the dog will get replacements for the hormones it's starting to lack due to the no longer functioning of the adrenals.

It's just a thought and an Addisonian dog is (normally) easier to regulate then a Cushing's dog on treatment. At least, that's the way they think and deal with it overhere. For example, they are able to remove the pituitary gland here surgically...but it is extremely expensive and after such a surgery a dog still needs replacement therapy. So many people here choose for the method I mentioned here...it's a lot cheaper then the surgery and most, me included just wouldn't have the money to have the surgery done. And this "making the dog Addisonian on purpuse" treatment, I wouldn't know why it would be worse then treating the dog with Lysodren or Trilostane. But there are lots of people here that will certainly respond and explain it much better then I can :)

Hope this helped,

Saskia and Yunah :)

[labblab]

We are in Michigan so MSU might be an option for testing however it is 2 hours one way which for intial testing wouldn't be an issue. I am more concerned on how to manage the follow up care once we begin treatment. Can your regular vet do that or do I have to take her back to MSU?
Hi Melanie,

In many instances, our members' regular vets ARE able to manage the monitoring and testing subsequent to Cushing's diagnosis. In those cases, the specialists may continue to act as consultants to the regular vets. But the consultation may be in the form of telephone contact between the two vets if questions or problems arise. However, this arrangement would depend upon your regular vet's comfort with such a situation, and also your own relationship with your regular vet (and your confidence that your own vet WOULD consult if she were faced with a situation about which she had questions). The monitoring test that is required for Lysodren or trilostane treatment is called an ACTH stim test. Some regular vets are able/willing to administer this test, some are not. So if you are considering MSU, these would all be good questions to ask your regular vet: whether she would want to refer you to MSU in the first place, whether she has had any experience (either good or bad) with them, and whether she would be able to perform the subsequent testing for you. Do you know whether she has had much experience with seeing or treating Cushing's dogs herself?

As far as Saskia's two suggestions (the LDDS urine testing and the purposeful induction of Addison's), we know she is correct that those are the norms in parts of Europe. What I don't know is why they are not considered conventional treatment here. But she is right -- they are not. And so I don't know that you would find a vet who would be willing to treat Truffle in such a manner. Since forcing a dog into Addison's is potentially life-threatening, you would definitely need to have the process overseen by someone who is knowledgeable about handling cases in this way. And even though prednisone is very inexpensive, many Addisonian dogs also need to be supplemented with an additional drug, the cost of which I am not certain about here in the U.S. Since the LDDS testing and treatment have been performed in this manner for quite some time in Europe, I cannot say that they would not be reasonable options. But once again, I CAN say that they are unconventional here, and you may or may not be able to find a specialist who would consider approaching Truffle's testing and care in such a manner. But these are questions that you can certainly ask the specialists about.

Have you started Truffle on the Anipryl yet, and if so, are you seeing any changes in her? Given the costs of testing and treatment, I surely understand why you want to consider every other choice carefully. And there is no need to make an immediate, instant decision. You can continue to take some time in educating yourself further about the options, and by reading more and talking more with both the folks here and also your own regular vet.

Marianne

[SasAndYunah]

Hi Melanie,

Marianne is absolutely right. You can and should take the time to educate yourself and talk with the vets treating Truffle. I do remember that a vet on this board (I am so sorry I forgot his name) answered my question about why they don't use the urine test in the USA, he replied that "they suppose that people in the USA don't like to store urine samples in the fridge :) Not sure if that was serious or not...but I can tell you that everytime I read about those expensive tests in the USA, I am flabbergasted why the urine tests aren't more common.... And I personally believe that unless the "clients" start to ask for it, vets won't change their method of testing. And I can't recall the vet saying it was unreliable... (can't find that thread back :( ) They do seem to use the urine test as a "screening method" but the same test, over a 3 day period can be used as a diagnostic tool. So they should be familiar with it since they do run the UC:CR test.

Also, I remember when I came here first because of my Cukie, the Cushpup that brought me here, I was frantic when the specialist had told me they wanted to make Cukie Addisonian on purpose... I think it was Cushy who told me that this method was still used in the USA in cases that couldn't be treated otherwise...dogs that could not be controlled on Lysodren for example.

And yes, if you want to consider this option, you should find a vet that is familiar with the procedure, but that goes for every special procedure I think :)

And I am really not pushing you towards this option but just wanted to let you know that it is perhaps a possibility... When Trilostane became first in use in the USA, many people on this board worked together with their vets, since the vets at that time, weren't familiar with the use of Trilostane but they were willing to learn. So why wouldn't a vet, if asked, not want to learn and try and use the urine test for diagnosing and differentiating, for example, if asked by his client? (being chronically ill and disabled myself, I have learned to open my mouth, to question treatments and procedures etc for myself, so why not for my pet? :D)

Anyway, it's an interesting discussion, I think :) Just hope it helps you in finding what would be the best way for Truffle and yourself...

Saskia and Yunah :)

ETA: Hi Sas, I have edited to add the quote from Dr Bruyette that you referred to. Hope you don't mind ;)


I think its because pet owners in the United States dont want to handle dog urine

Dave Bruyette DVM DACVIM


John, not at all...very pleased about if even :D Thanks :)

Sas :)

[Truffle's Mom]

Hi Everyone,

Truffle's excessive urination and urinating in the house is one of the reasons we suspected Cushing's however the accidents indoors are now happening right in front of my husband and I. Last night we had our girls on the bed and Truffle got up and squatted right on the comforter and sheet. This happened a few nights ago but we weren't sure if it was her or our new puppy.

Just wondering if anyone has experienced a similar situation. Until recently she mostly peed indoors when we weren't home or in the same room.

Thanks!

[jrepac]

this sort of thing is pretty common; with treatment, it will alleviate somewhat (or completely, if you are lucky)..

when my Aussie started having accidents all over, with frequency, I knew that was a sign of cushings

however, you should get her urine checked to make sure there is no infection (UTI)

[Truffle's Mom]

We are on Day 11 trying the Anipryl. I understand it may take some time to work, if its going to work at all.

This urinating right in front of us is brand new though so was just wondering if this is routine for most Cushing's doggies or something more. Could be a UTI though, that's a thought.

[Squirt's Mom]

Hi Melanie,

The frequent need to pee and apparent loss of house-training is one of the signs of excess cortisol. However, it is also a sign of other conditions, UTI just being one. I would get her in and have her checked out fairly soon. The Anipryl could take a bit of time to work but I would have expected a better resolution by now. If this came on suddenly, it may not be Cushing's related so I would suggest you have your vet give her a going-over.

This reminds me...I was supposed to give you some info when I got back home. My feeble mind forgot. :o Check out your thread in a bit and I hope to have some links posted there for you.

Hugs,
Leslie and the girls

[bgdavis]

Hi,

I take it your dog hasn't been diagnosed as having Cushings'? I would have a simple blood test done to rule out the possibility of diabetes, which does cause excessive urination, lots of drinking, weight loss, and increased appetite.

Anipryl is no longer recommended to control Cushings', as it does nothing to correct the medical problem, but does cover some symptoms.

Bonnie and Angel Crissy

[Squirt's Mom]

Hi! :D

Here you go:

Anipryl info*

http://www.pfizerah.com/product_overview.aspx?drug=AR&country=US&lang=EN&species=CN

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

http://vetmedicine.about.com/cs/diseasesall/a/aniprylseniors.htm

http://www.lbah.com/anipryl.htm

http://www.selegiline.com/

http://www.1800petmeds.com/Selegiline-prod10305-10305.html

http://www.petplace.com/drug-library/selegiline-hcl-anipryl/page1.aspx

http://www.drugs.com/vet/anipryl-5-mg-can.html

Hope this helps a bit!

Hugs,
Leslie and the girls

[Truffle's Mom]

Thanks for the links Leslie :)

Is anyone here in SE Michigan by chance? Just wondering who is treating their fur-kid and if they have any experience with Cushing's

[jrepac]

We are on Day 11 trying the Anipryl. I understand it may take some time to work, if its going to work at all.

This urinating right in front of us is brand new though so was just wondering if this is routine for most Cushing's doggies or something more. Could be a UTI though, that's a thought.

Right, UTI's are very common with Cushings, as the cortisol depresses the immune system...and Anipryl can't do anything to counteract a UTI, for sure....

worth getting a urine sample over to the vet...

[labblab]

Hi Melanie,

Just thinking about you guys today, and wondering how Truffle is doing. We'll be watching for an update whenever you have the chance.

Continuing best wishes,
Marianne

[Truffle's Mom]

Just posting a follow up on Truffle...I have had some medical issues myself so I apologize for not responding sooner.

They have checked her heart...no murmur.

Her symptoms seems to be worsening...belly has gotten much bigger and her appetite has her ransacking the garbage can in the kitchen, pulling boxes of food out of the cupboard. She even went after the vegetable oil in a plastic container and was licking up off the floor. After two episodes of raiding on back to back days, I am now crating her when I leave the house and can't watch her.

I am calling the IMS today to set up a consult with the vet. While we have some credit left on our Care Credit card, it will not cover much beyond the test and xrays he wants to do. I need to find out what follow treatment will be needed once she starts loading and the price and some pricing info on each of the medicines that might be used before we go further.

Hope everyone and their furkids has a wonderful week.

[lulusmom]

Hi Melanie,

I don't have time to go back to refresh my memory on Truffle's history but wanted to mention that if she is drinking and urinating excessively, please make sure you have plenty of water in her crate. Most cushdogs do not concentrate their urine and they drink to keep up with the peeing. If left without water, dogs with this problem can dehydrate within hours and die.

It sounds as though you do need a confirmed diagnosis and then on to an effective treatment. We'll look forward to your report after Truffles' consult.

Glad to see you back and thanks for the update on your girl.

Glynda

[Harley PoMMom]

Hi Melanie,

It is so good to hear from you but I am so sorry to hear of your health issues, are you feeling well now? And please no apologies needed, ok.


They have checked her heart...no murmur.
This is great, no murmurs. Yahoo.


I am now crating her when I leave the house and can't watch her.
I think this is a good idea too bc if she is eating everything in sight then you have to be careful, some foods can be toxic to our pups.


I am calling the IMS today to set up a consult with the vet. While we have some credit left on our Care Credit card, it will not cover much beyond the test and xrays he wants to do. I need to find out what follow treatment will be needed once she starts loading and the price and some pricing info on each of the medicines that might be used before we go further.
Maybe your IMS will let you set-up a payment plan? And if Truffle has no heart murmur then I don't know why they need the X-rays but I am no vet.
We can help you with the pricing info too, let us know what your vet/IMS says when they see Truffle, ok. Remember you are not alone on this journey, we are here to help you in any way we can.

Love and hugs,
Lori

[littleone1]

Hi Melanie,

I hope you're feeling better.

I totaly understand the financial aspect of taking care of our babies. I know Corky's vet's and IMS bills have been unbelievable during this past year. I lucked out because I was able to get a reverse mortgage on my house, which really helped.

I wish the best for you and Truffle. As Lori said, once you have a confirmed diagnosis, there is help as to where to buy the meds Truffle will need to take.

[Truffle's Mom]

Just reading through some of the archives and came across something that has me thinking...insanyone here familiar with Hypercalcemia?

Looks like many of the same symptoms as Cushings..

[Roxee's Dad]

Hi Melanie,
I hope you don't mind but I summarized your post to make easier for our members to review Truffle's history. My only comment is that I don't see any conclusive diagnosis of Cushing's although all the symptoms all seem to be there.

Summary:

12 year old Border Terrier, Truffle - 15 pounds

Clinical signs of Cushing's; increased appetite, water consumption and urination, pot belly, thin coat, flaky skin, lethargy and panting,

3-7-2008: Saw vet for excessive thirst/urination. Total health plus T4 done along with urinalysis chemstik. Treated with Clavamox tabs 125 mg. wt 18 lbs

8-9-2008: same symptoms. Complete urinalysis.Treated with Cranvet and Cephalexin 250 mg. weight 17 lbs

11-3-2008: same symptoms. Complete urinalysis done. Treated with Happy Traveler for possible behavioral issue. 17 lbs

CBC done in April 2009 – nothing abnormal (see post# 9)
At this time our regular vet also did a complete urinalysis which came back negative and a x-ray. X-ray revealed some inflamation of the large intestine and some dark spots.


04-11-2009: Same Symptoms. Total Health Plus T4 and Complete urinalysis. X-Ray also done. Treated by changing food to IVD Canine Rabbit for possible food allergy. 17 lbs

04-30-2009: Emergency surgery for bloat . Sent home with Canine ID and Cephalexin 250 mg. 16.8 lbs (bloat due to overeating)

05-16-2009: Complete urinalysis

10-24-2009: Visit to Specialty vet-Internal Medicine
Ultrasound: Normal- Adrenal glands appear similar size

Urine Culture & Susceptibility
Source: Urine-Cysto
No-Growth

Urine Cortisol/Creatinine
Urine Cortisol 18.8 ug/dL
Urine Creatinine 74.6 mg/dL
Urine Cortisol/Creat Ratio 79

Urine Cortisol:Creatinine ratio <13.5 rules out hyperadrenocorticism
Urine Cortisol:Creatinine ratio > 13.5 indicate elevated serum cortisol but may be adrenal or non-adrenal illness.
Additional testing using LDDS or ACTH Stim is recommended for further identification of hyperadrenocorticism.


Vets notes: raised UCCR no other abnormalities
Next steps three view *not sure what the word is here-waiting for vet
LDDS

Collective findings to date consistent with PDH

Leptospirosis Panel also done- negative



11-11-09 - treatment with Anipryl 7.5 mg once a day

11-17-09 -Day 11 trying the Anipryl. I understand it may take some time to work, if its going to work at all.

Urinating right in front of us is brand new though so was just wondering if this is routine for most Cushing's doggies or something more.

[jrepac]

How is Truffle doing?

Still on the Anipryl? If it is not working, your vet may want to up the dosage to 10mg or 15mg a day...

BTW...did you ever get an ACTH test or LDDS to confirm the suspected Cushings?

Jeff

[Truffle's Mom]

Anipryl doesn't appear to be working..appetite is much worse. Thirst and urination is the same.

Called and spoke to the vet's tech...he wants 108.00 just to meet with my husband and I to discuss potential casts and tests that will be required which I think is ridiculous after we have already paid 1000.00 upon our intial meeting for office visit and testing.

I have no idea what to do. Our only means of paying for any additional cost is with our Care Credit card and our regular vet doesn't accept it.

Is there anyone on the board here in South East Michigan that might be able to recommend someone? I did check the archive but it didn't turn up anyone other that MSU and Michigan Veterinary Specialists which is where we have already been seen.

[labblab]

Hi Melanie,

I've temporarily revised your thread title to let people know you are anxious to find a vet referral. We can change the title again shortly, but I'm hoping that maybe this will help to get you some feedback!

Marianne

[Roxee's Dad]

Hi Melanie,

I'm so sorry your vet tech quoted you so much just to meet and discuss. Especially during these difficult economic times we are experiencing. Some time ago when I lived in AZ and volunteered at a local rescue, the local humane society offered discount vet care for people that could not afford care for their pups.

I don't know exactly where you live but maybe you can check out this link to the Michigan Humane Society, I noticed they offer vet care. You can possibly give them a call, explain the situation and symptoms that Truffle is experiencing.


The Michigan Humane Society operates three veterinary centers in Detroit, Rochester Hills and Westland.


I would first ask for an ACTH Stim test to check the cortisol levels then when confirmed, follow up with an LDDS to determine if it's PDH or ADH. It seems to me the least expensive way to go with the least amount of gamble. Then if the test prove positive for cushings, decide which route you wish to take (Lyso or Trilo)

Just my opinion of diagnosing Cushing's on the least expensive route with the least amount of gamble.

Here is a link to the Humane society of Michigan, hope they have an office near you.

http://www.michiganhumane.org/site/PageServer?pagename=vetcare

[Squirt's Mom]

Hi Melanie,

Here is a site that may help you find a good Cushing's vet in your area. You can search by state, I believe.

www.acvim.org

Hope you find one that has a bit more compassion than greed this time. :( This is expensive enough to deal with as it is without addition "just because" charges. :mad::rolleyes:

Please let us know how Truffle is doing. What dose of Anipryl is on right now? Still the 7.5mg? It may be possible to increase that dosage a bit and help the signs some, but it may not either. I think if I were you I would be getting some cush specific testing done as soon as you can...I know how hard that is right now even as I say that. :( And boy do I understand!

One thought I have on the testing that may save you some money in the long run. The Uni of TN does a test called a full adrenal panel that will check not only the cortisol level but also 5 other hormones that can cause Cushing's. This is a blood draw that is done via your vet and the sample is sent directly to UTK. UTK's cost for this test is $140.00 then your vet will tack on their charges plus shipping. The avg. cost around here seems to be around $350 for the whole deal. Just a thought and I will include links to UTK about this test for you.

Keep your chin up, honey, and remember Cushing's is a slow progressing condition so try not to panic just yet. :)

Hugs,
Leslie and the girls

UTK Panel
Explanation of hormones
http://www.vet.utk.edu/diagnostic/endocrinology/treatment.php

Referral policy
http://www.vet.utk.edu/clinical/referrals.php

Cost sheet
http://www.vet.utk.edu/diagnostic/endocrinology/index.php

[Truffle's Mom]

Thanks for changing the title of my thread along with the cyber support. I'm not in full panic mode but I am concerned that Truff might be suffering or at least be uncomfortable while I'm trying to sort through all this. She is such a lovable muppet and it pains both my husband I to see her going through this.

I'm thinking I may just get on the phone and start calling vet office's to see who might be willing/able to help her. I'll let you all know what I find out.

[jrepac]

This vet sounds like a crook!:mad:

You may want to up the anipryl dosage to see if it offers any relief...if you are at 7.5mg now, the vet would likely ok it up to 15mg (this is what Pfizer recommends; 30 days at standard dosage and if no relief, then double it for another 30 days and see if it works). But, you may be in that contingent of owners for who anipryl has no effect (unfortunately). Also, maybe try to get the generic (selegiline) which comes in 5mg tablets...1-800-Pet Meds charges $25 for a bottle of 60 5mg tabs. Very reasonable; much cheaper than the branded version.

If money is tight, I'd suggest getting the ACTH test, which can be done for $180-$220 or so w/most regular vets. That would give you a pretty good handle on the cortisol situation. From your UCCR, it does look like Cushings and likely PDH. The ratio is very high.

If you can swing a bit more $$$, the UTK test is a good one, as it is more comprehensive...you would want the "full adrenal profile"..in many cases, the 5 other intermediate hormones can be elevated w/the cortisol. Then, the course of treatment is slightly different, as they will add melatonin and lignans to the mix.

Shoot, you might want to give the melatonin a try right now, until you get the situation under control...3mg once or twice a day might be of help....(use standard version, not time released). It will help inhibit the cortisol, which is what drives the Cushings symptoms. You can get it at any drugstore or supermarket on the vitamin shelf.

Jeff

[Truffle's Mom]

So do I need to talk with my vet before upping the Anipryl to 15 mg or do you think it is ok to go ahead just based on Pfizer's reccomendations?

I'm not familiar with the serotonin...how do you determine the dosage?

And yes I am beginning to think the prices reflect what they need to charge to pay for the building and all the fancy equipment. Not a happy camper. :(

[Squirt's Mom]

Hi Melanie,

Anipryl is a prescription drug so I think you will need a new script from your vet. You might be able to achieve that with a phone call, tho, VS a visit.

Jeff is talking about melatonin, not serotonin. Melatonin and flax lignans are what are used to treat Atypical Cushing's resulting from elevations in one or more of five other hormones, Estradiol, Androstenedione, 17-Hydroxyprogesterone, Progesterone and Aldosterone. While it probably wouldn't hurt to add them to Truff's regimen, they may skew any future testing if they are not stopped for a period before hand. This treatment can take 3-4 months to see results, so if you do decide to add them, don't expect to see changes quickly.

Ideally, you will be able to find a vet soon and get the proper testing done so you know what you are dealing with. I know the cost is a factor but once the diagnostic phase is over, the expense drops quite a bit. For Truff's sake, getting her tested is the way to go. ;)

I wish you were near me here in TN and I could send you to some wonderful vets, but since you ain't, I will pray you find one as great as ours soon.

Hugs,
Leslie and the girls

[jrepac]

Hi Melanie,

Anipryl is a prescription drug so I think you will need a new script from your vet. You might be able to achieve that with a phone call, tho, VS a visit.

Jeff is talking about melatonin, not serotonin. Melatonin and flax lignans are what are used to treat Atypical Cushing's resulting from elevations in one or more of five other hormones, Estradiol, Androstenedione, 17-Hydroxyprogesterone, Progesterone and Aldosterone. While it probably wouldn't hurt to add them to Truff's regimen, they may skew any future testing if they are not stopped for a period before hand. This treatment can take 3-4 months to see results, so if you do decide to add them, don't expect to see changes quickly.

Ideally, you will be able to find a vet soon and get the proper testing done so you know what you are dealing with. I know the cost is a factor but once the diagnostic phase is over, the expense drops quite a bit. For Truff's sake, getting her tested is the way to go. ;)

I wish you were near me here in TN and I could send you to some wonderful vets, but since you ain't, I will pray you find one as great as ours soon.

Hugs,
Leslie and the girls

Leslie is correct. Melatonin treatment takes some time to "kick in"...it assists in lowering those hormones she mentioned and supposedly helps w/cortisol as well (according to UTK). Same story w/lignans. After using both melatonin & lignans(flax) for 5 months, in tandem with generic anipryl, I was very happy to get a much lower cortisol reading from recent testing. But, every case is different, each pet can respond differently.

Regarding the anipryl, I am not sure what tablet size you are using...it might be easy to just add a pill, or half a pill, as needed. I'd say give the vet a quick call to see what they say/think. I'm using 5mg pills, so it is pretty easy to go up/down w/dosage. If you do increase the dosage, and don't see any response in 4 weeks, you can pretty much conclude that it is not working.

Good luck!

[Truffle's Mom]

Just an update on Truff:

Upped her Anipryl dose from 7.5 mg to 15 mg. approx 1 week ago.

She seems to be panting more...I've also noticed that she has developed dark mole type spottting in her groin area and on her hind legs...is this from the cushings? I'm worried that this could be something else...melanoma? :(

We have an appointment with our regular vet on January 5th.

[littleone1]

Hi Melanie,

I don't know if the mole-like spots are related to Cushings, but Corky has been getting them for a few years, way before he was diagnosed with Cushings. He's had several removed, but they weren't anything to worry about.

I'm glad you have an appoinment with your vet. I'm sure it will help to put your mind at ease.

Terri

[Truffle's Mom]

Truffle update:

Saw our regular vet and we are all of the opinion that the Cushing's is most likely advancing as her appetite is through the roof now and the dark spots in her groin and along her back legs are calcification of the skin due to the Cushings.

Monday we are taking her in for a LDDST and will likely start her on Trilostane next week. After reading about Zoe, another 12 yr old Border Terrier, I am so afraid that Truff might develop something similar and our efforts will be for naught. :(

So I am crossing my fingers that we haven't waited too long. I was looking through some of the posted links and will continue to look but perhaps someone can direct me as to what is the recommended beginning dose of Trilostane for a 13 pound dog or is more based on how her numbers come back after testing?

[littleone1]

Hi Melanie,

If it's any consolation, Corky was almost 12 and 1/2 when he started being treated for Cushings. Every dog is different, and what happens to one dog might not happen to another dog, even if they are the same breed.

In my opinion, not treating Cushings is much more detrimental to them than treating it.

I hope you are able to make a good decision as what to do.

Corky was just a little over 20 pounds when he started his treatment. His IMS started him on the lower dosage, which was 1mg per pound, so he started on 20 mg of Trilo once a day, and this is where he remained for almost three months.

Terri

[Harley PoMMom]

Hi Melanie,

Cushings is a slow progressing disease and many pups do go years undiagnosed, but they do, hopefully, get treated and they DO get better. ;):)

As far as the initial dosing, there are two protocols that your vet may choose to follow, one by Dechra and the other by UC-Davis.

Now on Dechra's product insert it states 1-3mg per lb but one of our Administrators, Marianne has talked to an IMS from Dechra, Dr Allen, and he now says that this has changed to 1mg per pound.

Terri, (Corky's Mom) has had the same conversation with Dr Allen and confirmed the same findings.


Hmmmm....Terri, I am thinking that there is some misunderstanding about this. As it turns out, I too have had occasion to talk to Dr. Allen recently. I had some general questions that I wanted to ask him, and initial dosing was one of them. He told me that he is personally recommending that people start at the lowest end of the Dechra range, which is 1 mg. per pound (and not 1 mg. per kg.). I don't think I misheard him, because we went on to discuss the differences in Dechra's recommendation from UC Davis.

He stressed that they are in no way challenging any vet's decision to follow Davis' guidelines if that is their preference. But the dosing protocols are not identical. I really wish that there would be written revision to Dechra's chart, in order to clarify this revised recommendation. But barring that, I will encourage people to contact Dechra directly in order to get the information first-hand in the event that they want more info. Here's contact info for Dechra's U.S. office: "Contact Us" (http://www.dechra-us.com/page/contact-us)

Marianne

The UC-Davis protocol is 1 mg/kg. Here is a link to an article about that:
http://veterinarynews.dvm360.com/dvm/article/articleDetail.jsp?id=460965&sk=&date=&pageID=3

Here is a link to the U.S. Dechra Product Insert:
http://www.dechra-us.com/File/prod_vetyrol.pdf

Here is a link to our Trilostane/Vetoryl Information and Resources Thread:
http://www.k9cushings.com/forum/showthread.php?t=185

With Trilostane or Lysodren you want to make sure you have prednisone on hand. Also when you get the LDDS test done could you post the results of the test.

Remember you're not alone on this journey, we are here for you and Truffle.

I just wanted to clarify that the dosing is based on her weight, so if they go by Dechra's 1mg per lb then she should get 13mg of Trilostane once a day. If they go by UC-Davis 1mg per kg then her dose would be 5.9mg once a day.

Love and hugs,
Lori

[Truffle's Mom]

Thanks Terri and Lori..

Our appointment was rescheduled due to bad weather on Monday to today. (Our vet is 40 minutes away).I dropped Truffle off this morning and hubby and I will pick her up at 5 tonight.

I will get the results tonight ( I think) and will post them tomorrow. Is there anything else I should be sure to ask or get from our vet today?

She did tell me that she just began treating another dog in her practice and there is a compounding pharmacy in the area that will be able to make up the proper dosage of Trilostane so that was reassuring. Just trying to be prepared so I can relay the details necessary to all you experts out there.

We appreciate your help and support more than you know.

[Harley PoMMom]

Hi Melanie,

Make sure to walk out of that office with prednisone in your hand, and if you have to, demand it. Some vets have a misleading notion that Trilostane cannot cause Addison's in a pup, but according to the U.S. Dechra Product Insert (link included below), pups most certainly can, so one must have prednisone on hand to be given to the pup in case of such emergency. The quote is taken from the U.S. Dechra Product Insert.

U.S. Dechra Product Insert
http://www.dechra-us.com/File/prod_vetyrol.pdf


PRECAUTIONS:
Hypoadrenocorticism can develop at any dose of VETORYL Capsules. In some cases, it may take months for adrenal function to return and some dogs never regain adequate adrenal function.

Is she aware that the ACTH tests for a Trilostane pup have to be done within 4-6 hour after dose. The one thing I would do would be to print out that Dechra Product Insert and read it yourself, I mean really try to familiarize yourself with everything it says you must do. At every ACTH stim test, Truffle's electrolytes must be checked also.

Another really important thing is her dose, we did post to you about what Dr Allen has told us that Dechra is now recommending ~ 1 mg. per pound ~ If she in not following this protocol then your vet probably does not have this information, if she would contact Dechra and talk to Dr Allen so that Truffle can be put a dose of Trilostane that is right for her.

Best of luck on your vet appt. today and I will be checking back for the LDDS test results.

Love and hugs,
Lori

[Truffle's Mom]

Thanks Lori...I printed out the info the other day when you posted it. I will be sure to bring it with me tonight along with Dr Allen's name and what he is recommending should she need to contact him for specifics on Truffle's dosage.

[Truffle's Mom]

Ok Here are the results of the LDDS:

Cortisol Sample 1: 6.0 (HIGH) Ref Range: 1.0-5.0 ug/dL

Cortisol Sample 2: 4.3 (HIGH) Ref Range: 0.0-1.4 ug/dL

Cortisol Sample 3: 3.3 (HIGH) Ref Range: 0.0-1.4 ug/dL

Our vet is suggesting beginning Truffle's dose at 5 mg x per day.

Hubby is picking up Prednisone today. Vet is checking on pricing from her sources and is calling me with our options.

Thoughts?

[labblab]

Hi Melanie,

Thanks so much for posting those LDDS test results! They definitely support a diagnosis of Cushing's. However, since neither the 4-hour nor 8-hour result was less than 50% of the baseline value, the results do not help differentiate between the pituitary and adrenal forms of the disease. But I see that Truffle did have an abdominal ultrasound on 10-24-09 and the ultrasound did not reveal any adrenal masses or abnormalities. So that would be supportive of the diagnosis of pituitary Cushing's (PDH).

And so now the trilostane treatment begins, and I am sending you all my positive thoughts that everything will go smoothly. Am I correct that you are starting Truffle on 5 mg. ONCE a day? If so, that is a very conservative starting dose -- even a little bit lower that the UC Davis protocol which is, itself, more conservative than Dechra's. And I am not suggesting there is anything wrong with starting really low. I think it is much better to start low and work upward rather than vice versa. But just be forewarned that you may not see a lot of symptom improvement to begin with, and the dose may need to be increased after the first ACTH test. Please don't be down-hearted if this is the case, since the dosage always CAN be increased if need be. Here's a link to Dechra's "Treatment and Monitoring" Flowchart to help you make more sense of the significance of different monitoring ACTH results and symptom patterns:

http://www.dechra-us.com/File/vetoryl_Treatment_and_Monitoring_Flowchart.pdf

Thanks so much for updating us, Melanie, and please let us know how things go with the trilostane.

Marianne

[Squirt's Mom]

Hi Melanie,

Well, now you have a diagnosis and a plan in place! :) The coming days may be a bit stressful for you but in no time you will see a difference in Truffle and you will be glad for all that has gone before to get her to that point.

Know that we are always here for you and Truffle. If you have any questions, concerns, or just need to VENT don't hesitate...that is what we are here for! :)

My personal prescription for your stress is a hot bubble bath, a good book and a chilled glass of wine. Just close the door and relax. Does wonders for the soul! :D

Hang in there! You are doing a great job!
Hugs,
Leslie and the girls - always

[littleone1]

Hi Melanie,

I just want wish you and Truffle a successful treatment.

[Truffle's Mom]

Marianne: The 5 mg dose will be twice a day not once to start.Does that seem more in line?

Hubby and I are taking a trip the first weekend of Feb to a Bed & Breakfast in one of our favorite cities in MI. We are having in-house massages and our room has a two person jacuzzi. I am hopeful that our dear Truff will be showing some signs of improvement by then so while we can not only de-compress, we can also do a little celebrating. The 3 girls will be taking their mini-vay-kay at the home of our breeder, which they love. :D

[labblab]

Yup, the total of 10 mg. per day fits right in the middle between the Dechra and Davis dosing recommendations that Lori calculated for you earlier. :)

One thing you will notice when you look at Dechra's monitoring recommendations is that they suggest starting off with once-daily dosing, and only moving to twice-daily dosing if symptoms seem to rebound later in the day. Although several research studies have endorsed twice-daily dosing, the question still doesn't seem to have been "settled" among clinicians who are actually treating Cushpups. So you will find dogs here who are being dosed in either manner. Some vets prefer one approach, some vets prefer the other. An endocrinology specialist who is a member here (Dr. David Bruyette) has told us that dogs who are dosed twice daily tend to end up needing a lower overall daily dose than do dogs dosed once daily. But the "flip" side is that dogs dosed twice daily may be more likely to experience over-suppression of cortisol -- and thus their cortisol levels and electrolytes need to be monitored even more closely.

But the proof will be in the pudding when you see how Truffle responds -- and I hope that will be very well! ;)

Marianne

[Truffle's Mom]

Thanks Terri and Marianne!

Spokw with the vet last night...she was hoping to find a local pharmacy such as CVS or Walgreen's who might be able to fill the Trilostane script but unfortunately neither had even heard of it. She has a call into the compounding pharmacy and will continue checking a few other spots for pricing. I think we may go with the compounding pharmacy at least until we have figured out Truff's proper dosage as they are local and will mail the script to our home.

Once we know how much she is going to need, I can look online for a source.

I'll keep you posted...:)

[lulusmom]

Hi Melanie,

Vetoryl (Trilostane) is a veterinary drug so I am not surprised that CVS and Walgreens doesn't carry it. Many of us members use Diamondback Drugs in Scottsdale, AZ for our compounded versions of Trilostane and Lysodren. They ship anywhere in the U.S. and I found that they are very competitive in their pricing, which includes a set shipping charge. I'm in California and my two cushdogs' internal medicine specialist as well as their prior gp vet call in prescriptions and refills to DBD for me. I normally receive refills in a day or two. I use them for all of my dogs medications. Mike and Roy, the owners, are very familiar with our group and are always happy to answer any questions. I know because I've picked their brains about more drugs than those used to treat cushing's. Here's a link to their website which has their contact information.

www.diamondbackdrugs.com

I believe there are a few other compounding pharmacies that other members have suggested and hopefully, they'll be by to share that information with you.

Glynda

[Harley PoMMom]

Hi Melanie,

Altho I have not used Center Pet Pharmacy myself, I thought I would include it here for you with Gina's response.

Hope this helps.

Love and hugs,
Lori


Hi Glynda and Jeff –

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

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

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

Myrna


Hi...

Just wanted to share my experience with Center Pet Pharmacy...they are the best!!! When Trilo was approved here in the US, I looked all around for the cheapest price, and they were definitely the cheapest. They were also super nice, and Fed-Exed me the pills overnight. I would recommend them to anyone.

Gina