Mackie the mini schnauzer, 9 yrs old, diabetic, Cushing's, trilostane

[recruiter]

Hello, I'm Bill, the owner of Mackie, four years a diabetic and diagnosed today with pituitary-dependent Cushings. We're starting Trilostane on Saturday.

I've joined for the pending advice I'll need and one immediate issue: Food. He's been on Wellness Core reduced fat, but the high protein is a concern to his vet and he's suggested Holistique Solid Gold - which is a little higher in carbs than I'd like for a dog on Novolin.

We're going to be searching for the right insulin dose, if any, as well, so any immediate thoughts or questions would be appreciated.

[BestBuddy]

Hi Bill and welcome to you and Mackie.

Your story is a little like my Buddy and me. Buddy had been a diabetic for 4 years before the pituitary cushings diagnosis. How old is Mackie and what is his weight and what is your trilo dose.

We didn't change food with the cushings and just stayed with the same as was suiting him and the diabetes. In the months before finding out he had cushings Buddy has been getting erratic BG numbers which had previously been pretty stable for 4 years and we needed to increase his insulin, it went from about 4iu to 6iu. We were advised to cut the insulin by at lease 10% when we started the trilo and had to keep a watch on the BG numbers which forced me to start doing BG testing at home. Within a month or so we were back to the 4iu and BG numbers had become stable again.

Do you home BG test and what sort of numbers are you getting?

Jenny

[frijole]

Hi there! My schnauzers are 14 and 16 - the older one has cushings but not diabetes. They have been on Solid Gold foods for 10 yrs now. They use the Holystique.

I can only vouch for the food having played what I feel is a role in my dog's lives. There was a noticeable difference in their energy levels, skin etc when they made the switch. Even my 40 something brother noticed it!

Like I said, I will let those with diabetes knowledge comment on that end of it. Glad you found us.

Is the diabetes under control at this time? How long has the cushings been diagnosed? Can I ask what tests were done to dx? I'm asking because the symptoms often mimic each other and diagnosing can be somewhat tricky.

Welcome aboard! Kim

[recruiter]

Mackie is 9 and he weighs about 18 pounds.

The diabetes isn't under control at the moment, largely due to the Cushings, which is my concern. He has some hair loss on his tail and some muscle mass loss. We were consistently in the low 100s, then in November the numbers spiked into the 400s and have basically yo-yod between 250 and 450 since then.

We've had trouble settling on food. He really loved Wellness Core, which is what I went to after we discovered that Science Diet WD - recommended for him by his vet - was garbage. Holistique is fine, but it's about 55 percent carbs, which is WAY too high for a dog with diabetes.

He's been through the standard round of testings, but I don't have any readings in front of me at this point.

[recruiter]

Also, what are some of the complications you watch for with Trilostane?

[frijole]

It is my understanding from having read here for over 3 yrs that it is important to try to regulate the diabetes and get it under control PRIOR to starting to treat the cushings. This is because there can be so many false readings on tests for cushings due to the diabetes. Also, cushings is not a disease that must be treated immediately. Often once the diabetes is under control the "cushings symptoms" disappear meaning the dx was false.

This is why I asked for specific testing info that was done to dx the cushings. We see this alot. Cushings tests include acth, LDDS to name a few. Those are the most common. Do you recall which ones? If so, do you happen to have the results?

Re the trilostane, I will give you a link to our important info section where there is lots of information. I used lysodren so I cannot help with this question personally. I can tell you that it is recommended to start on a low dose and tweak as needed. It can take some time and again, with the diabetes not under control... it can be difficult because you aren't sure what the cause of symptoms is (cushings or diabetes)

What symptoms of cushings are you seeing?

I am off to work but will check in at lunch. Meanwhile others will chime in I am sure.

Here is the link! http://www.k9cushings.com/forum/forumdisplay.php?f=10

PS Are you working with a vet or a specialist? I ask simply because oftentimes members have gone to specialists when their dogs are facing multiple medical issues. Thanks.

[recruiter]

It is my understanding from having read here for over 3 yrs that it is important to try to regulate the diabetes and get it under control PRIOR to starting to treat the cushings. This is because there can be so many false readings on tests for cushings due to the diabetes. Also, cushings is not a disease that must be treated immediately. Often once the diabetes is under control the "cushings symptoms" disappear meaning the dx was false.

This is why I asked for specific testing info that was done to dx the cushings. We see this alot. Cushings tests include acth, LDDS to name a few. Those are the most common. Do you recall which ones? If so, do you happen to have the results?

Re the trilostane, I will give you a link to our important info section where there is lots of information. I used lysodren so I cannot help with this question personally. I can tell you that it is recommended to start on a low dose and tweak as needed. It can take some time and again, with the diabetes not under control... it can be difficult because you aren't sure what the cause of symptoms is (cushings or diabetes)

What symptoms of cushings are you seeing?

I am off to work but will check in at lunch. Meanwhile others will chime in I am sure.

Here is the link! http://www.k9cushings.com/forum/forumdisplay.php?f=10

PS Are you working with a vet or a specialist? I ask simply because oftentimes members have gone to specialists when their dogs are facing multiple medical issues. Thanks.

I guess regulation is in the eye of the beholder - we've gotten him down to about 125 through some more insulin, but it's inconsistent because I've been unable to get a learned recommendation for food. He's on Holistique Solid Gold Blendz right now, but the carb content there - 55 percent - is giving me some trouble. You get a different recommendation from every single person you ask on what to feed a diabetic dog, and it's proven fairly vexing - after trusting the vet for too long on Science Diet WD.

As for symptoms - since November, we've struggled with high water consumption and urination - which is down now - hair loss on the tail, muscle mass loss, vastly elevated ALP readings - 2400 - etc. The initial diagnosis was liver disease, but he didn't have many of those symptoms - no lethargy, no appetite loss, feces are normal brown, etc.

He's seeing a vet, who's in consultation with some Cushing's specialists at Michigan State University. I'm really too new to this disease to be able to converse intelligently on readings and such, but we do have a meeting tomorrow with the vet to pick up the medication and discuss some questions. His "low dose" test numbers were in the mid-400s, if that means anything.

[gpgscott]

Welcome Bill and Mackie,

I don't treat with either Trilo, or for diabetes so please take that into account.

Has the Dr. said what the problem is with protien, is he concerned about too much burden on the liver with the addition of the Trilo.

And are you familiar with our friends at http://www.k9diabetes.com/

Scott

[recruiter]

No, and unfortunately this discussion has become a little confrontational - he sells Science Diet and rebels quite a bit against the suggestion that it's bad food.

It appears to me that Wellness Core Reduced Fat is the best option, so I think we're going to remain on it. Mackie loves it.

[Squirt's Mom]

Hi Bill and welcome to you and Mackie! :)

Many vets, unfortunately, seldom know much about nutrition other than what they are told in school (minimal) and what the dog food manufacturers tell them. So don't hold it against your vet that he is not open to discussing anything other than Hills SD. One of Squirt's vets was not at all happy when I decided to start cooking for her but after seeing her lab work since, has shown much more acceptance of my decisions. Another of her vets is very much in support of home-cooked diets, but she has spent extra hours since getting her degree taking courses in canine nutrition and has a much better understanding of the difference it can make. She was also instrumental in getting her clinic to drop Hills. ;)

If Mackie has been doing well on her current feed then I wouldn't make any changes at the present time. If you feel the feed may be playing a role in the BG rise and fluctuation, well, that's a different story.

I do hope you will check out our sister site, K9Diabetes, the link Scott gave you, as they are the diabetes experts and will have much info and support to offer you and Mackie.

I am glad you found us and hope to learn more about you both as time passes.

Hugs,
Leslie and the girls - always

[recruiter]

Groan.
Back to square one - due to content, Mackie can only have a cup and a quarter of Wellness Core a day. He'll never buy into that.

Anyone know anything about Champion Petfoods and Orijen?

[Squirt's Mom]

Hi Bill,

Never used it myself, but I know Orijen is a good food! You might also look into Acana and Fromm.

Hugs,
Leslie and the girls - always

[recruiter]

Acana is by the same maker, Champion Pet Foods.

I've run across some information online about Orijen being named the best pet food for diabetic cats and dogs by the Glycemic Research Institute.

[Squirt's Mom]

Hi Bill,

When you are calculating the carb content, you are including the moisture content in the pecentages, right? If not, add that to the fats and proteins, and that will lower the carbs a bit.

Hugs,
Leslie and the girls - always

[frijole]

Checking in a lunch time. I am glad someone pointed out the K9Diabetes site... we kind of work together! My aunt's dog was diagnosed a year ago and I was surprised that most people aren't doing anything real different with the diet. I would definitely go over there.

Cushings wise you want to stay away from fatty foods - that's the main thing.

Kim

[recruiter]

I'm liking the look of this Orijen. The local pet shop gave me some samples, so I think I'll take them to the vet tomorrow.

[labblab]

Hi Bill!

Welcome to you and Mackie from me, too. I just have a couple of quick thoughts to add to what has already been said. First, I do feed Acana kibble to my Labrador retriever, and I have been happy with the apparent quality. However, my Lab is neither diabetic nor a Cushpup. I'm gonna chime in with the others and strongly recommend that you visit k9diabetes.com, because feeding discussions will be just one of the many benefits. Here is a link to the forum index there:

http://www.k9diabetes.com/forum/index.php

Once there, if you click on "Search" at the top of the page, type in Orijen or Acana, and then click on "Posts," you'll be rewarded with a list of all the posts in which those foods have been discussed :). I do believe there are members there who are using Champion foods. One word of warning in terms of availability of Champion kibble: there appears to be a temporary shortage of some Champion foods in different regions of the U.S. -- particularly the foods that are made primarily of fish. So you may want to check with local Champion suppliers to see what is currently available in your area before you get your heart set on using a specific Champion food right at the moment. We are using the chicken-based Acana "Wild Prairie," with no supply difficulty.

Moving on, I am really glad to know that your vet is consulting with specialists at Michigan State. As Kim has already pointed out, unraveling diabetic and Cushing's symptoms can be a challenge! Usually we feel the most comfortable when a diabetic dog has been diagnosed with Cushing's via the ACTH blood test rather than solely with the LDDS. This is because the ACTH is less likely to be "skewed" by the presence of nonadrenal illnesses such as diabetes. But if your vet is consulting with Michigan State, then it is likely that they are taking Mackie's entire symptom and testing profile into account in arriving at the diagnosis. And if you are having difficulty keeping his blood glucose well-regulated now that's he's being treated for diabetes, I'm guessing that is one of the reasons leading them to suspect Cushing's as a culprit.

You say that Mackie weighs 18 pounds? Can you tell us what dose of trilostane he'll be starting on tomorrow? Here's a specific thread on our Helpful Resources forum that deals solely with trilostane treatment and monitoring:

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

Hopefully, you'll find answers to many of your questions about trilostane. But if not, please feel free to ask us whatever comes to mind!

Marianne

[recruiter]

He's starting on 30 mg once a day, probably at supper time tomorrow. What concerns me the most is that I'm only cutting his insulin dosage by a third, per his vet, although he speculates that the insulin need will be "greatly reduced or almost eliminated" by the Trilostane.

It's a long story, but his original vet was an incompetent and uncaring moron. I made the switch at the diabetes diagnosis in late 2005, when he advised me to "put him down because he's going to cost you a lot of money and he's going to be blind."

The blind part turned out right - I couldn't get him regulated before cataracts set in almost six months to the day after the diagnosis. Those have been removed at Kansas State University, and Mackie sees better than I do right now.

So the moron was right: He has cost me a lot of money. But that's OK, because I'm more fond of Mackie than I am a lot of people.

[SachiMom]

He's starting on 30 mg once a day, probably at supper time tomorrow.
Hi Bill,

I just noticed that you are considering starting the medication in the evening. It may end up being a lot more convenient to give the medication in the morning, namely because the followup ACTH testing done in 10 days (as well as all future ACTH tests) needs to be performed 4-6 hours after the dose was given, otherwise the reading will not reflect the correct cortisol levels.

Also, if the trilostane is going to be affecting the blood sugar, you may not want this to happen in the middle of the night when you are sleeping. Not to say it will, as I have no idea, but just something else to consider.

Just a thought ~ Mary Ann

[k9diabetes]

Hi Bill,

In my experience (I administer the canine diabetes forum mentioned, www.k9diabetes.com/forum (http://www.k9diabetes.com/forum)), dog's metabolism of food and insulin is so individualized that no one can tell you very much about what will or won't work for your dog.

Obviously a lot of carbs can be problematic. But some dogs who metabolize insulin quickly and get a big kick from it actually benefit from some carbs to go with the strong surge of insulin.

I've seen diabetic dogs do well on pretty much every healthy diet out there. And some do extremely well on WD even though the content is not popular.

It sounds like you might have decided to stay with the Wellness and since that was working so well for your dog, that would be my inclination too unless there is some very strong need to curb the amount of protein.

Maybe now that they've determined that it's Cushing's and not liver disease, that is less of a concern.

Since you have the Cushing's to get settled with treatment, this would be a really good time NOT to change the diet so you can eliminate that as a variable and have a clearer picture of how he's doing with the Trilostane reducing his cortisol by watching whether his blood sugar comes back under control.

Natalie

[AlisonandMia]

Hi and welcome from me too.

I agree with Mary Ann (SachiMom) that it is probably preferable to start the Trilostane in the AM - which is when most people give it when doing once-a-day dosing. Trilostane kicks in pretty fast and doesn't last long in the body (peaks around 4 - 6 hours after dosing). If it was me I'd want to be awake and up and about when the cortisol was going to be dipping to its lowest and when the BG is most likely to be most affected by the lowering of the cortisol. That way you can avert any hypoglycemic crisis - and that he's going ok with the Trilostane.

I doubt very much that treating the Cushing's is going to "cure" the diabetes at this stage. Some dogs temporarily become diabetic when they develop Cushing's and their diabetes resolves when the Cushing's is treated but that is very rare. It sounds like Mackie (like Jenny's Buddy) was diabetic long before the Cushing's began and will continue to be diabetic once it is treated. His insulin requirements are likely to go back to around what they were before the Cushing's once the cortisol production has been reduced to a more healthy level by treatment. Diabetes is very common in Mini Schnauzers, unfortunately.

Good luck and keep us posted.

Alison

[Dollydog]

Hi Bill and welcome,
My Australian Terrier had Cushings for the last 44 months of her life and diabetes for the last 32 months of that time. She was 17.5lb as a healthy adult dog and dropped to 15lb+ after being diagnosed with diabetes. It was a struggle to keep her bg under control. She was treated with trilostane, and after starting out with once daily dosing we eventually switched to twice daily.
A starting dose of 30mg per day seems like a safe place to start. But I would second Mary Ann and Alsion's comments that evening is not a good time to start.... because testing is done in the am and the chances of the bg going down too low and no one awake to watch him.
Cutting the insulin by 1/3 seems safe also.
I experimented with food to get the best quality that I could and ended up with quite a varied and mixed diet, always keeping in mind that she needed to have what she liked and would always eat. Lady ate Science Diet Senior Small Bites as part of that diet as she liked it a lot. But I was aware that it wasn't the best quality food out there so included other foods, bought and home made.
Will be checking in tomorrow to see how everything works out, take care.
Jo-Ann & my Dollydog angel :)

[labblab]

Bill, good luck with starting Mackie's trilostane today! One additional note about trilostane dosing...I see that you are starting Mackie off with 30 mg. daily. I don't know whether you are using brandname Vetoryl or a compounded trilostane. Either way, 30 mg. daily is indeed the recommended starting dose for a dog of Mackie's weight per the published treatment chart put out by Dechra (the Vetoryl manufacturers). However, it has recently come to our attention that Dechra's U.S. technical reps are verbally recommending that dogs start out at the lowest end of their published dosing range: at 1 mg. of trilostane per pound. Here is the dosing range published in their U.S. Product Insert (http://www.dechra-us.com/File/prod_vetyrol.pdf):


The starting dose for the treatment of hyperadrenocorticism in dogs is 1.0-3.0 mg/lb (2.2-6.7 mg/kg) once a day based on body weight and capsule size (see Table 1). VETORYL Capsules should be administered with food.

This updated dosing information has been relayed to us by Dr. Allen at Dechra's U.S. office in Overland Park, Kansas. Here's contact information in the event that you or your vet wants to talk with Dr. Allen directly: "Contact Us (http://www.dechra-us.com/page/contact-us)."

So in Mackie's case, Dechra's revised recommendation would be to start him closer to 20 mg. daily rather than 30. I know you will be watching Mackie very closely, and that you will be performing an ACTH monitoring test within 10-14 days. But I wanted to mention this new dosing info so that you won't be surprised in the event that he may actually end up needing a dosing decrease down the road. Also, if you are using brandname Vetoryl, you may want to make future purchases in the form of 10 mg. capsules rather than only 30 mg. capsules so as to give you greater dosing flexibility.

Marianne

[recruiter]

Do any of you have any issues with sneezing? Over the past couple of days, he's began making a noise like he's trying to clear his nose, and he's sneezed outright maybe three or four times. It's not constant, by any means.

[frijole]

I have 2 min schauzers and they do from time to time sneeze. I have one that sneezes when her gums are infected - she has just awful teeth (but then she is over 14). I assume breathing is normal with Mackie or you would have mentioned it.

Best of luck today with the trilostane.

[Dollydog]

Hi Bill,
Lady had a lot of sneezing during the last few months of her life. And the clearing her nose thing...never did find out what that was all about though....so much else going on with her.
Have been checking back to see if you've updated...hope all is well.
Jo-Ann & my Dollydog angel :)

[recruiter]

His sneezing was its most frequent yesterday, but has slowed down today quite a bit. There's no discharge and no coughing, so when I talked to his vet about it, he wasn't concerned. His teeth aren't great. He's been so hyper throughout his life that he required sedation pre-diabetes for a haircut and his vet's been reluctant to sedate him post-diabetes for a cleaning. I do have a solution that I use on them, when I check for infections and things like that.

We're almost through day one of the Vetoryl without incident - his BGs dropped to about 175 at their lowest. Still drinking water, but he enjoyed a couple of long rides in the car.

The facts sheet with the pills says it will be two weeks before improvement. Is that most of your experience.

[Roxee's Dad]

Hi Bill,
A belated welcome from me too. :)


His sneezing was its most frequent yesterday

Just wondering if Mackie has vomited recently. Our Roxee had a sneezing episode just before being diagnosed with cushings. She had just vomited and sneezed for a number of days. Vet thought she had some vomit in her nasal passages. Gave her an antibiotic to head off any sinus infection.

[recruiter]

No, he's never vomited. In fact, he's an aggressive eater, even today.

Which led me to a discovery just now - I bought him a new smaller feed bowl. I was watching him attack his food, and I saw it flying out of the new bowl. He's pushing his nose to the bottom of the bowl to eat.

I'll bet the smaller bowl is why he's sneezing.

[frijole]

Results vary from dog to dog AND it is dependent upon whether the dosage amt is right. Trilo often requires tweeking up or down and the only way to know is trial and error along with periodic ACTH stimulation testing. It isn't as easy as the pamphlet makes it sound. Anyway, it is great that day 1 has gone well. Kim

[lulusmom]

Hi Bill.

Dogs are quite sensitive to Vetoryl in the first week and cortisol can drop quite rapidly. Improvements are often seen much sooner than two weeks and can be as soon a two to three days.

[Dollydog]

Hi Bill,
Good detective work with the sneezing and the smaller food bowl....it's amazing how a little thing like that can effect their comfort level.
All our dogs react differently to trilo and we need to be watching every day till we see a change, especially with the diabetes involved. It sounds as if you're keeping a close eye on Mackie and his bg. Glad to hear that day 1 is going so well.
Jo-Ann & my Dollydog angel :)

[recruiter]

A couple of observations after a fairly busy night going outside:

His water consumption, if anything, has gone up to a point where we're running outside all the time.

His BGs went up Sunday night as well. I suppose the two are related. I dropped him from 9.5 units to 6 when we started the trilo, and I'm leaning heavily toward going up a half unit tonight due to the water consumption and the BGs.

He's a little lethargic, although he'll fire up for the usual attractions: Dogs nearby, loud trucks, etc. No runny poop, but his stools are softer than normal, but we are transitioning to Orajin.

[Franklin'sMum]

Hi Bill, and a very belated welcome to you and Mackie,

You've been given some great info from people who really know their stuff :)

No runny poop, but his stools are softer than normal, but we are transitioning to Orajin.
How slowly are you transitioning to Orijin? I ask just in case that's the reason for the softer poop. Also, is he enjoying the Orijin? If he is slow to eat, or leaves food in the bowl, it could be an indication to go in for an acth stim test, or to try a different food for that meal, in case Mackie doesn't want to eat the orijin.

Hope everything continues to go well for you both,
Jane and Franklin xx
________
Kitchen Measures (http://kitchenmeasures.com/)

[recruiter]

He loves Orajin, and the poop's better today.

As a matter of fact, most everything is - he slept all night, and we got good blood readings before he went to bed last night. He was pretty lively last night as well.

[SachiMom]

Hi Bill,

So happy Mackie had a good day!!! That'll put smiles on everyone. :D
And here's to hoping tomorrow is even better! :D:D:D

~Mary Ann

[recruiter]

Today was pretty much like yesterday. Just tested him 4 hours post-shot and got a 205 reading. A week ago pre-Trilo, we were in the high 300s.

[BestBuddy]

All good news.:D

Every little improvement means heading in the right direction. Are you still on 6iu or did you go up a bit?

Jenny

[recruiter]

Still at 6. We went out a couple of times in the night to pee, but he was pretty efficient about it so neither one of us lost any sleep.

Still pretty heavy on the water. How long does it take the Trilo to tamp that down?

[recruiter]

Noticed something that's been fairly unusual this afternoon. He's been seeking out cool places - my house is old and drafty - so the floor was a good place for him.

This afternoon, I found him planted firmly in the sun shining in the front door, which is something I'm sure he wouldn't have done a week ago.

Progress?

[Dollydog]

Sure sounds like it....hope everyone gets to sleep through the night!:)

[BestBuddy]

It is a great improvement.

I know both high BG's and too much cortisol overheats the body making the dog want cool places to lie so the fact that Mackie was sun baking must be a good sign.

Jenny

[recruiter]

Last night, I got a 160 reading at bedtime, and he slept through the night - after an evening of fighting and playing. His favorite game is to run around the house growling then sweep in to make a play-bite at my hands.

[frijole]

Great news. Keep it coming. Kim

[recruiter]

One other note I forgot: It's been about 30 hours - and one huge new dog food bowl - since he sneezed.

[lulusmom]

Hooray on both counts!!! Keep up the good work.

[recruiter]

Another round of sunning himself today.

[gpgscott]

Can't help with first hand experience Bill, but I can cheer you both on.

The others will help you fill in the blanks.

Best to you both.

Scott

[MiniSchnauzerMom]

Hi Bill,

Another MiniSchnauzer lover here just dopping by to join the other members in cheering Mackie on. Sounds like he's progressing nicely. Although it's already been said, I'll say it again....keep up the good work! Will be watching for your next update.

Louise

P.S. Would love to see some pictures of Mackie. :D

[recruiter]

We have a lengthy cataract journal on canine diabetes.org, although the photos are almost four years old.

http://www.caninediabetes.org/cataracts.html

[MiniSchnauzerMom]

Bill,

Thanks for the link to the journal and pictures. Mackie is a handsome guy! My Munchie is fuzzier these days and looks quite similar to Mackie.

Louise

[AlisonandMia]

Hi,

It sounds like you are getting a really good response to treatment. Mackie sounds like one of those unusual ones that have been so good as to "read the book". :):)

It does sound like his cortisol could still be continuing to decrease (not unusual at this stage of treatment) and/or he is becoming increasingly sensitive to the insulin now his cortisol level is no longer excessive. I wonder if you shouldn't consider dropping his insulin dose a little bit, at least for a while. That really good number (160 I think it was) in the evening after high numbers in the evening earlier this week makes me wonder if he isn't heading towards a hypo on his present insulin dose. I am a real worry wart!:o:p

What was he old, pre-Cushing's insulin dose?

Alison

[BestBuddy]

Alison has made a good point about closely watching that BG because as the cortisol drops it could get dangerously low fairly quickly.

I don't Know how Mackie handles stress and what it does to his BG but Buddy nearly always dropped 100 points at a vet visit and when we had ACTH testing done it seemed to drop him even more and he would need an extra meal on those days to keep him from going hypo.

Jenny

[recruiter]

He was at 9.5 before the Trilo - hence the constant testing. I'll take another in about an hour.

[recruiter]

Another pretty good day - naps in the sun, and on my bed, followed by a 122 reading tonight - so we're going down a half-unit in the morning. Getting too close for comfort, so we'll go 5.5 and see how that tests out. Didn't drink a lot of water - until tonight, when he drank a little more.

[BestBuddy]

It's all looking good.:D

You and Mackie have had 4 years of this diabetes stuff so just wondering what dose of insulin was he regulated on before cushings reared it's ugly head?

Buddy (11 lbs) was doing well on 5iu and then the cushings pushed it up to about 7 and after trilo we did well again on 4iu.

Jenny

[recruiter]

Jenny, he sat at 8.5 units twice daily of Novolin for about three years. He was a very tough regulate.

[recruiter]

My recollection is that could be an indication of too much Vetoryl. Anyone know anything about that?

Postscript - too many treats (frozen green beans)

Oops.

[AlisonandMia]

Yes, it could be. Low cortisol can definitely cause vomiting.

Alison

P.S. (Just read your PS) As can too many frozen beans. BTW, you tend to get low BG with low cortisol - even in a non-diabetic.

[recruiter]

I got a 256 about 10 minutes before he vomited.

[MiniSchnauzerMom]

Glad you are checking with Mackie's vet about the vomiting as it is listed as one of Vetoryl's adverse reactions. Hope it is just too many green beans.

The following info is from Dechra's U.S. Product Insert which you can find in our Resources section at the following link.

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



INFORMATION FOR DOG OWNERS :
Owners should be aware that the most common adverse reactions may include: an unexpected decrease in appetite, vomiting, diarrhea, or lethargy and should receive the Client Information Sheet with the prescription. Owners should be informed that control of hyperadrenocorticism should result in resolution of polyphagia, polyuria and polydipsia. Serious adverse reactions associated with this drug can occur without warning and in rare situations result in death (see ADVERSE REACTIONS). Owners should be advised to discontinue VETORYL Capsules and contact their veterinarian immediately if signs of intolerance are observed. Owners should be advised of the importance of periodic follow-up for all dogs during administration of VETORYL Capsules.

Hope Mackie is feeling better.

Louise

[recruiter]

He barked happily and ate his supper, so the vet and I are leaning to the green beans. It's happened before, prior to the cushings.

[MiniSchnauzerMom]

Whew! That's good news. I'm glad everything is ok and that Mackie is happily barking and eating his din-din without problems.

Louise

[Dollydog]

Glad to hear he's feeling better. Lady vomited mid-morning once and it was just too many green bean treats too! :p
Jo-Ann & my Dollydog angel :)

[recruiter]

I did screw up lowering his insulin yesterday, though. His BGs went up and have stayed up today. No more vomiting, thankfully, but he's been laying around and just being himself in spasms, like when the neighbor boy came outside. Barked happily at mealtime.

[recruiter]

An informational question:

We're into the second week of Vetoryl, and I'm wondering just how "sluggish" some of your dogs have become on the treatment.

Mackie definitely fires up for his meals, his ride, anyone he can see to bark at - but beyond that, he's pretty inclined to just lay around and sleep. That's a little out of his character.

Beyond that, no real signs of problems with the drug. His poop is solid - fairly dark, thanks to the Orijin. He vomited once on Saturday but that was my fault, by giving him too many frozen green beans.

He just seems more subdued than usual.

[BestBuddy]

I remember that Buddy became a bit sluggish too. It makes sense that they would be less active with the cortisol being lowered. This is one of the reasons you need to do the ACTH at day 10 to make sure the cortisol isn't being lowered too much.

Jenny

[recruiter]

Now, today he's more like his old self - not laying around, following me everywhere, the guttural 'take me outside' bark, etc.

[frijole]

Great news! Seems like Mackie is one of the lucky ones that is textbook perfect. Lucky dog! And you too. Appreciate the updates. Kim

[recruiter]

I think we're gonna make it to the Monday vet check. Mackie was pretty glad to see me tonight.

But ... he lacks his old energy, he's skin and bones and there's a sadness in his eyes that just eats at me. I hope this drug continues to work.

[BestBuddy]

It may just be that the lowering of the cortisol is giving Mackie the yukkies. The next ACTH test (done 4-6 hours after trilostane) will give you an idea on what is happening. Maybe the cortisol is being lowered too quickly. It's also important to remember that even after several months at the same dosage the cortisol can keep dropping so that needs to be taken into account with the first readings.

Jenny

[recruiter]

It may just be that the lowering of the cortisol is giving Mackie the yukkies. The next ACTH test (done 4-6 hours after trilostane) will give you an idea on what is happening. Maybe the cortisol is being lowered too quickly. It's also important to remember that even after several months at the same dosage the cortisol can keep dropping so that needs to be taken into account with the first readings.

Jenny

Thanks, Jenny,
Coming up on Monday is the next test, so I hope that sheds some light on the situation.

It's been a weird ride this week - he was really energetic Monday and Tuesday, more like his old self, and then the last two days the sadness in his face really tears me up.

[recruiter]

Off to the vet today for the checkup.

Interesting weekend - we were up quite a bit Friday night and I flat forgot his Vetoryl pill. He perked up Saturday and although we're obviously back on the pill, he's been better since then.

And, the vet got the protocols wrong for the test, so it's off until Wednesday. And ... Mackie just puked again. The vet's been informed about the signs of low coritsol.

[recruiter]

The ACTH is done, and it'll be a week before we get the results. His glucose curve was atrocious, so we raised the insulin a unit. Vet says it'll be tough to get the BGs down until the Vetoryl takes hold.
Which brings me to a question: I've read all the literature, and it looks like anywhere from three days to three months before the medication begins to work. He still wants a bunch of water. Anyone have any input on that?

[lulusmom]

See my comments below in blue.


The ACTH is done, and it'll be a week before we get the results.

Was the acth stim test done within 4 to 6 hours of Mackie's morning Vetoryl dose?

His glucose curve was atrocious, so we raised the insulin a unit. Vet says it'll be tough to get the BGs down until the Vetoryl takes hold.
Which brings me to a question: I've read all the literature, and it looks like anywhere from three days to three months before the medication begins to work. He still wants a bunch of water. Anyone have any input on that?

Vetoryl takes hold immediately; however, effective control depends on whether or not Mackie is getting the right dose. This can only be determined by way of the acth stimulation test. When your vet made the comment about Vetoryl taking hold, s/he was probably referring to the fact that some dogs will require multiple adjustments and sometimes it can take a few months to find the right dose. We'll be very interested to see the results of the stim test.

FYI, Vetoryl has a short half life, meaning it's enzyme blocking abilities do not last throughout the day. Every dog is different and various studies show that Vetoryl's effect starts to diminish anywhere from 6 to 20 hours. For this reason, a lot of vets that have much experience with treating both concurrent conditions will prescribe twice daily dosing for their patients to insure consistent control of cortisol throughout the day. The vet has to be very careful when prescribing twice daily dosing as there is some overlap during the day.

[recruiter]

Yes, it was within the morning dose, and we have already discussed the possibility - given the major slowdown he experiences after 6 p.m. each day - of perhaps doing a 10mg in the morning and a 10mg in the evening, at both feedings. He also mentioned 15 and 15, but I have no idea how you'd do that.

[lulusmom]

If your vet thinks twice daily dosing would be in Mackie's best interest, he will be able to determine an appropriate dose after assessment of the results of the acth stimulation test. If you have 30mg Vetoryl capsules, you can have them repackaged into smaller doses by a compounding pharmacy or you can have 10mg capsules repacked into larger doses.

[recruiter]

I'm hopeful the test sheds some light on this. Not a lot of progress, or so it seems, so far.

[Dollydog]

Hi again, it may not seem as if you're getting anywhere but you are. It's much more complicated when you're trying to get those two diseases regulated. Lady wanted to drink a lot of water at the beginning but it eventually went down to normal. It took a few months though!
Jo-Ann & my Dollydog angel :)

[recruiter]

As soon as I say I'm discouraged, he bounces back with a really bright night. He's on his game tonight. Still drinking, but running around the yard doing what he does best - barking.

[BestBuddy]

Treating either diabetes or cushings can be a real merry go round let alone treating both together. Even when you get your maintenance doses sorted out there will still be those days when something isn't right and you will fell like nothing is working but the next day all is well again.

Us humans have days when we don't feel great for no reason so I suppose dogs are the same. I think the best way to deal with it is to hope for more of the good days than the bad. Enjoy the good times.

Jenny

[recruiter]

I think you're right. There's a spring back in his step, and curiously - after a big belt of water right after his Vetoryl - his water consumption has dropped.

[recruiter]

I've noticed one immediate trend with the 30mg he's on with his morning food at 6 a.m. - from 10 a.m. to about 10 p.m. each day, his water consumption drops off dramatically.

Then, the nights aren't great - he wants water a couple of times a night and has to go outside two or three times.

Sounds to me like he needs a 6 a.m. and a 6 p.m. dose at some level. It will be Wednesday before the 14-day ACTH numbers are back.

[lulusmom]

If Mackie's 14 day stim comes back with good results and you are still seeing increasing symptoms as the day wears on, Mackie very well could be a dog that can benefit from twice daily dosing. Increasing cortisol in the evening will also increase bg levels. Please let us know as soon as you get the results back.

[recruiter]

An update: We've gone off the Vetoryl temporarily due to two vomiting episodes in the last five hours, three in the last 30 hours. The on-call vet - not his regular vet - thought that 30 mg for a 16 lb dog was "way too much Vetoryl."

However, he's still very enthusastic about eating, barking loudly this morning for his food 15 minutes after vomiting.

[zoesmom]

Hi Bill and Mackie - Haven't posted to you before and have no diabetes experience, but do have lots with trilo. That 30 mg might have been a tad high for Mackie. And sometimes it can take as much as four weeks for a dose to catch up with a dog (i.e. - their cortisol will continue to slowly drop over that period of time.) But since Mackie is still actin' spunky, it could be just a tummy upset. You are giving it the trilo with food, right? When Zoe started on trilo, she got verrrry sick - vomiting, diarrhea and very down and out on the 3rd day. Has Mackie had any diarrhea or loose stools? Obviously, he's not showing a lack of appetite or listlessness!:) so that's good!

But since it's always best to be safe rather than sorry, I agree that stopping the trilo is the best move - especially until you get the ACTH results back. Are you in the boonies? Just wondering why it takes a whole week? :confused:

If there should be any further vomiting, you might want to ask about giving Mackie some prednisone. If he's vomiting because of too low cortisol, that pred should do the trick. And that would be a good clue that it IS the cortisol levels causing it. I assume the vet asked you to keep in close touch, if there are any changes in symptoms?

I've always felt that starting a dog on the lower end of the trilo dosing range is the best option. You can always increase it down the road if the cortisol isn't coming down enough. But any change should always be approached slowly and cautiously (unless it's obviously too high a dose). That's because many dogs take several weeks to settle in to some sort of stability, as I mentioned. And with the diabetes factor, that might even take longer.

I do agree with the others that it sounds like Mackie would benefit from twice daily dosing. Ten or 15 mg twice a day might be about right. But definitely, that will depend on those ACTH results. I get Zoe's trilo compounded and by doing that, you can get any specific dose you need (or in liquid from some places.) We order online from pethealthpharmacy.com - their prices are also very reasonable.

I know that diabetes can complicate regulating both diseases. But over time, you will get a feel for Mackie's trilo response. I found that measuring Zo's water intake was the most helpful - since her appetite was never a good indicator. Hope this is just a minor blip on the radar screen. But do keep us posted - and I will be interested to see those ACTH results. Sue/Zo

[recruiter]

The stools thing is interesting. They are soft, not terribly loose - but when he vomits, it always comes after an attempt to poop.

We're just back from a ride when he barked his head off at his fellow dog friends.

The timing of the vomiting is interesting the last two days - about 3 hours after his Trilo would cycle out.

Mackie's vet works with a professor at Michigan State, who's one of the best at the tests.

[zoesmom]

The timing of the vomiting is interesting the last two days - about 3 hours after his Trilo would cycle out.


So by that you mean, about 8-12 hours after a dose, and then another 3? (i.e., when the trilo is running low in his system?) Which would be sorta odd, and less indicative that it's the trilo, since that is probably when his cortisol is starting to creep back UP. The fact that he's NOT acting too sick (barking and eating and enjoying life, etc) would seem to point to some other explanation, other than the cortisol. Are his stools normally pretty firm? A dog with too low cortisol usually acts pretty sick - vomiting and very loose stools/diarrhea and lethargic and weak - the whole works. Sue

[maggiebeagle]

When my Maggie was taking trilostane, she weighed about 18 pounds and at one time took 180 mg/day. This was what was required to keep her stims within therapuetic range and her symptoms at bay. Trilostane seems to vary quite a bit in the mg/kg dose required for each dog. When her cortisol did go to low after two years on the trilostane at that dose, she didn't want to eat at all.
Luckily for us we didn't have the added complication of the diabetes.
I'm not sure where you live, but my non-cush pup always has problems with nausea and vomiting this time of year due to allergies. The trees are all blooming or leafing out here in Houston.
Hope you get the answers you need soon.

[recruiter]

Yeah, his stools usually are pretty firm.

Now, a week ago, he vomited in the middle of the day. And the last round of vomiting today was about 530 this morning.

But, since we've skipped the pill, he seems to feel pretty good today. So, not too much makes sense right now, and it probably won't until Wednesday or Thursday, when the stim test results come back.

[recruiter]

Add to this a little vexing.

Mackie's vet wanted him back on the Vetoryl today, saying that the vomiting we're seeing - undigested food - is actually regurgitation from an overfeeding, or him gorging himself on water.

OK, I have no real clue. So, he took the pill about 10 a.m. today and 90 minutes ago he "regurgitated" some more undigested food.

Minutes ago, he just ate, barking for his food.

I really don't understand this.

[Harley PoMMom]

Hi Bill and Mackie,

If your vet feels this way, then ask him if you can give Mackie Pepcid AC 20-30 minutes before his meals. It might help?

Love and hugs,
Lori

[recruiter]

Made it halfway through the day without any repeat incidents.

This is an interesting deal, because there's no pattern to anything. I was SURE he'd be up all night drinking and running outside last night - instead, we got up once to potty and he got a small drink and then went back to bed.

This morning, pre-Vetoryl, he was snarfing water down again.

I don't get it.

[recruiter]

Go figure.

I woke up at 4 this morning, after not getting up with Mackie all night, and it scared me to death.

I ran over to his box, and there he was on his side, sound asleep and snoring. I woke him up to take him outside, and he raised his head up, looked at me and said, "Errrp?"

Plus, a dose of his old rambunctiousness, including a head-first dive off the front porch after a rabbit inside his fence - fortunately, the rabbit beat him out the gate.

[recruiter]

I'm not ready to claim victory yet, since the stim test results are due in today.
But over the last three days:
BGs have been consistently in the low 100s.
He's slept for three consecutive nights.
Water consumption is down.
The hair is coming back on his tail.
His mannerisms are almost back to his old, obnoxious self.

[frijole]

Great news. We celebrate progress of any kind here. :p Good luck with the testing. Kim

[MiniSchnauzerMom]

Your update on Mackie sounds promising and positive. Hopefully he will soon be back to his old self 100% (with a full growth of hair on his tail!) Will be watching for Mackie's new stim test results.

Louise

[Dollydog]

YES!!!
I'm afraid to cheer too loudly in case I jinx something....enjoy the good days while you can. These signs are so promising and encouraging.
Jo-Ann & my Dollydog angel :)

[recruiter]

Baseline Cortisol - 29 (15-110)
Cortisol 1 hr post ACTH - 215 (220-550)
Cortisol 2 hr post ACTH - 159 (220-550)

We're good for another 90 days.

[lulusmom]

Those are great numbers and as I recall, these results are for the 14 day stim test right? If so, it is very important that you have another stim at 30 days, especially since vetoryl/trilostane can continue to drop cortisol levels in the first 30 days. As I also recall, Mackie had a vomiting and/or diarrhea episode after the stim test was done which could have been an indication that cortisol levels were continuing to drop a bit too low. Just be very careful, keep a close eye on your guy and make sure you schedule another stim test for the 30 day mark.

Glynda

[BestBuddy]

Those are magic numbers.:D

Like Glynda said, the cortisol can keep dropping for the next month or more so watch for those signs. For now you can relax just a bit and enjoy Mackie, you both deserve it.

Jenny

[recruiter]

That's what his vet said - keep an eye on the BGs and on how he's behaving.

[recruiter]

Major step backwards today. He found a nest of baby rabbits - and ate them. He's thrown up a couple of times, once aided and abetted by the vet after x-rays, and clearly feels rotten. Can't feed him a full meal, and no shot tonight.

[frijole]

Oh bady boy Mackie. :o;):p:o My schnauzers are 14 and 16 but in their "younger" days rabbits were their very favorite thing. I only know of one that they caught... brought it into the house. ha. Hope our little guy feels better tomorrow.

[recruiter]

He's perking up a little bit, showing a little interest in food but the vet said to skip the shot and take it easy on the food until in the morning.

[BestBuddy]

Oh dear poor Mackie, he must have had such fun finding those bunnies but now he is probably regretting it.

Hope iall is back to normal soon.

Jenny

[recruiter]

Got just short of a cup down him, half on his own, half hand-fed. Still dragging around, though, and his poo is dark, stringy and way too watery. He's going to spend the day at the vet's for a broader checkup.

[Franklin'sMum]

Oh, poor little boy :( I hope he gets over his "bunny binge" soon.
Fingers and paws crossed for you and Mackie with the testing tomorrow.
Jane and Franklin xx
________
Zerg strategy replay sc2 (http://screplays.com/replays)

[recruiter]

Well, I look like an idiot at the moment: He's been yapping at all his bunkmates, ate a bowl of food for the vet and when she put him on the floor, he made a mad dash for the exit - after moving around last night like every step pained him. They're going to re-xray his abdomen this afternoon just to be sure.

[Squirt's Mom]

:p Oh! This is so funny! :p

I am glad Mackie is acting better and hope he is home soon.

Poor Dad...poor Mackie...poor bunnies....but still funny! :D:p

Hugs,
Leslie and the girls - always

[frijole]

:D I'm really starting to get attached to Mackie. You got any photos to share? Sounds like a real character. Sorry he worried you but you did the right thing...

[recruiter]

This is the quickest route: http://www.caninediabetes.org/cataracts.html

He's a very frenetic, verbal little dog when he's well so it's pretty easy to tell when he's not. Very expression-filled face and a bunch of personality. I wish we could groom him, but the stress sends his BGs into the stratosphere so I cut it in shifts - that last about two weeks, since he doesn't much like the experience.

[frijole]

Wow - thanks for the link! He is a doll. Or should I say handsome fella? :D You can see feisty in his eyes for sure. I didn't have time to read the whole story but will try to later. So he had cataract surgery at K State?! This little guy has had a journey. Thanks for sharing - will read more of it later. Meanwhile - hope the rabbits are safe today. :eek: Kim

[recruiter]

Things are good. He's bouncing back nicely.
It's a LONG story, but he's one of the family, albeit one who's familiar with hospitals. He loves his vet and the techs.
He's also pretty sharp, with the exception of intruders into his yard. In his lifetime, he's captured and killed two rabbits, a rat, a snake, smacked down a cat and three months ago, latched onto the leg of an ailing goose who landed in the yard. That one was the biggest challenge: The goose was pecking at his face and those valuable eyes of his. I kicked it three times to dislodge it from his grip, and then threw it over the fence.
His whole life has been one degree of crisis or another, I guess, but I wouldn't have missed the ride for the world.

[Franklin'sMum]

Classic! I love the description "I kicked it 3 times to dislodge it then threw it over the fence". So glad Mackie is feeling a bit better, and thanks for the laugh, I needed it
Jane, Franklin and Bailey xxx
________
Volcano vaporizer review (http://www.vaporshop.com)

[recruiter]

It's been quite the week. The bunnies and the tummy - plus the skipped shot and skipped Vetoryl - have really thrown him off. He's still subdued, a little less so than yesterday, but still not himself. It can take him a handful of days to get back on track, though, when the diabetes gets messed up.

[recruiter]

Really big step in the right direction today - a lot of his old enthusiasm is back. He takes a liquid vitamin supplement and I gave him his first post-incident dose last night, and that really seemed to help.

[Dollydog]

Good news...what a great update. :)

[recruiter]

He's driving my mom - who watches him during the days - nuts again, just like old times. He wants to run and play outside.

Maybe, just maybe, we're on the right track.

[Dollydog]

:D :D :D :D :D :D :D :D :D ....except for the part about driving your mom nuts, of course! ;)

[frijole]

Go Mackie go! :p

[recruiter]

So far, so good. We're still trying to hone in on an insulin dose, but he's feeling good, eating well, hair is growing back on his tail.

[recruiter]

Hello again. Things are still going well. Mackie is very playful and very happy, blood sugars are good, still eating well.

What I am puzzled by a little is the frequency of his pooping. He used to go a lot once or twice a day. Now, he goes a little a half-dozen times a day. Have any of you experienced this change?

[BestBuddy]

Buddy was a prolific pooper and that was putting it nicely. Sometimes it seemed that he would poop more each day that he weighed.:p

Bud was on high fiber food and I also added extra fiber so I always thought that caused it. What is Mackie eating?

Jenny