Rebel, 8 year old mix with Cushings - Rebel has been released

[Rebelsmom]

Hi everyone, I stumbled across this site while looking for information on Cushings. My 7 1/2 year old mixed pup was diagnosed with Cushings last week. He is on 60mg of Veteroyl a day and weighs 37lbs, he has been on it 7 days now. I have started to see some improvement in his drinking and urinating and he seems to be a little more active. He even tries to play a little now. However today he seemed a little out of sorts. I bring him to work with me everyday because he was having trouble holding his bladder all day. Well when I had taken him out and brought him back in he seemed a little confused and was just wandering around. I called him and it took him some time to come back over to me. I'm trying not to read to much into it, but I'm wondering if the veteroyl could have caused him some confusion or if I'm just reading too much into it and maybe he smelled something and was just ignoring me.

Any other information you can provide would be great. He goes back next Friday for the follow up test to determine if he is on the right dosing.

Thank you, Melissa

[labblab]

Melissa, welcome to you and Rebel!

Yes, it is possible that this dose of Vetoryl may be too high for Rebel.

Here is a link to a Treatment and Monitoring Flowchart published by Dechra (the manufacturers of Vetoryl). The Flowchart is followed by Dechra's U.S. Product Insert, which gives you a lot of additional information about dosing and possible side effects associated with the medication.

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

As you will see, if dogs are acting unwell after having started Vetoryl, it is important to find out whether the cortisol level has dropped too low. Sometimes dogs can still feel yucky even when their cortisol has not dropped dangerously low, but it is important to find out for certain what is going on. This is determined by an ACTH test and also checking their electrolytes (or blood chemistries).

Per the instructions on Dechra's Monitoring Flowchart, if Rebel continues to behave oddly as the day progresses, do call your vet to move up his ACTH test and also hold off on giving him any more Vetoryl.

Also, can you please tell us more about Rebel's health history -- his symptoms and Cushing's testing? That will help us to give you our best feedback.

Thanks so much in advance!
Marianne

[Squirt's Mom]

Hi Melissa,

Welcome to you and Rebel! :)

We have several Trilo parents here who will be happy to share their experience and knowledge with you. I am sure more of them will be along shortly.

As Marianne said, if you have copies of Rebel's testing and could post the results, that will help us give more meaningful feedback. One of our members is a lab tech and helps us a great deal with blood labs. The more we know about Rebel, the better. We won't get too nosy til we get to know you a bit better. :p

How wonderful that you are able to take him to work with you! My last job was like that and Squirt loved it! My office became her second home and she just loved the students. She would run down the hall and go visit the classrooms uninvited...she was always welcome! She was our little satellite college mascot! :p

Keep your chin up! and stay in touch. Don't hesitate to ask questions and we will do our best to help you understand. What we don't know, we will learn together. The important thing is that you and Rebel are not alone on this journey. You have a whole bunch of folks by your side now and we will be with you every step.

Hugs,
Leslie and the girls - always

[Rebelsmom]

Hi everyone, I just wanted to introduce myself. My name is Melissa and I have a 7 year old mix terrier named Rebel and a 2 year old mixed lab named Sadie.

Just recently Rebel was diagnosed with Pituitary Cushings. He has been on Veteroyl for about 3 weeks now. He had his ACTH retest last week and his cortisol levels are back to normal. A lot of his symptoms have subsided some. He drinks less (still more than normal though) and he does not have accidents anymore (unless he's mad at me). I no longer have to bring him to work he can stay home all day without him urinating everywhere!! He has more energy and is even playing some now!! I'm so excited I seem to be getting my puppy back.:D

He still has a pretty big appetite and is always hungry. He was on a Hypothyroidism med from my first vet. My new vet (whom I love) took him off until we got the Cushings under control. He goes back next week to re-check his T4 levels to see if he actually does need the meds.

I have a few questions.. How long before I should expect all his symptoms to go away? His first few blood tests had shown high liver enzymes, does cushings cause that and should I have the vet re-check them? I don't have his test results here with me, but I can post them up tomorrow.

This is all so new too me. It's a lot to take in along with a very expensive disease. Any information you can share with me would be great. He is by far worth every penny I have spent trying to find out what is wrong.. I even changed vets because I had mentioned cushings to my first vet months ago and he wrote me off!!

Thank you all for any information..:o

Melissa

[sherrylwatts]

I'm still pretty new to Cushings myself, so I don't have a lot of advice to give you, but the people on here are GREAT. My Pepper has pancreatitis, and it's effected her liver so her enzymes are out of whack also. She takes Adenosyl once per day and hopefully that's helping - still early to tell, she's only been on them since Saturday. What were your ACTH results?

[ohh]

Hi Melissa,

I'm very new to the site as well.. welcome!

My dog has Cushing's, Hypothyroidism, and heart issues. It's a rough road but I'm glad to hear your Rebel is doing better.

All this health stuff is so scary, and expensive but I agree with you.. they are well worth it! Brophy is being tested again for his Thyroid tomorrow...

Good luck and I'll check your post for updates!

Onalisa & Brophy

[lulusmom]

Hi Melissa,

I have merged your two threads so that we have all of Rebel's information in one place. Sometimes it's difficult to find our original thread when they fall off of the first page. I'll send you a handy link to this thread by PM so that all you have to do is click on it to find it.

I'm happy to hear that Rebel's symptoms are improving. I will echo Sherryl and ask that you post the results of Rebel's last acth stimulation test here. I believe Leslie and Marianne have already asked this but can you tell us what symptoms Rebel had and can you please get your hands on the tests that were done by your vet to diagnose Rebel and post those results here too.

With respect to the elevated liver enzymes, they can take quite a while to normalize and sometimes they don't ever normalize. If the elevations were mild, I would wait a month or two to have them checked. If they were severely elevated, I would talk to the vet about putting Rebel on liver support such as milk thistle and/or Sam-e. Many of our members have their dogs on these supplements and they help a lot. Here is a link to more detailed information:

http://k9cushings.com/forum/showthread.php?t=192&highlight=milk+thistle

With respect to the hypothyroidism, your vet is on the money. Most dogs with cushing's have a low T-4 which is secondary to the cushing's. A lot of underlying conditions impact the T-4 but once these conditions are addressed, the T-4 will normalize. This is a transient condition called Euthyroid Sick Syndrome. If Rebel is in the majority, he will probably not truly be hypothyroid and you won't have to continue giving him the Levothyroxin.

Glynda

[Rebelsmom]

Hi Melissa,

I have merged your two threads so that we have all of Rebel's information in one place. Sometimes it's difficult to find our original thread when they fall off of the first page. I'll send you a handy link to this thread by PM so that all you have to do is click on it to find it.

I'm happy to hear that Rebel's symptoms are improving. I will echo Sherryl and ask that you post the results of Rebel's last acth stimulation test here. I believe Leslie and Marianne have already asked this but can you tell us what symptoms Rebel had and can you please get your hands on the tests that were done by your vet to diagnose Rebel and post those results here too.

With respect to the elevated liver enzymes, they can take quite a while to normalize and sometimes they don't ever normalize. If the elevations were mild, I would wait a month or two to have them checked. If they were severely elevated, I would talk to the vet about putting Rebel on liver support such as milk thistle and/or Sam-e. Many of our members have their dogs on these supplements and they help a lot. Here is a link to more detailed information:

http://k9cushings.com/forum/showthread.php?t=192&highlight=milk+thistle

With respect to the hypothyroidism, your vet is on the money. Most dogs with cushing's have a low T-4 which is secondary to the cushing's. A lot of underlying conditions impact the T-4 but once these conditions are addressed, the T-4 will normalize. This is a transient condition called Euthyroid Sick Syndrome. If Rebel is in the majority, he will probably not truly be hypothyroid and you won't have to continue giving him the Levothyroxin.

Glynda

Sorry about the double post when I first signed up I was having trouble with the site and I had no idea my first thread posted. I have been so busy at work that today was the first day I was able to log back on.

I don't have the test results here with me at work but I have them at home and I will either log on tonight or tomorrow and post them. I don't have copies of the last ACTH he got a few days ago but his level was at a 5 I believe. Which the vet said was good.

As far as his symptoms were the first thing I started noticing was the amount of water he was drinking. (This was back in Oct). Then he started having accidents in the house which has never happened. He was also ravenous with his eating he could never get enough food and was starting to get himself in trouble by getting into things he shouldn't. He had also put on a lot of weight and had a pot belly. I took him to the vet and had blood work urine tests. The first tests showed high liver enzymes but his T4 was fine then. The vet put him on some kind of liver med (forgot name) and antibiotics to rule out infections. Went back 30 days later for more blood work, liver enzymes still high and T4 level was low. Vet put him on the thyroid meds (.4mg twice a day). On the same visit I brought up cushings, after doing lots of research, he seemed to have most of the syptoms at this point. He now had the bony face and was panting a lot. My vet insisted that he had some form of liver disease and blew off my idea of cushings. He told me I had to go get an ultrasound at this very expensive place over an hour from me. I ended up finding a vet in town that did them. She saw him once and thought he had cushings. We did the ultrasound just in case, his liver is slightly enlarged but everything else looks ok. Next day we did the cushings test. Low and behold his cortisol levels came back high. I will post results later.

Sorry I know that was long... I had actually bought some milk thistle to start giving him, but after we got the cushings results I stopped it. I didn't know if it would be ok to continue to give it to him. I was gonna ask the vet next week when I saw her for his thyroid test.

The only symptom that doesn't seem to be getting better yet is his urine. it still seems really clear, except for a couple times it had been a little yellow. And of course he still thinks I'm trying to starve him.

Sorry this was so long and if it's hard to read.

Thanks again for your help and input.

Melissa

[Rebelsmom]

I have one more question. Is it safe to keep him on his heartworm med? i hope so because I gave him his dose this morning. It is heartguard. We live in Florida so mosquitos are bad and I cannot see him coming off his meds and risk getting heartworms.

Melissa

[Nathalie]

Hi Melissa,:)

"Vet put him on the thyroid meds (.4mg twice a day). "

That amount seems to be on the higher end....
My Phillip, who weighs 64 lbs is getting .4 twice per day.

I am just wondering what the result of the last Free T4 test was?
Are you pilling 1h before or 2h after feeding?
Was the last blood draw done 4-6h after pilling in the am?

Cheers,
Nathalie

[Rebelsmom]

Hi Melissa,:)

"Vet put him on the thyroid meds (.4mg twice a day). "

That amount seems to be on the higher end....
My Phillip, who weighs 64 lbs is getting .4 twice per day.

I am just wondering what the result of the last Free T4 test was?
Are you pilling 1h before or 2h after feeding?
Was the last blood draw done 4-6h after pilling in the am?

Cheers,
Nathalie

I thought it was high to and when I questioned my original vet about it he took offense and told me to stop reading the internet. I now have a new vet...

This is how it started on 11/04/09 his T4 was 1.7, on 12/04/09 it was .4. That is when he was put on the meds. He was retested on 01/15/10 6 hours after a pill and it was 2.5, which made my vet then think all was good.

He never told me to give it hour before or 2 hours after, I always gave it to him right before he ate.

He has been off the pills since 03/25/10 per my new vet. She wants to get the cushings regulated and then test his T4 levels again. Which will be this coming Wednesday.

Melissa

[Rebelsmom]

Good morning everyone. I hope all our babies are doing well this morning. Rebel is finally having so yellow urine again. He is also still doing well at home all day with no accidents. He played last night with me and my other dog for awhile until he got bored with us. lol

I have his results with me this morning. I'll start with the original blood work from my first vet. I'll just list the ones that were high.

On 11/04/09:
ALK Phosphate - 308 (10-150)
ALT - 336 (5-107)
GGT - 17 (0-14)
Amylase - 440 (slightly low) (440-1240)
Cholesterol - 537 (112-326)
B/C Ratio - 30 Range not given
Trglyceride - 462 (20-150)
Neutrophil SEG - 85% (60-77%)
Lymphocytes - 11% (slightly low) (12-30%)
Eosinophil - 1% (slightly low) (2-10%)

This led my vet to believe he had some form of liver disease and he put him on antibiotics and a liver med (can't remeber name) for 30 days. More blood work was done 30 days later.

On 12/04/09 the results were:
ALK Phosphatase - 325
ALT - 259
GGT - 15
Amylase - 545 (in normal range now)
Cholesterol - 532
Glucose - 139 (was fine month before but a little high this time)
TCO2 - 26 (again was normal last month, only a little high this time)
Triglyceride - 244

He had also put him on the prescription diet R/D to help him lose weight. He is not on it anymore however.

Wow I know this is long, but I wanted to share what I have. My original vet wanted to do MORE blood work in another 30 days.. What for? He was doing nothing to help the symptoms and on the last visit I brought up cushings because he had no other symptoms for the other liver diseases out there. (he kept leaning towards cancer)

Off I went in search of another vet and found a great one. She immediatley said I think he might have cushings. I almost fell out of the chair!! She did an ultrasound to rule out anything else and the next day they did a Dexamethasone suppresion test..

Results were:
7:30 am - 9.2 ug/L
11:30 am - 5.6 ug/L
3:30 pm - 7.2 ug/L

Normal range should be 1.4 ugL 8hrs post-dex.. Someone correct me if I'm wrong here.

He was started on 60mg veteroyl once a day. He had his ACTH test 14 days later and I don't have copies yet but I believe she said his levels were 6 or 7 ug/dl. Which normal is 5.5-20. So this is good right?

Sorry for the long post.

Melissa

[Rebelsmom]

I have a few questions I hope someone can shed some light on. I asked this earlier and was wondering if I should keep Rebel on the Milk Thistle and if it was ok to keep him on his heartworm meds?

Also I just read some other posts about enlarging tumors. While reading these with tears running down my cheek I'm wondering if this is something that I will have to worry about? Will getting his cortisol levels in check make the tumor start to grow? He is only 7 and still seems so young I'm not sure I can deal with thoughts of losing him, esp when he seems to be improving already.

Thank you for your thoughts and help.

Melissa

[Nathalie]

I thought it was high to and when I questioned my original vet about it he took offense and told me to stop reading the internet. I now have a new vet...

This is how it started on 11/04/09 his T4 was 1.7, on 12/04/09 it was .4. That is when he was put on the meds. He was retested on 01/15/10 6 hours after a pill and it was 2.5, which made my vet then think all was good.

He never told me to give it hour before or 2 hours after, I always gave it to him right before he ate.

He has been off the pills since 03/25/10 per my new vet. She wants to get the cushings regulated and then test his T4 levels again. Which will be this coming Wednesday.

Melissa

Glad you got yourself a new vet – that comment is just rude – and he did not give you correct instructions on how to administer the thyroid meds to boot.

When they retest for thyroid function, you want to make sure that you get a Free T4, don’t just let them do an in-house T4 – it is not as specific.
If Rebels test results indicate he needs to get back on thyroid replacement we can revisit on how/when to pill and test etc.

The starting dose for thyroid replacement is usually .1mg per 15 lbs.
.2mg would probably be a good starting point if need be.

Cheers,
Nathalie

[StarDeb55]

Melissa, I can't comment on trilostane usage a whole lot, as I don't use it. What I can comment on is the labwork as I'm a medical lab technologist with 30 years experience. I really need to see the normal ranges, along with reporting units, to be able to give you any meaningful feedback on the general labs that you have posted.

The low dose results appear to be consistent with Cushing's but do not differentiate what type. When you are reading a low dose result, you really aren't looking at a normal range. What you are comparing are the 4 & 8 hr. draws to the baseline result, & whether they are >50% or <50% of baseline. You are also looking to see whether those 2 values are >1.5 or <1.5. I'm glad to hear that Rebel did have a ultrasound. Do you have a copy of that report & could you post the results? Did the report say what the adrenal glands looked like? The ultrasound was probably what determined that Rebel has pit Cushing's. The normal range that you posted of 5.5-20 is the normal range for a healthy, non-cushpup. You are looking for a totally different range for pups being treated. Normally, that range is 1-5, but I believe that Dechra recommends a range of 1.45-9 on the 10-14 day stim result. I'm sure some of the other members who do use Trilostane will be along to comment.

When it comes to using milk thistle, this is a good thing. A large number of members do use MT along with several other supplements for liver support since the great majority of our baby's do have increased liver enzymes do to their Cushing's My Harley has been on MT since he was diagnosed 2 years ago.

The tumor enlarging is not that common. When the tumor does enlarge to >1 cm. in diameter, this is termed a macroadenoma, rather than a microadenoma. The micro is absolutely the most common reason for Cushing's in our pups. Brachycephalic breeds such as Boxers, pitbulls, & Boston terriers are more likely to develop macros than other breeds.

Hope all of this helps.

Debbie

[Rebelsmom]

Melissa, I can't comment on trilostane usage a whole lot, as I don't use it. What I can comment on is the labwork as I'm a medical lab technologist with 30 years experience. I really need to see the normal ranges, along with reporting units, to be able to give you any meaningful feedback on the general labs that you have posted.

The low dose results appear to be consistent with Cushing's but do not differentiate what type. When you are reading a low dose result, you really aren't looking at a normal range. What you are comparing are the 4 & 8 hr. draws to the baseline result, & whether they are >50% or <50% of baseline. You are also looking to see whether those 2 values are >1.5 or <1.5. I'm glad to hear that Rebel did have a ultrasound. Do you have a copy of that report & could you post the results? Did the report say what the adrenal glands looked like? The ultrasound was probably what determined that Rebel has pit Cushing's. The normal range that you posted of 5.5-20 is the normal range for a healthy, non-cushpup. You are looking for a totally different range for pups being treated. Normally, that range is 1-5, but I believe that Dechra recommends a range of 1.45-9 on the 10-14 day stim result. I'm sure some of the other members who do use Trilostane will be along to comment.

When it comes to using milk thistle, this is a good thing. A large number of members do use MT along with several other supplements for liver support since the great majority of our baby's do have increased liver enzymes do to their Cushing's My Harley has been on MT since he was diagnosed 2 years ago.

The tumor enlarging is not that common. When the tumor does enlarge to >1 cm. in diameter, this is termed a macroadenoma, rather than a microadenoma. The micro is absolutely the most common reason for Cushing's in our pups. Brachycephalic breeds such as Boxers, pitbulls, & Boston terriers are more likely to develop macros than other breeds.

Hope all of this helps.

Debbie

I went back to my original post and added the ranges given on my paperwork. They are in red. His levels don't seem to be as high as others I have seen so that makes me a little hopeful.

I'm really confused on how you were explaining the results. Do you think he might not be a cush-pup? The meds seem to be helping his overall well being, but could it be something else? He was on the thyroid meds for 2 months with no change in anything other than a normal T4 level 30 days later. Anymore info you can give me on the tests would be great and very appreciated.

Regarding his ultrasound, the vet said everything looked normal. His liver was slightly enlarged, but she wasn't concerned. She said he adrenals looked good along with kidneys, gall bladder, etc. This is why she thought it was pituitary cushings.

As far as the milk thistle goes is there a recommend dose? Any thoughts on other meds like a daily vitamin and his heartworm pills?

Thank you so much for the tumor info? That is a really scary thing to think about.

Melissa

[StarDeb55]

No, his low dose results are consistent with Cushing's, you just can't tell from those results whether it's pit or adrenal Cushing's. The following link from our important information section will give you a flow chart that explains how to read a low dose result. This is what I use all the time.

http://www.k9cushings.com/forum/showthread.php?t=217

Rebel shows elevations in his liver function tests, alk phos, ALT, & cholesterol, that are commonly found in the majority of our babies. The liver is under stress due to having to process the extra cortisol that the adrenals are pumping out. An elevated alk phos is frequently what will clue a vet to looking at Cushing's. When it comes to MT dosage, I would consult with Rebel's vet. All I can tell you is Harley weighs about 12 lbs. & gets 100 mg. of MT.

I just want to confirm that the vet said that the adrenals looked normal on the ultrasound.

Debbie

PS- I'm a little confused by the vet's comments concerning the adrenal glands on the US. Frequently, dogs with pit Cushing's will show bilaterally enlarged adrenal glands. I think it's possible that the adrenals can be of normal size, but I need to get some input from some of the other members. Other things that are commonly found on ultrasound reports in our pups is that the liver will have what is termed a "hyperechoic" appearance. This is also due to the liver having to process the cortisol.

[Rebelsmom]

No, his low dose results are consistent with Cushing's, you just can't tell from those results whether it's pit or adrenal Cushing's. The following link from our important information section will give you a flow chart that explains how to read a low dose result. This is what I use all the time.

http://www.k9cushings.com/forum/showthread.php?t=217

Rebel shows elevations in his liver function tests, alk phos, ALT, & cholesterol, that are commonly found in the majority of our babies. The liver is under stress due to having to process the extra cortisol that the adrenals are pumping out. An elevated alk phos is frequently what will clue a vet to looking at Cushing's. When it comes to MT dosage, I would consult with Rebel's vet. All I can tell you is Harley weighs about 12 lbs. & gets 100 mg. of MT.

I just want to confirm that the vet said that the adrenals looked normal on the ultrasound.

Debbie

PS- I'm a little confused by the vet's comments concerning the adrenal glands on the US. Frequently, dogs with pit Cushing's will show bilaterally enlarged adrenal glands. I think it's possible that the adrenals can be of normal size, but I need to get some input from some of the other members. Other things that are commonly found on ultrasound reports in our pups is that the liver will have what is termed a "hyperechoic" appearance. This is also due to the liver having to process the cortisol.

She said is adrenals looked fine. She didn't say they were enlarged just his liver. She did say there was one small white spot on his liver but she wasn't concerned about it.

On the milk thistle I was just opening one capsule and sprinkling it on his food once a day. So he was not getting much. I just wanted something a little extra.

Melissa

[StarDeb55]

After sending PM's to a couple of the admins, normal adrenal glands on an ultrasound are most definitely consistent with a diagnosis of PDH.

Debbie

[Rebelsmom]

After sending PM's to a couple of the admins, normal adrenal glands on an ultrasound are most definitely consistent with a diagnosis of PDH.

Debbie

So we are on the right track then?

Melissa

[lulusmom]

Hi Melissa,

It looks like Debbie has done her usual good job of covering all the bases and to answer your question, yes, it does look like you are on track. The only thing I would like to add is that Vetoryl can continue to reduce cortisol in the first 30 days and since Rebel's first post stim was 6 or 7 ug/dl, you don't have a lot of leeway if Rebel turns out to be one of those dogs that see decreasing cortisol after 14 days. Just make sure you keep a close eye on him for signs of low cortisol until you have the 30 day acth stim test done. Those signs would be not eating, extreme lethargy, vomiting, diarrhea and tremors.

I think you also asked a question about taking heartworm meds with Vetoryl. I've never read anything that says you can't give the two together; however, I'm hoping that members that do give their dogs heartworm meds will chime in.

Glynda

[Rebelsmom]

Hi Melissa,

It looks like Debbie has done her usual good job of covering all the bases and to answer your question, yes, it does look like you are on track. The only thing I would like to add is that Vetoryl can continue to reduce cortisol in the first 30 days and since Rebel's first post stim was 6 or 7 ug/dl, you don't have a lot of leeway if Rebel turns out to be one of those dogs that see decreasing cortisol after 14 days. Just make sure you keep a close eye on him for signs of low cortisol until you have the 30 day acth stim test done. Those signs would be not eating, extreme lethargy, vomiting, diarrhea and tremors.

I think you also asked a question about taking heartworm meds with Vetoryl. I've never read anything that says you can't give the two together; however, I'm hoping that members that do give their dogs heartworm meds will chime in.

Glynda

Thank you Glynda. My vet said we didn't have to have another test for another 6 months.. Should I insist on another at the 30 day mark?

I hope it's not an issue. I had a dog with heartworms once and it was heartbreaking. It really is to common around here to not keep him on the meds.

Melissa

[lulusmom]

Yes, you should have another stim test done at the 30 day mark and if all is good, you need to have another in no less than 3 months. Six months is way too long for a dog that has just started treatment. As a matter of fact, at least one of the experts on Vetoryl, who was involved in the original field studies on the drug, suggests that a stim be done every 30 days for the first three months and then every three months for the first year and then 4 to 6 months thereafter. Also, make sure that your vet checks Rebel's electrolytes whenever you do the acth stim test as Vetoryl lowers aldosterone and if the dose is too high, it can throw off the electrolytes.

Glynda

[Rebelsmom]

Yes, you should have another stim test done at the 30 day mark and if all is good, you need to have another in no less than 3 months. Six months is way too long for a dog that has just started treatment. As a matter of fact, at least one of the experts on Vetoryl, who was involved in the original field studies on the drug, suggests that a stim be done every 30 days for the first three months and then every three months for the first year and then 4 to 6 months thereafter. Also, make sure that your vet checks Rebel's electrolytes whenever you do the acth stim test as Vetoryl lowers aldosterone and if the dose is too high, it can throw off the electrolytes.

Glynda

Thanks for the information. I will speak to the vet about it. He is supposed to go next wed for a blood draw to check his thyroid. Next friday would be 30 days for him. So I'll see what she says. He is doing so well right now I'm scared to get my hopes up.

Melissa

[lulusmom]

Melissa, dogs actually do very well on Vetoryl and I think the positive signs you are seeing means that Rebel is going to do fabulously on it. Don't worry yourself sick over this, just revel in your baby's daily steps to an improved quality of life. We've all rejoiced when our babies started acting like their old selves again and Rebel may not be 100% there yet but he will be.....and we're all going to be here to give you a huge pat on the back and big cyber hugs for surviving it all. :D

Glynda

[Rebelsmom]

Quick update on Rebel. He is doing very well and I continue to see improvments everyday. Had a long talk with his vet last night (she gave me cell number!!) regarding the best way to handle him long term. I love my vet she is great. He goes in tomorrow for his retest on the thyroid. I will let everyone know the results as soon as I do.

I bought him some new toys this past weekend as he is finally showing interest again in playing. He is back to being my happy puppy!!

Melissa

[labblab]

I think you also asked a question about taking heartworm meds with Vetoryl. I've never read anything that says you can't give the two together; however, I'm hoping that members that do give their dogs heartworm meds will chime in.

Glynda
Melissa, that is wonderful that Rebel is doing so well!!

Also, I just noticed you had earlier asked a question about giving heartworm meds along with Vetoryl...Here's a quote from an info page for vets that is published by Dechra (the manufacturers of Vetoryl):


VETORYL Capsules were administered concurrently with a variety of medications that are commonly dispensed to middle-aged and geriatric dogs.The most commonly dispensed concurrent medications include heartworm prophylaxis, flea and tick treatments, routine vaccinations, antimicrobials, levothyroxine, non-steroidal anti-inflammatories, and joint supplements.

Here's the source of the quote:

http://www.dechra-us.com/page/veterinarians

So hopefully this can put your mind at ease about giving Rebel his heartworm pills. :)

Marianne

[Rebelsmom]

Melissa, that is wonderful that Rebel is doing so well!!

Also, I just noticed you had earlier asked a question about giving heartworm meds along with Vetoryl...Here's a quote from an info page for vets that is published by Dechra (the manufacturers of Vetoryl):



Here's the source of the quote:

http://www.dechra-us.com/page/veterinarians

So hopefully this can put your mind at ease about giving Rebel his heartworm pills. :)

Marianne

Thank you for the information that is great to hear. My vet didn't seem concerned about giving him his meds either. So I'm more at ease with all of this right now. Thanks to all of you who have helped me through the beginnings of this.

Melissa

[mypuppy]

Hi Melissa and Rebel,

I'm Jeanette, and my 7 year old chocolate lab, Princess, was diagnosed with PDH Cushings 6 months ago. She is presently on 1 60mg of trilo once a day also. I am glad you have seen improvements already with Rebel. It is so heartwarming, to say the least, to have them back isn't it? So for that, I am extremely happy and thrilled for both of you. I hope Rebel continues to do well on his treatment--it is all we can possibly pray and hope for with this condition. Sending you some very tight hugs and belly rubs to little Rebel. xo Jeanette
I

[Rebelsmom]

Took Rebel in today to get his thyroid checked again. They are runing a T4 and a free T4. Should have the results back in a couple of days. I got an actual copy of his ACTH stim test and his results were 8.2 ug/L. Normal is 5.5-20. We will do another stim test in 4 weeks.

Melissa

[lulusmom]

Hi Melissa,

A post stim number of 8.2 ug/dl is pretty darn good, especially if you are seeing great improvements in Rebel. Have all of his symptoms resolved now?

Glynda

[Rebelsmom]

Hi Melissa,

A post stim number of 8.2 ug/dl is pretty darn good, especially if you are seeing great improvements in Rebel. Have all of his symptoms resolved now?

Glynda

I wouldn't say all have. He drinks less and urinates less. He is playful again. He still has some diluted urine although not all the time. He still eats like I'm starving him, and still has a small pot belly (it is smaller though). It's also taking a long time for his hair to grow back where they shaved him for the ultrasound. I don't know if that's a symptom or not. He doesn't pant as much, but still more than my 75lb pup. So we still have ways to go, but he just seems happier lately not depressed. Have any of you ever told non-dog people your dog seems depressed and gotten that look? You know the how do you know your dog is depressed, did he tell you? HAHA.. We just know!!

Melissa

[Boxer_lover]

Amen to that...non dog people..sheeesh! My Ben is less depressed for sure!

[lulusmom]

Hi again,

You're almost there and there's a good chance that you things will resolve in the next 30 days. If Rebel is still symptomatic when you have his next stim test done and his post stim is still higher than 5.5 ug/dl, you should discuss increasing the dose with your vet.

Glynda

[Rebelsmom]

Another question for all you experts... Rebel seems to poop a lot!! Maybe 3 or 4 times a day. This normal? It is solid, not wet at all. It is regular color with no blood. It's never big piles or anything like that.. Is he just a healthy pooper?

Melissa

[lulusmom]

I am not an expert on poop but I can tell you that according to my four dogs, not everybody has the same amount of daily poops nor do they all go at the same time. If Rebel's poop looks normal, I wouldn't worry about it.

[Rebelsmom]

I thought that to, just thought I would ask cause you know with this cushings thing you just never know what it might hold in store for you!! haha

He's just a healthy pooper!! At least one healthy thing!

Melissa

[Rebelsmom]

Hi everyone, just checking in to say that things seem to still be going well with Rebel. I took him and his sister Sadie to the beach yesterday. He played in the water, barked at some other pups and chilled by my chair. I uploaded some pics to my profile of our day. If you have a chance check my bablies out. Love to everyone.

Melissa

[O'Riley]

Rebel'sMom...Is Rebel a Rat Terrier? He's adorable! At 37 pounds, he certainly carries his weight well. I've had a Rat Terrier for a few months who looks a lot like Rebel. He has tons of personality and I'm just crazy about him.

[Rebelsmom]

Rebel'sMom...Is Rebel a Rat Terrier? He's adorable! At 37 pounds, he certainly carries his weight well. I've had a Rat Terrier for a few months who looks a lot like Rebel. He has tons of personality and I'm just crazy about him.

He is a mixed blue heeler. Little bigger than a rat terrier and he is now down to around 34.5lbs and counting. Just trying to get his belly down a little.

Here is a link to blue heelers. http://www.dogster.com/breeds/Blue_Heeler

Melissa

[O'Riley]

Is your avatar a picture of Rebel? We have a Blue Heeler neighbor who herds his horses -- great fun to watch.

[Rebelsmom]

Is your avatar a picture of Rebel? We have a Blue Heeler neighbor who herds his horses -- great fun to watch.

Yeah that's him. When he was younger and I had first gotten my other pup Sadie, he used to try and herd her around the yard. Quite funny to watch, but he is paying for it now since she is bigger than him! I have more pics in my profile of him.

Melissa

[Rebelsmom]

He is actually the stumpy tail blue heeler. His little tail was not docked he came that way. Along with the one ear up one down thing. He is special!! lol

Melissa

[mypuppy]

Hi Melissa,
I just loved your doggie pics....My favorite was Rebel's bath with his bath robe on and posing none other...haaaaaaa......I couldn't stop laughing. Thanks for sharing those with us....too cute for words. BTW, I'm jealous! While you and the babies were at the beach just today it seems, we were indoors to avoid the rain. UGH, UGH. I love the beach. Take care and lots of tight hugs coming your way. xo Jeanette ps: please send the nice weather this way...LOL.

[Rebelsmom]

Hi everyone, just wanted to check in. I should have Rebel's T4 results today. I will post them as soon as I find out. I wanted to ask about his hair on his belly. They shaved his belly back when they did the u/s and almost 5 weeks later it has barely grown back. This pretty normal with cush dogs?

Melissa

[mypuppy]

Hi Melissa,
Oh yes, that's truly normal. I had the same thing after Princess had her abd. u/s. In Princess's case, it took a good 5 months for all her hair to finally/completely grow in. Now you'd never know she had her belly shaved. I was happy that in all grew back, so be patient, you'll get there too. BTW, and this is my own personal experience with Princess, but just in the event it happens to your little Rebel, I don't want you to get "freaked out" the way I did. While Princess was in remission of her cushings symptoms and off treatment, I started noticing big globs of hair coming off her and more excessive hair shedding than I had ever witnessed in 7 years. I panicked, thought this was the cushings starting to take over again and thought she was going to start losing all her hair, so I started the trilo. Luckily someone on the forum called me IMMEDIATELY and shed some light as to what was really going on with Princess and I stopped giving her the trilo again. Princess was "blowing her coat" which means she was losing her old, frail coat. And don't be surprised if Rebel starts showing some flaky, dandruffy skin as well. After a few oatmeal/baking soda baths, Princess's skin and hair is back to normal. Perhaps someone here can chime in and explain why and how this process works, but all I learned is that it is normal, as much as we don't like it. Take care and best regards, xo Jeanette

[Rebelsmom]

Hi Melissa,
Oh yes, that's truly normal. I had the same thing after Princess had her abd. u/s. In Princess's case, it took a good 5 months for all her hair to finally/completely grow in. Now you'd never know she had her belly shaved. I was happy that in all grew back, so be patient, you'll get there too. BTW, and this is my own personal experience with Princess, but just in the event it happens to your little Rebel, I don't want you to get "freaked out" the way I did. While Princess was in remission of her cushings symptoms and off treatment, I started noticing big globs of hair coming off her and more excessive hair shedding than I had ever witnessed in 7 years. I panicked, thought this was the cushings starting to take over again and thought she was going to start losing all her hair, so I started the trilo. Luckily someone on the forum called me IMMEDIATELY and shed some light as to what was really going on with Princess and I stopped giving her the trilo again. Princess was "blowing her coat" which means she was losing her old, frail coat. And don't be surprised if Rebel starts showing some flaky, dandruffy skin as well. After a few oatmeal/baking soda baths, Princess's skin and hair is back to normal. Perhaps someone here can chime in and explain why and how this process works, but all I learned is that it is normal, as much as we don't like it. Take care and best regards, xo Jeanette

Thanks Jeanette. I have actually been tempted to shave him completely. He has always shedded pretty bad, so when I saw the pretty smooth skin after the u/s I thought hmmmm. I won't do it to him though, his sister might pick on him. I'll just continue to brush white and black hair off of me!

Melissa

[mypuppy]

melissa,
lol

[Rebelsmom]

Got Rebel's thryroid results back this evening. His free T4 is 16 (range 8-40) his resting T4 is .8 (range is 1-4). The vet dosen't think he has hypothyroidism. SHe says she knows the resting T4 is a little low, but she is not worried about it. She does not think he needs the soloxine. What do you guys think?

Melissa

[Nathalie]

Hi Melissa,

Personally, I would keep him off the Soloxine for now and retest at a later point once the cortisol is well controlled for a while unless he shows symptoms of low thyroid.
Combine the thyroid test with a stim test to safe yourself money for the blood draw;)

Nathalie

[Rebelsmom]

Hi Melissa,

Personally, I would keep him off the Soloxine for now and retest at a later point once the cortisol is well controlled for a while unless he shows symptoms of low thyroid.
Combine the thyroid test with a stim test to safe yourself money for the blood draw;)

Nathalie

The vet wants to retest in 6 months. What are the syptoms of low thyroid?

[lulusmom]

The vet wants to retest in 6 months. What are the syptoms of low thyroid?

Take a look at this site for some easy to understand info on hypothyroidism, including symptoms.

http://www.peteducation.com/article.cfm?c=2+1597&aid=449

[Rebelsmom]

So at about 4:45 this morning Rebel woke me up throwing up. I don't know why or what could have caused it. Maybe he ate something he shouldn't have? I thought I might have seem something foreign in it, but was trying to clean it up quickly or I woulda been right there with him. It was a little pile and this morning he seemed fine. He had normal poop and he wanted to eat. I waited till he ate all his food and gave him his trilostane. I'm kicking myself for not bringing him in with me this morning, but I will be so busy it will be hard to keep an eye on him. I'm also leaving on a business trip this afternoon and will be gone all weekend. I'm worried sick that something will happen while I'm gone. My roommate wil have strict instructions on his care, but man this is killing me. He had to do this when I had to go away. Who knows maybe he knows I'm planning on leaving for a few days and he is trying to stop me!!

Someone put my mind at ease if you can.

Melissa

[mypuppy]

Hi Melissa,
Same thing happened to my Princess this week, but it was right after she ate her breakfast and I got to thinking it was because she basically woofed down her entire serving in seconds, way too fast and threw up a little pile right after. As you, got scared and thought oh no, hope this is not a side effect. Whatever it was, went away. She's been fine otherwise, and still on the trilo. I think at times their stomach does get a bit upset. I find with my Princess it happens mostly first thing in the morning. But I do understand your concern in this happening when you need to be away from him. UGH, UGH. Ain't it always the case. I hope whatever was bothering him has resolved so you can go on with your trip, but good thing you are leaving strict instructions with your friend in the event something should arise. Please let us know upon your return how he's doing. Have a nice trip although Im sure your mind will be elsewhere. Best regards, xo Jeanette

[Rebelsmom]

Hi Melissa,
Same thing happened to my Princess this week, but it was right after she ate her breakfast and I got to thinking it was because she basically woofed down her entire serving in seconds, way too fast and threw up a little pile right after. As you, got scared and thought oh no, hope this is not a side effect. Whatever it was, went away. She's been fine otherwise, and still on the trilo. I think at times their stomach does get a bit upset. I find with my Princess it happens mostly first thing in the morning. But I do understand your concern in this happening when you need to be away from him. UGH, UGH. Ain't it always the case. I hope whatever was bothering him has resolved so you can go on with your trip, but good thing you are leaving strict instructions with your friend in the event something should arise. Please let us know upon your return how he's doing. Have a nice trip although Im sure your mind will be elsewhere. Best regards, xo Jeanette

I hope it's just a little something. I guess things were going to well, something had to happen! lol

Melissa

[Harley PoMMom]

I am also trying the milk thistle and trying to find the right dosage. It's all still new to me so I'm not sure what affect it has had yet.

Melissa

In this article you can find the recommended dosage amount for your pup.

http://www.lowchensaustralia.com/health/thistle.htm

From our Resource Thread we have many links to article about milk thistle that might interest you.

Milk Thistle/Sam-e and more (for liver "support")
http://www.k9cushings.com/forum/showthread.php?t=192

Hope this helps.

Love and hugs,
Lori

[jrepac]

there is a lot on milk thistle out there; for a pup w/liver issues, 200 to 300mg a day is not uncommon from what I have read; one vet suggested 300mg to me; I thought that maybe was a bit much and went with the standard 175mg dose per day. you also should give with food as it can upset the tummy

I give it everyday, but maybe 2 weeks out of the year I will give her a break from it (1 week breaks when I go on vacation or such).....there are mixed opinions out there re: how long to keep giving it. I feel that since the cortisol risk is always present, I'd rather give it daily, rather than stopping for weeks/months at a time.

[Rebelsmom]

there is a lot on milk thistle out there; for a pup w/liver issues, 200 to 300mg a day is not uncommon from what I have read; one vet suggested 300mg to me; I thought that maybe was a bit much and went with the standard 175mg dose per day. you also should give with food as it can upset the tummy

I give it everyday, but maybe 2 weeks out of the year I will give her a break from it (1 week breaks when I go on vacation or such).....there are mixed opinions out there re: how long to keep giving it. I feel that since the cortisol risk is always present, I'd rather give it daily, rather than stopping for weeks/months at a time.


I started Rebel on the 250mg which is what 30% came up to for him. Do you guys give them the whole pill with the capsule or do you break it open over the food? I have heard both.

Melissa

[Rebelsmom]

Quick update on Rebel. He is still more active and playing now. Drinking less and urinating less. Still waiting on him to stop feeling like I'm starving him. lol

I added a new pic of him being silly today. I also have a video of him getting excited about going for a walk but can't seem to get my pc to save it right.

Melissa

[frijole]

Melissa, thanks for the updates! Sounds like you have things under control for the moment. Congrats. I give milkthistle with each meal so I split the capsule (200 mgs) in half. I just pour it over the food and mix it up.

Loved the photo! Kim

[Rebelsmom]

Little concerned today. Rebel seems to be drinking more again and urinating more. I'm worried that maybe the 60mg might not be enough, but I'm worried what could happen if we go up in dose. He goes back first week in June for another stim test. Should I wait for that or speak to the vet sooner?

[Harley PoMMom]

How is his appetite? Is this also increasing? The increase in thirst and urination might be a UTI, or he might need BID dosing instead. Does his urine have any smell to it, any blood in it? Is he straining to pee? Our cush pups are known to get diabetes also, and they can get this disease at any time. Increased thirst and urination are some of the symptoms of diabetes. When was the last time his Glucose was checked? This would have been a blood draw for a chemistry panel.

Love and hugs,
Lori

[Rebelsmom]

How is his appetite? Is this also increasing? The increase in thirst and urination might be a UTI, or he might need BID dosing instead. Does his urine have any smell to it, any blood in it? Is he straining to pee? Our cush pups are known to get diabetes also, and they can get this disease at any time. Increased thirst and urination are some of the symptoms of diabetes. When was the last time his Glucose was checked? This would have been a blood draw for a chemistry panel.

Love and hugs,
Lori

His urine is still pretty clear. It's the one symptom that hasn't cleared. He is not straining at all. His last blood work was Feb. His appetite is the same. He still acts like I'm starving him. He is acting fine, still playing and seems happy.

[Harley PoMMom]

Hi Melissa,

From looking thru your thread I see your posted that Rebel's Dec. 09 lab results showed his glucose was a little high...hmmm. But if he is still acting like a ravenous piggy :eek: and his urine has no icky smell or odd color to it then I don't thick it's a UTI...I think, if Rebel were my pup, I would call his vet and see about testing his cortisol and have a chemistry panel done too...want to see the electrolytes and the glucose.


On 12/04/09 the results were:
ALK Phosphatase - 325
ALT - 259
GGT - 15
Amylase - 545 (in normal range now)
Cholesterol - 532
Glucose - 139 (was fine month before but a little high this time)
TCO2 - 26 (again was normal last month, only a little high this time)
Triglyceride - 244

Melissa

[Rebelsmom]

I have put in a call in to my vet to discuss Rebel's symptoms returning. He still seems to be drinking more water than he was and is urinating more. He also started licking the carpet again, which he had stopped doing for awhile. I guess it was too much to ask for us to get it right on the first shot.

On the plus side he seems to be acting fine. he still wants to play and go on walks. Still eating very well and would eat more if I let him. I have been measuring his belly lately and it has been staying the same size. Not growing larger.

Melissa

[zoesmom]

Yes, a glucose check might be in order as Lori said. And I'd still want to rule out a uti. Zoe got them frequently and although I could usually tell when she was in the throes of one, there were times when it was less clear. However, she would sometimes do the carpet licking thing and I think it was because she was leaving little dribbles of pee and then would try to lick away the 'evidence'. :eek::eek::eek: Let us know what the vet suggests next. Sue

[Rebelsmom]

Yes, a glucose check might be in order as Lori said. And I'd still want to rule out a uti. Zoe got them frequently and although I could usually tell when she was in the throes of one, there were times when it was less clear. However, she would sometimes do the carpet licking thing and I think it was because she was leaving little dribbles of pee and then would try to lick away the 'evidence'. :eek::eek::eek: Let us know what the vet suggests next. Sue

I missed the call from the vet last night, she is gonna call me again tonight. My phone will be attached to me!!

Are there any other symptoms of UTI? Rebel has never had one so I wouldn't know what to look for. Also the glucose levels were only a couple points above the normal level. What other test need to be done or symptoms does he need to have for them to determine if it is diabetes?

Does anyone think that he might just need a little more trilo? Maybe another 10mg a day? He is one 30mg now and is right around 33lbs. His belly went down 1/2" in the last week..

Melissa

[mypuppy]

Hi Melissa,
Sorry Rebel seems to have regressed a tiny bit--as you, I also feel Princess may need a small increase since her symptoms do not seem to resolve on the lower dose. Nevertheless it is a good idea to check for the Uti just to be on safe side. As for diabetes testing, Princess had blood tests, urine and a water deprivation test to rule it out. I don't recall now when Rebel began his trilo and considering this is the initial dose he's been on, again it could just be all related to a dose adjustment. Please let us know what your vet recommends and keep us updated on Rebels progress or any other issues. I certainly will be keeping fingers crossed it will all be a simple fix. Sending you my warmest regards and luv and belly rubs to the Rebel. Xo Jeanette

[lulusmom]

Hi Melissa,

Symptoms of a UTI can be decreased energy levels, dehydration, licking of the genital area, insatiable thirst, fever, tenderness in lower stomach region, weight loss, vomiting/nausea, increased urgency to pee even when bladder is empty, urine smells horrible, sometimes blood in urine and sometimes obvious pain when peeing.

Mild increases in glucose is very common if the dog is stressed or scared during the blood draw or it could be due to a recent meal. Cushing's can also transiently elevate glucose levels which will normalize once you get the cortisol within range.

At this point, I don't think you know what Rebel's cortisol status is so I would agree with Lori that an acth stim test should be done. It could very well be that Rebel needs an increase in dose and the results of the acth stim is the only way to find out. If the post stim cortisol is too high then this would explain Rebel's excessive drinking and peeing.

[Rebelsmom]

I just spoke with teh vet. She wants me to drop off a urine sample in the morning. And I am taking him in next week for blood work and she wants to just recheck the ultrasound to make sure nothing has changed there. We are gonna wait for the results of the urine and blood before we do the stim again. Since the cushings seems to be mostly under control and his last stim was good she wants to rule out other things first. His stim is still scheduled for June 3rd. I'm almost praying for a UTI, something easy to fix would be nice.

Melissa

[Rebelsmom]

Dropped off Rebel's urine this morning to the vet. Boy did he think I was crazy chasing him around the yard with a cup!! He ended up picking the only tree in the backyard to go on. Of course it had weeds growing all around it, so I had to push through those to get the cup under him.. Needless to say he made it so I had to work for it and get it everywhere! Such a smart dog.

Should have the results back tomorrow. On a positive note it was yellow and not completely clear like it has been.

Melissa

[mypuppy]

Hi Melissa,
Isn't it crazy the things we do to get our babies better! Good thing Rebel at least finally let you, the times I've tried chasing Princess with a cup in my hand, she'd run to the end of the yard so I wouldn't catch her. It's like she knew I had something foreign in my hand and knew it wasn't kosher. lol. They are just too smart alright. Good luck with the test. Let us know the results. Take care. xo Jeanette

[Rebelsmom]

You should have seen the look on his face when I was chasing him around the yard. He actually looked at me like I was losing my mind. Then I think he figured out what the cup was for and decided to get me!!

[Rebelsmom]

Got Rebels urine tests back. Nothing wrong there. He goes in Wednesday for another u/s so she can check his liver again and make sure nothing has changed. He will also have some blood work done. Wish is luck in figuring this out.

Melissa

[mypuppy]

Hi Melissa,
Yes, we are most definitely sending you and your precious Rebel our best wishes so he can start feeling better soon. Keeping the faith all will be well. Warmest regars and tight hugs too. xo Jeanette and Princess

[MiniSchnauzerMom]

Melissa,

You've certainly got my best wishes for Rebel. I had to laugh when I read about how you chased him around with the cup for the sample. I remember those urine catching days with my Munchie. They do tend to give you "that look" don't they. :D Glad his sample came back A-ok. Hope all will be fine with the u/s too and that Rebel's doc will be able to determine what's going on.

Louise

[Rebelsmom]

Melissa,

You've certainly got my best wishes for Rebel. I had to laugh when I read about how you chased him around with the cup for the sample. I remember those urine catching days with my Munchie. They do tend to give you "that look" don't they. :D Glad his sample came back A-ok. Hope all will be fine with the u/s too and that Rebel's doc will be able to determine what's going on.

Louise

I was actually secretly hoping for a UTI. I just wanted something to be an easy fix for once. I'm nervous about the u/s, she had originally found a small white spot on his liver. At the time she said she wasn't concerned about it. She wants to look at them now that we have the cortisol under control and see if anything has changed.

On another note my young pup Sadie is having some issues now. I noticed her walking around funny with her tail tucked and would not wag her tail at all. So doctor Mom rolled her over and found a tick right at the base of her tail and one on her back leg. NASTY bugs!! So I grabbed the tweezers and pulled them out. She is still not her normal self, but was a little better this morning. There are lumps where I pulled them out, but it's not red or inflamed. She still acts like it hurts, so I'm not sure if it was just the location and it's sore or if there might be an infection.

Man I just need a break!! Can't my babies just have a normal month, week, day even! lol

Sorry to vent, just needed to let it out.

Melissa

[Dogwalker]

Hi
I found with my Westie that he was very disorientated and doing lots of strange things before the tablets kicked in. Since he's been on Vetoryl I've not had that behaviour so hang in there and you should see a change. Vetoryl kicked in on about day 10 behaviour-wise for Hamish but all dogs re-act differently. Just keep being there for Rebel and comfort him.
It's a scary time when they go on the drug isn't it. I was very emotional for the 1st week.
x

[Rebelsmom]

Hi
I found with my Westie that he was very disorientated and doing lots of strange things before the tablets kicked in. Since he's been on Vetoryl I've not had that behaviour so hang in there and you should see a change. Vetoryl kicked in on about day 10 behaviour-wise for Hamish but all dogs re-act differently. Just keep being there for Rebel and comfort him.
It's a scary time when they go on the drug isn't it. I was very emotional for the 1st week.
x

He has actually been on the veteroyl for almost 2 months now. I did notice a big change after about 2 weeks. Now his symptoms seem to be gradually returning. I was and I still am very emotional about the whole situation. It just seemed like things were getting better and now a set back. We will keep pushing though.

Melissa & Rebel

[lulusmom]

I was actually secretly hoping for a UTI. I just wanted something to be an easy fix for once. I'm nervous about the u/s, she had originally found a small white spot on his liver. At the time she said she wasn't concerned about it. She wants to look at them now that we have the cortisol under control and see if anything has changed.

Hi Melissa,

I went back through your thread and I din't see where you posted a recent acth stim test result that shows that Rebel's cortisol is udner control. Rebel's last post stim was a bit over 8 and this cannot be be interpreted as having the cortisol under control, especially if all symptoms have not resolved. If symptoms have totally resolved, which Rebel's have not, a post stim of 7 to 9 is acceptable. Some dogs do fine with cortisol running a bit higher but in my experience, the majority of dogs will need to have a post stimulated cortisol number of 1.5 ug/dl to 5.5 ug/dl before symptoms go away.

If Rebel's only symptoms is excessive drinking and peeing, my bet is that the cortisol is not being adequately controlled throughout the day. Having had the UTI ruled out, I personally would not be spending extra money to find out why the PU/PD is not resolved without addressing the obvious culprit, high cortisol.

As I recall, Rebel had an acth stim test done two weeks after starting treatment but your vet was not following protocol and wanted to wait six months before doing another acth stim test. Do you know if your vet has much experience with cushing's and did s/he tell you that a post stimulation test of 8+ ug/dl is acceptable for Rebel, despite his being symptomatic?

Glynda

[Rebelsmom]

Hi Melissa,

I went back through your thread and I din't see where you posted a recent acth stim test result that shows that Rebel's cortisol is udner control. Rebel's last post stim was a bit over 8 and this cannot be be interpreted as having the cortisol under control, especially if all symptoms have not resolved. If symptoms have totally resolved, which Rebel's have not, a post stim of 7 to 9 is acceptable. Some dogs do fine with cortisol running a bit higher but in my experience, the majority of dogs will need to have a post stimulated cortisol number of 1.5 ug/dl to 5.5 ug/dl before symptoms go away.

If Rebel's only symptoms is excessive drinking and peeing, my bet is that the cortisol is not being adequately controlled throughout the day. Having had the UTI ruled out, I personally would not be spending extra money to find out why the PU/PD is not resolved without addressing the obvious culprit, high cortisol.

As I recall, Rebel had an acth stim test done two weeks after starting treatment but your vet was not following protocol and wanted to wait six months before doing another acth stim test. Do you know if your vet has much experience with cushing's and did s/he tell you that a post stimulation test of 8+ ug/dl is acceptable for Rebel, despite his being symptomatic?

Glynda

She said she had had a lot of exp with Cushings. She thought his cortisol was actually on the lower side. She said normal range is 5-20. His symptoms were getting better after 2 weeks of treatment. It has just been the last week that I have noticed he has started drinking more again. He is scheduled for another stim test first week in June (2 weeks from now).

She is not going to charge me the regular price for the u/s, she said she would charge me $50 just to go and look around again to make sure the first spot she saw on his liver has not changed. Nothing else has really changed with him, just the water intake has gone up a bit. It's nowhere near as bad as it was before he started the trilo though.

Melissa

[lulusmom]

Melissa,

The range of 5 to 20 ug/dl is for a normal dog not a dog with cushing's. For purposes of monitoring treatment, the normal range for a cushingoid dog is 1 to 5 ug/dl. This is cushing's 101 so I personally would be very concerned if my vet did not know this. Are you absolutely sure that your vet told you that Rebel's post stim number of 8 was on the low side of normal?

[Rebelsmom]

Melissa,

The range of 5 to 20 ug/dl is for a normal dog not a dog with cushing's. For purposes of monitoring treatment, the normal range for a cushingoid dog is 1 to 5 ug/dl. This is cushing's 101 so I personally would be very concerned if my vet did not know this. Are you absolutely sure that your vet told you that Rebel's post stim number of 8 was on the low side of normal?

Unless I misunderstood her.. I just called and left a message for my vet to see about just moving up his stim test to Wed and forgoing the blood work until later. 1-5 is normal? I'm so scared about dropping him too low and it going the other way...

Melissa

[Rebelsmom]

I just read this post. http://www.k9cushings.com/forum/showthread.php?t=187

Man I hope I just misunderstood what my vet said. She has been so great and said she has dealt with a lot of cush dogs. I'll let you know what she says when I speak with her.

Melissa

[labblab]

Melissa, here's another link that you should take a look at. It's the current U.S. "Treatment and Monitoring Flowchart" published by Dechra, the manufacturers of Vetoryl. As you will see (and as Glynda has said), after 30 days of treatment, their ideal post-ACTH range is 1.45 - 5.4 ug/dl. If Cushing's symptoms are not fully resolved and the ACTH result is greater than that, then a dosage adjustment is recommended.

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

Marianne

[labblab]

His symptoms were getting better after 2 weeks of treatment. It has just been the last week that I have noticed he has started drinking more again. He is scheduled for another stim test first week in June (2 weeks from now).

Melissa, I just re-read your earlier reply, and is Rebel just now at the 3-week mark since beginning treatment? If so, you may still want to wait an additional week to retest so that his cortisol level truly has the chance to stabilize on the current dose. The fact that you are seeing an increase in thirst does suggest that his cortisol is running a bit too high and that he'll benefit from a dosage increase. But depending upon the severity of the symptom rebound, you may want to sit tight for one more week before retesting. Dechra's expectation is that cortisol levels may continue to drift downwards throughout the first 30 days of treatment at any specific dosage level. That's why they generally suggest holding off on dosage adjustments until after that amount of time has passed, unless a dog is unwell. But if you are seeing an increase in thirst, whether to test this week or next is truly a judgement call, and I don't think there is any right or wrong answer.

Marianne

[mypuppy]

Hi Melissa,
Gosh, I completely understand your anxiety and the uncertainty that comes along with this condition. Tomorrow will be 4 weeks since Princess restarted her trilo at the lower dose, and her cortisol showed a drop at her last stim (10.7) but I know that is not an ideal post cort., at the same time, Princess's symptoms have not yet resolved, and it is extremely frustrating, to say the least. I have also scheduled her next stim for June 1st. As much as I wanted to have her stimmed earlier than that, I was recommended to hold off and give the trilo a little more time to do it's job and see where her levels are on June1st. I've been praying religiously for her symptoms to abate between now and June 1st so that she does not need a dose adjustment, but my gutt's telling me, we'll probably need to anyway. I know it's so hard to judge this and decide what to do. I am sure whatever decision you make will be with Rebel's best interest at heart, and hey, at your vet fees, I'd probably have Princess stimmed every month just to make sure things are going smoothly. But here in the East Coast, that's not my luxury...UGH, UGH...Try to take one day at a time. Hang in there...tight hugs...xo Jeanette.

[Rebelsmom]

Rebel has been on trilo since March 26th, so it has been 71/2 weeks since he started and 5 1/2 weeks since his last stim test. I will talk to the vet when she calls and hope she does not take offense to me questioning her. She has been really great since we started and encouraged me to get all the info I can, so hope she still feels that way.

Jeanette, I'm guessing you are northern east coast, hence the snow? I'm down in sunny FL (not so sunny today). Thanks for the encouragment, I'm wondering since his numbers were close maybe just a 10mg increase would be ok??

Feel like banging my head against the wall. I'm torn on which way to go. Part of me wants to do blood work also to see if anything has changed in that area also. His last panel was back in Feb. I think re-doing the stim is the right way to go though and get his meds adjusted properly.

Thank you all for your help and support,
Melissa

[lulusmom]

Melissa,

Thanks for clarifying that Rebel has only had one stim test done two week after starting treatment. According to treatment monitoring protocol, Rebel should have had another acth stim test at the 30 day mark so he's technically three weeks overdue. I think your plan to move up the stim test to Wednesday is a sound one. That is exactly what I would do. If your vet encouraged you to learn all you can then she should be proud of you for taking the time to educate yourself about the serious drug that she has prescribed. As a matter of fact, you may want to share the link that Marianne provided you with your vet. I don't know why she would fault or resent you for suggesting that she follow the manufacturer's recommendations.

Glynda

[Rebelsmom]

The vet has not called me back yet, but I called in this morning and told them that I wanted his ACTH moved up to tomorrow when I bring him in. They said that was fine and they would make sure she called me back today.

Melissa

[lulusmom]

Melissa,

We're staying tuned and will be waiting with you to get the results of the acth stim test.

Glynda

[Rebelsmom]

Can someone tell me which way stress can cause Rebel's ACTH test to go? It's getting harder each time to drop him off. He didn't used to be so scared of the vet, I guess after so many visits that it's starting to get to him. He also has some seperation anxeity. Breaks my heart to see him pulling away to get back to me.

Melissa

[zoesmom]

Melissa - Typically, stress will raise a dog's cortisol levels. So 'up' on the numbers. How much probably depends on the dog. Zo became the same way about vet visits over time. Just too many and she knew what was coming. I had to pretend like I was walking into the back rooms with her or she wouldn't go. One thing I did was if any other things were scheduled (even a nail trim), I'd ask that they do them after the completion of the ACTH so as not to raise her anxiety level any higher. Sue

[Rebelsmom]

Melissa - Typically, stress will raise a dog's cortisol levels. So 'up' on the numbers. How much probably depends on the dog. Zo became the same way about vet visits over time. Just too many and she knew what was coming. I had to pretend like I was walking into the back rooms with her or she wouldn't go. One thing I did was if any other things were scheduled (even a nail trim), I'd ask that they do them after the completion of the ACTH so as not to raise her anxiety level any higher. Sue

Thanks for the input Sue. I feel so bad that I keep putting him through this, but I know in the long run it will help him.

Melissa

[Nathalie]

Melissa - is there a particular reason why you have to leave Rebel at the vets?
I have never ever left any of my animals at the vets may it be for testing or minor surgery etc.
So, Phillip still loves going there even so we have done tons of blood draws in the past year.

Nathalie

[Rebelsmom]

Melissa - is there a particular reason why you have to leave Rebel at the vets?
I have never ever left any of my animals at the vets may it be for testing or minor surgery etc.
So, Phillip still loves going there even so we have done tons of blood draws in the past year.

Nathalie

Well for the ACTH test the blood draws are an hour apart. I work about 25 mins from the vet. So it's easier to drop him off before work and just pick him up after. Although today I just went and picked him up since he was a little stressed this morning. We also live 40 in from the vet, so it's easier for them to keep him while I'm at work. But like I said I went and got him early today. He seems to be doing ok now and they said when I left he was fine and not real stressed. I guess it's just that initial shock of me leaving him. Now we play the waiting game with the test results.

Melissa

[mypuppy]

Melissa,
That's what my little one's teacher tells me every time I drop her off at school and she's holding on to my leg for dear life. Once I am out of sight, she's fine. Princess has never been clingy or apprehensive before this cushings thing, and now even in the car before we get to the vet's office, I sense her very nervous and trembles. It breaks my heart too, but I guess it's all normal. Who likes being poked and probed right. Wonder if our pups can take valium prior to their stims? LOL...I have heard melatonin is suppose to help them with anxiety, but not sure how quick that works??? Hope you and Rebel are well otherwise. Warmest regards, xo Jeanette

[Nathalie]

Hi Melissa,
I was just wondering because some vets seem to insist for some strange reason that the dog stays for the duration of the time it takes to test.

A lot of people have good results with Rescue Remedy to take the edge off in stressfull situation. Works like a charm for myself. You may want to give it a try.

Hope that the stim test results are what you hoping for.
Nathalie

[Rebelsmom]

Rebel had a rough day yesterday. He seemed better when I picked him up and brought him to work, but when we left to go home it seemed he was actually scared. I think he thought he was going back to the vet. He shivered the entire way. Once we got home and he ate he was all good. We are waiting on the results of the test to come back. I finally did speak with the vet last night, she wants to see what his tests say then evaluate what we should do. She agrees that if we decide to up his trilo that we will do it slowly.

On another note they removed a cyst from the top of his head and he his on precautionary antibiotics for 7 days. It just never ends.

Melissa

[Rebelsmom]

Does anyone have any exp with Orijen dog food? I'm looking for a better food for my pups without breaking my already low budget. They will pretty much eat whatever, but I know its my responsability to feed the good stuff. They were eating purina one weight control and then I changed them to Iams weight control thinking it was better. Reading the info about it though, well guess it's not so great.

Can I buy the orijen a local places or is it something I would have to order?

Melissa

[labblab]

Hi Melissa,

I feed my girls Acana Provincial kibble made by Champion Pet Foods, which also manufactures Orijen foods. Both lines are grain-free; the Orijen line is high-protein, and the Acana Provincial line is moderate-protein (although still higher than many other commercial kibbles). Champion is considered to be a quality manufacturer, and their products are generally rated highly. I have been very happy with the apparent quality of the kibble, and with the feeding results.

I am able to buy the kibble from an independent pet store in my area. If you go to Champion's website, you can check to see whether there are any retailers near you. I have had only two "issues" with Champion. The first is that my store has experienced intermittent shortages of some of the products -- especially the fish-based kibble. I have heard and read various explanations on the internet. Champion is a Canadian company, and their products have seen a rapid increase in popularity in the U.S. So one explanation has simply been that they have not always been able to keep up with the export demand to the U.S. An additional explanation I've read for shortages in the fish-based kibble is that Champion is a family-owned business that relies on their own contracted fishing fleets in order to provide fresh product. And during lulls in the fishing seasons, they are not able to supply as much product. At this point, I've transitioned both my girls over to the chicken-based kibble. We have never had shortages in that product.

My only other complaint is that they were REALLY slow in the past to respond to questions that I submitted to them, both via email and by telephone. However, I've been told that they have recently expanded their customer service staff in order to improve this problem. I've not had questions for a while now, so can't confirm whether or not this is the case -- but I hope so.

I also hope this info helps.
Marianne

[Rebelsmom]

Hi Melissa,

I feed my girls Acana Provincial kibble made by Champion Pet Foods, which also manufactures Orijen foods. Both lines are grain-free; the Orijen line is high-protein, and the Acana Provincial line is moderate-protein (although still higher than many other commercial kibbles). Champion is considered to be a quality manufacturer, and their products are generally rated highly. I have been very happy with the apparent quality of the kibble, and with the feeding results.

I am able to buy the kibble from an independent pet store in my area. If you go to Champion's website, you can check to see whether there are any retailers near you. I have had only two "issues" with Champion. The first is that my store has experienced intermittent shortages of some of the products -- especially the fish-based kibble. I have heard and read various explanations on the internet. Champion is a Canadian company, and their products have seen a rapid increase in popularity in the U.S. So one explanation has simply been that they have not always been able to keep up with the export demand to the U.S. An additional explanation I've read for shortages in the fish-based kibble is that Champion is a family-owned business that relies on their own fishing fleets in order to provide fresh product. And during lulls in the fishing seasons, they are not able to supply as much product. At this point, I've transitioned both my girls over to the chicken-based kibble. We have never had shortages in that product.

My only other complaint is that they were REALLY slow in the past to respond to questions that I submitted to them, both via email and by telephone. However, I've been told that they have recently expanded their customer service staff in order to improve this problem. I've not had questions for a while now, so can't confirm whether or not this is the case -- but I hope so.

I also hope this info helps.
Marianne

I was looking at the acana also. Is it pretty expensive? I go through about 44lbs a food a month between my to dogs. Right now I can get the Iams and Purina One at sams for $30 for 44lbs. Rebel at one time was one R/D, but between paying for that and the other for my other dog, I couldn't keep him on it. Now I feel like I should just bite the bullet eat tuna myself and get the dogs the good stuff! lol

Thanks for the info as always everyone is a big help here.

Melissa

[Rebelsmom]

I found 1 place bout 20 mins from me that carries the Acana. man $55 for 30lbs. Guess its tuna for me. lol

Melissa

[lulusmom]

Hi Melissa,

Iams and Purina One are inferior dog foods, chocked full of low quality, high allergen grains, unidentifiable sources of protein (by-products) and questionable fillers. I've always wonderered how companies that fill their food with cheap grains, guaranteed to make your dog fat, could possibly label it as weight control formulas.

All of the Champion dog food products are way superior to Rebel's current food. I know how expensive good quality food is so I was extremely happy that Petco and Petsmart now carry a few very good brands of dog food. Petco carries Core Wellness and Natural Balance, both of which are excellent foods. Before putting my dogs on a commercially prepared raw diet, they ate Natural Balance and loved the Duck and Potatoe kibble and canned food. If you have a Petsmart, I would suggest Blue Buffalo Wilderness which is an excellent food. No matter which food you choose for Rebel, just make sure that you transition him over very, very slowly so as to spare him any tummy upset, which is usually accompanied by diarrhea.

Glynda

[labblab]

Yup, Orijen/Acana is expensive food. In addition to the fact that there haven't been shortages of the chicken formula, another reason I switched was because it's the least expensive of the three (as opposed to the fish and lamb formulas)...:o

I'm able to get a 30 lb. bag of the Acana chicken for about $51 (plus tax).

Marianne

[Rebelsmom]

So would you say that the Blue Buffalo Wilderness is as good as the Acana?

[Rebelsmom]

I think I'll go with the Acana. It is $55 locally for 30lbs and the Blue Buffalo Wilderness is $50 for 24lbs. The Acan seems to have higher ratings on the site. Only plus side is that petsmart would be closer to me than where I would pick up the Acana. Whenever I have changed foods I have always transitioned them slowly so all good there.

Rebel was at one point on R/D anyone have an opinion on that? I was to excited about it.

Melissa

[labblab]

Melissa, I can't comment on the R/D food. But here's a website where you can find the ingredient analyses and read reviews for various commercial kibble products: www.dogfoodanalysis.com. I don't always agree 100% with the assessments that I've read there, but it is a source of some good comparative information.

If you do decide to go with the Acana, be sure to ask your retailer about Champion's refund program: if you buy 12 bags of their food, they'll give you the 13th bag for free. Your retailer should be able to give you a Champion envelope within which to keep your proofs of purchase and receipts. :) After my next purchase, I'll be getting my first free bag. :) :) :)

Marianne

[lulusmom]

Melissa, I checked out a site called dogfoodanalysis.com to see how they rated Acana and Blue Wilderness. If you place a lot of stock in this site, which I do, Blues Wilderness wins. Acana is 4 stars and Blue Wilderness is 6 stars, with 6 stars being the best. You can read the reviews yourself using the links below:

Blue Wilderness
http://www.dogfoodanalysis.com/dog_food_reviews/showproduct.php?product=2292&cat=all

Acana
http://www.dogfoodanalysis.com/dog_food_reviews/showcat.php?cat=all&stype=1&si=acana&perpage=12&sort=2&stype=&limit=&cat=all&ppuser=0

[labblab]

Glynda, that's too funny...I had just posted the "dogfoodanalysis" website link a nanno-second ahead of you.

But just to set the record straight, the Acana Provincial line gets 5 stars, and per the review of Blue Wilderness -- it almost ended up in the 5 star category, as well ;). It's the "regular" grain-containing Acana that is in the 4 star category.

Here's the link to the 5 star Acana Provincial page: http://www.dogfoodanalysis.com/dog_food_reviews/showcat.php/cat/3

Orijen has consistently been ranked as a 6 star food there. But there are reasons why I prefer the Acana. That's what I mean about not always being in total agreement with their assessments.

Marianne

[lulusmom]

Marianne, I noticed that you and I were doing that mind meld thing again. :D I only had a chance to check out the ratings for three of the Acana foods, all of which were 4 star. That's why I provided a link to the ratings page that lists all of the Acana formulas. Dangit, work does get in the way of doing a thorough job on the forum. :D

[labblab]

And with all the different formulas listed in various places, it can get really confusing trying to sort out what is what, anyway!

And this is probably too much information, but the three Acana Provincial formulas have all been recently revised. So the current analysis and ingredient list differs a bit from what is listed on dogfoodananalysis.com. The chicken has also been renamed "Wild Prairie" instead of "Prairie Harvest." My retailer told me that Champion decided to switch because using the word "harvest" confused people who were wanting to buy a grain-free product...

Marianne

[mypuppy]

Hi Melissa,
I'm not sure what type of diet you need to put little Rebel on but have you looked into the Merrick brand? That is what I have been feeding Princess for many years now. Princess had a lot of digestive issues on all other dog foods, she would throw up constantly after eating and once I switched her to Merrick she has tolerated it wonderfully and never throws up anymore. Apparently this food has digestive elements added to it for sensitive stomachs. I thank my lucky stars Princess's digestive issues resolved on this food. I give her the Turducken dry kibble, with organic chicken as a main ingredient, turkey, and grains. Glucosamine and chrondontin is also added to it as well as flaxseed oil. I pay $32 for a 15 lb. bag. Yeah I know OUCH but well worth it. And as you I too have been eating tuna for quite some time also. Haaaaaaaaaaaaaaaa. Just food for thought no punn intended. Haaaaaaaaaaaaaaaa. Best of luck in your search. Warmest regards xo Jeanette

[Rebelsmom]

I just wanted a better food for him. He has never had any digestive issues (did I just jinx myself)! I went with the Acana Pacifica for both my pups. Y younger dog sadie had skin and allergy issues. The man at the store was very knowledable about all the foods and went through his own issues with skin problems on his pup.

I had found those links you posted from someones elses thread. I just wanted to see what others experiences were with the foods. I looked up the r/d on that site. Omg that food is crap! I can't believe my last vet reccomended it!

Thanks everyone for your opinions. I started tonight adding a little to their food. They were excited. It actually smells like fish, which I'm not sure is a good thing. Lol. Still waiting on the stim results should have them tm.

Lots of love,
Melissa, Rebel, & Sadie

[acushdogsmom]

I have been feeding all three of the different flavours of the grain-free Acana Provincial line to my dog for the past year or so. I also home cook for him, but the Acana Provincial line is the kibble that I feed.

I had originally wanted to feed Orijen, but my dog is a small Bichon Frise and we thought that the Orijen was a bit too high in protein for him. So we decided on the Acana Provincial food, which is not quite as high in protein but which is made by the same company (Champion Pet Foods) with the same high quality ingredients (grain free, ingredients that are fit for human consumption, etc) that go into the Orijen food. The owner of the store where we buy the Acana Provincial foods once mentioned to us that it is one of the only foods that they sell which not only identifies the type of fish etc in the food, they actually also identify the source of the fish, the chicken and the lamb that they use to make the food.

We rotate between the Pacifica, the Grasslands and the Prairie Harvest/Wild Prairie and my boy loves all three flavours. :) His skin and coat are gorgeous, his eyes are bright and clear, he is full of energy and we've had no digestive issues at all.

I'm no expert but in my opinion, the Acana Provincial line is a very high quality food and I think it's a really good choice.

Here's the links to the Acana Provincial foods website, where they have a lot of detailed information about the ingredients etc:

Wild Prairie:
http://www.championpetfoods.com/acana/show-product.php?formulation=phfd

pdf file with more details re Wild Prairie (full ingredient list etc):
http://www.championpetfoods.com/acana/fetch-pdf.php?pdf=ACANA-phfd.pdf

Pacifica:
http://www.championpetfoods.com/acana/show-product.php?formulation=pfd

pdf file re Pacifica with more details (full ingredient list etc):
http://www.championpetfoods.com/acana/fetch-pdf.php?pdf=ACANA-pfd.pdf

Grasslands:
http://www.championpetfoods.com/acana/show-product.php?formulation=gfd

pdf file re Grasslands with more details (full ingredient list etc):
http://www.championpetfoods.com/acana/fetch-pdf.php?pdf=ACANA-gfd.pdf

[Rebelsmom]

I'm glad i made the switch after reading the ingrediants in the old food compared to the new on!! Oh wow what a difference. Now my only problem with it.... My utility room smells like fish!! Lol I'm gonna have to go buy a bin to store the food in to control the smell.

[acushdogsmom]

To store the food, I use a bin that has a really good seal. (I am not a fan of fishy smells either ;))

If you really have a problem with the smell of the fish food (Pacifica) you could always try one or both of the other two flavours - Wild Prairie, which is the chicken formula, or Grasslands which is their lamb formula - both of which also contain some fish but don't smell fishy like the Pacifica does. :)

[Rebelsmom]

I'm gonna go get a bin. I got the fish one because Sdaie has some skin issues and I'm hoping this will help her out. The owner of the store also set me up on that buy 12 bags get one free deal. He is keeping the card for me and will fill it in each time I buy a bag.

Melissa

[Rebelsmom]

Got Rebel stim results back today. His pre was 3.1 and the post was 3.2. So all is good with that. She wants me to stop stressing out. Lol. She wants to scan his liver again and check on a small white spot she saw the last time and re-do his blood work again. She thinks he is doing very well and considering where he was before the trilo then he really is. He does hold his bladder all day again. So maybe I should stop worrying so much. Maybe the new food will help his appetite.

I can't take him for the scan and blood work until my next pay period in a couple weeks. I'll keep everyone updated on him. He really is a happier dog lately, now if mom could just be happy. Lol

Melissa, Rebel, & Sadie

[Rebelsmom]

Both my pups seem to be liking the new food so far. I have noticed Rebel eating a little slower lately so maybe he just needed so more time to start realizing he wasn't as hungry as he thought. lol

He is scheduled to go in for more blood work and a rescan on his liver on June 2nd. Just want to make sure nothing else is going on. Since his cortisol levels are good now I'm hoping we can relax for a bit. That would be nice.

Hope everyone is well.

Lots of love from Melissa, Rebel & Sadie

[Squirt's Mom]

Hi Melissa,

Glad your pups seem to be doing well on the Acana. It is really one of the very best commercial dog feeds on the market today...GREAT choice!

Hugs,
Leslie and the girls - always

[Rebelsmom]

So tonight I found one of Rebels veteroyl pills stuck to the side of the dog food bag!! So apparently he played me one morning(I think this morning). I guess he spit it out when I wasn't looking. Guess it won't hurt him right?

[lulusmom]

Luckily, there's no harm, no foul if Rebel misses a dose. Just make sure he doesn't fool you twice cuz you know what they say about that. :D

[littleone1]

Hi Melissa,

I was also worried when Corky did the same thing a few months ago, but I didn't need to worry, as long as it was just the one time. When he had to have 3 teeth removed and 2 masses in his mouth removed, he didnt get his Trilo, and he was fine.

Terri

[Rebelsmom]

Yeah I know if he fools me twice shame on me. He's such a sneaky dog. Lol. I didn't think it would be too big a deal to miss just one. The good news is that's the pill is still completely intact so he didn't cost me $8 for the pill. Lol

What did you think of his last stim results?

Melissa

[acushdogsmom]

Got Rebel stim results back today. His pre was 3.1 and the post was 3.2.




What did you think of his last stim results?

MelissaI never used trilostane (my dog was on Lysodren) but those stim test results sound pretty good to me! :) There's not much difference between the pre and the post numbers (usually the pre is a little lower than the post number) but the pre number can vary depending on how stressed or relaxed a dog is when you do the blood draw, so if Rebel had been more relaxed for the first blood draw, the number would likely have been lower and there would have been a bit more difference between the pre and post numbers. The numbers are not too low and not too high, so I definitely think I'd be happy with those results.

[littleone1]

I really can't give you an honest answer on Rebel's test results, as Corky's pre has always been much lower than his posts. I'm still learning more since Corky has only been on Trilo 7 months.

I can't believe you're paying that much for 1 pill. When Corky's dosage had to be increased, his IMS was increasing it to 30 mg a day, but since I still had a 2 months supply of 20mg, I asked her if it would be okay to give him 31mg a day. That way, I would be able to get it compounded for alot less. I'm paying less than $1 a day.

[Rebelsmom]

I really can't give you an honest answer on Rebel's test results, as Corky's pre has always been much lower than his posts. I'm still learning more since Corky has only been on Trilo 7 months.

I can't believe you're paying that much for 1 pill. When Corky's dosage had to be increased, his IMS was increasing it to 30 mg a day, but since I still had a 2 months supply of 20mg, I asked her if it would be okay to give him 31mg a day. That way, I would be able to get it compounded for alot less. I'm paying less than less than $1 a day.

Rebel is on the 60mg a day and the lowest I have found it was $70 for a 30 day supply just recently. So my daily price is down to $2.333333333. lol

I made sure he had it all gone this morning. No more fooling me.

Melissa

[lulusmom]

Hi Melissa,

I agree with Cushy about Rebel's stim. I would consider those numbers great as long as Rebel's symptoms are improving or resolved completely. How is he doing physically?

[Rebelsmom]

Hi Melissa,

I agree with Cushy about Rebel's stim. I would consider those numbers great as long as Rebel's symptoms are improving or resolved completely. How is he doing physically?

Physically he is doing well. It is extremely hot right now so he is drinking more but so is my other pup. He is able to hold it all day and he hasn't had an accident in the house in over a month. He has lost a pound so far and 1/2" off his belly. He is starting to eat a little slower also. His hair is still taking awhile to grow back on his belly where they shaved him, but he will be having another u/s in a little over a week so I guess that's ok. keeping my fingers crossed that we have crossed a hurdle and things can be normal for awhile.

Melissa, Rebel & Sadie

[littleone1]

Hi Melissa,

I'm glad you were able to get a much lower price. I hope Rebel is doing well.

[mypuppy]

Hi Melissa,
You're still ahead of me with the trilo. I pay $100 for 30 pills. OUCH! :( :(. Warm regards. XO Jeanette


Rebel is on the 60mg a day and the lowest I have found it was $70 for a 30 day supply just recently. So my daily price is down to $2.333333333. lol

I made sure he had it all gone this morning. No more fooling me.

Melissa

[Rebelsmom]

Hi Melissa,
You're still ahead of me with the trilo. I pay $100 for 30 pills. OUCH! :( :(. Warm regards. XO Jeanette

Jeanette, this is where I get mine. http://www.valleyvet.com/ct_detail.html?pgguid=057ae20c-efea-490b-b89e-562663425dfe

They have free shipping.

Melissa

[Rebelsmom]

I didn't want to hijack Brenna's thread so I thought I would post this here. You guys were talking about rabies vaccines. Does no one believe in them here? My dogs have always been up to date on there shots and maybe I'm to quick to believe the vets about them but rabies scares me. We have a running problem in my area with raccoons and rabies. I guess my question is when is it time to consider not giving the vaccine? Is it really that harmful? I have never heard of a dog having problems with it. Just curious is all.

Melissa

[Nathalie]

Hi Melissa,

I can’t speak for others but when I talk about the dangers of vaccines on this board I am talking about re-vaccination of mature or senior dogs that are not healthy due to various health issues eg. Cushings, Hypothyroidism, Pancreatitis to only name a view and vaccination of mature/senior dogs that previously received vaccines.
Dogs that are not healthy = immune system compromised should not longer receive vaccinations.

This article might be a good starting point for you http://www.canine-epilepsy-guardian-angels.com/ImmuneSystem.htm (http://www.canine-epilepsy-guardian-angels.com/ImmuneSystem.htm)

”As rabies vaccines are known to elicit severe and even fatal adverse reactions, and are among the strongest vaccines antigenically and contain potent adjuvants to bolster their immunologic effect, giving them more often than truly needed is unwise, unnecessary, and can be unsafe,“ -Dr. Dodds

You can find some excellent links here http://designerbostons.homestead.com/misc.html#anchor_13036 (http://designerbostons.homestead.com/misc.html#anchor_13036)

Vaccinating Unhealthy Pets: Beware Reactions & Vaccine Failure (http://www.dogs4dogs.com/blog/2009/04/29/vaccinating-sick-dogs-cats/)

Re-Vaccination: Vaccination for Previously Vaccinated Dogs and Older Puppies (http://www.caberfeidh.com/Revax.htm)

http://naturalrearing.com/coda/a_rabies_the_big_scam.html (http://naturalrearing.com/coda/a_rabies_the_big_scam.html)

Science of Vaccine Damage (http://naturalrearing.com/coda/a_science_of_vaccine_damage.html)

The best advise I can give you is to educate yourself so you can make informed decisions and then do what feels right for you and your dog in your situation.

For myself and my animals that means no more vaccinations. I have 2 vaccine damaged dogs and I have seen many adverse reactions. :(

Nathalie

[littleone1]

Hi Melissa,

Nathalie gave you some good advice and links concerning vaccine boosters. It is a very good idea for you to educate yourself in this area.

Corky is no longer going to get anymore due to his age and various medical conditions. His IMS is totally in favor of this.

Terri

[Escondido]

Hi Melissa,
My Bailey was on Trilostane for 5 years and did wonderfully with it until we had to put him down last Friday. I know how expensive it can be to buy. We used to buy 60 mg Veteroyl for him back when it couldn't be purchased in the US and had to be imported from England. When the FDA relaxed the rules, pharmacies were allowed to compound it...but because they compound it they can't make it for exactly 60 mg (must be FDA rules?). Instead they make it for 61 mg. So for the past year we have been buying it from Diamondback Drugs in Scottsdale Arizona. We were purchasing 61 mg. capsules for $1.20 each...60 pills costs $72 and free shipping (we live in California). It usually arrived 2 days after I phoned in the prescription. Their address is 7901 E. McDowell Road, Scottsdale, AZ 85257. Toll free phone is 866-646-2223. -Joyce

[Rebelsmom]

Hi Melissa,
My Bailey was on Trilostane for 5 years and did wonderfully with it until we had to put him down last Friday. I know how expensive it can be to buy. We used to buy 60 mg Veteroyl for him back when it couldn't be purchased in the US and had to be imported from England. When the FDA relaxed the rules, pharmacies were allowed to compound it...but because they compound it they can't make it for exactly 60 mg (must be FDA rules?). Instead they make it for 61 mg. So for the past year we have been buying it from Diamondback Drugs in Scottsdale Arizona. We were purchasing 61 mg. capsules for $1.20 each...60 pills costs $72 and free shipping (we live in California). It usually arrived 2 days after I phoned in the prescription. Their address is 7901 E. McDowell Road, Scottsdale, AZ 85257. Toll free phone is 866-646-2223. -Joyce

Thanks Joyce for the information. I will look them up when it's time to order again.

Regarding the vaccinations info. I will discuss it with my vet when the time comes for Rebel. It's a lot of information to take on.

Melissa

[mypuppy]

I recently found out myself through Corky's mom the risks in vaccinating an unhealthy dog and that I could waive these vaccines in the future for Princess. Nathalie I read one of your links on this issue and I was appalled to find what these vaccines can cause in our pets. Unfortunately, I found this out a bit too late since Princess was due for her rabies vaccine back in January '10 and I did have her vaccinated. You'd think my dumb ass IMS would even mention the fact it was risky to vaccinate Princess since she is cushonoid. Apparently, in my case, that would be expecting too much of this dr. Considering her track record since the beginning of Princess's treatment. And again we pay these doctors TOP $ for them not follow complete protocols and to withhold important facts from us. I think I am even more appalled by some of these doctors more than anything really. Sorry for the venting session here everyone but it really is stomach turning for me. BTW, considering Princess was vaccinated back in Jan. And fortunately she did not get any side effect from that vaccine, should I assume she's out of the woodwork with that and I shouldn't fear any adverse reactions at this point? Just wanting to make sure here. And at Princess's next exam I will most definitely ask my vet for a waiver letter to give our State when licenses are up for renewal. Thanks again everyone. Luv , still learning, Jeanette. (LOL). Xo

[Rebelsmom]

Rebel was vaccinated back in Aug of 09 at the time he wasn't showing any signs of problems so I didn't think anything about it. I will talk to the new vet when the time comes and see what she has to say.

My biggest questions is what if he doesn't get the shot and comes into another animal with rabies? If he gets it is that a death sentence? Can it be treated?

Melissa

[mypuppy]

Yeah I hear ya loud and clear on that one Melissa. I too wonder about that myself since I do live in "bear" country out here and I have seen a lot of wildlife since I've been living up here, bears, fox, coyote, snakes, racoons, possum, what next? heard we have mountain lions also...Yikes! let us know what your vet's take on this issue. I mean, I know there's a reason for these vaccines as well. I know there is a lot of controversy, even with childhood vaccines, but I choose to vaccinate my human kids. I think the benefit outweighs the risk of one of these terrible diseases. But anyway, do let us know if you get more info. Thanks. xo Jeanette

[acushdogsmom]

For what it's worth, I vaccinated my cushdog against rabies once every three years, which is the requirement by law where I live. As far as I know, the local authorities here do not accept any waivers or titer test results as proof for exception for rabies vaccination. I don't think they throw you in jail if you don't vaccinate your dog, but my guess is that if an unvaccinated dog ever bit someone, you might have a big problem on your hands.

As for diagnosis and treatment of rabies in dogs, there is lots of information on the Web about it - here's one that I found via a google search:

http://www.peteducation.com/article_print.cfm?c=2+1556&aid=347


Diagnosis:
The current way to diagnose rabies in animals is to submit the brain for microscopic examination. Some new testing techniques utilizing skin and or blood samples are being studied and used in a few research settings and show promise as a way of testing potentially exposed humans and animals. They are not routinely being used at this time.

Treatment:
There is no treatment. Once the disease develops in humans, death is almost certain. Only a handful of people have survived rabies after extremely intensive medical care. There have been several reported cases of dogs surviving the infection, but they are very rare.

As far as other vaccines are concerned, we vaccinated every three years for a number of years after the completion of the "puppy series" and then my Vet and my husband and I made the decision together about each of the various vaccines on an individual basis -- meaning that we did vaccinate for some dangerous diseases which were prevalent in our area, but not for all of the same diseases that we had routinely vaccinated against for most of his life. So in addition to what the law happens to be where you live, I think that you really have to think about benefits vs risks for your particular dog and then make an informed decision along with your vet.

[Nathalie]

That’s why it is so important to start doing your own research now so you can come to an informed conclusion and don’t have to make decisions based on fear.
This, IMO is not any different then being on top of your dogs cushings treatment.

This is an excellent presentation http://www.newvaccinationprotocols.com/ (http://www.newvaccinationprotocols.com/)

If the area you live in does not accept waivers or titers, perhaps it is time to change these laws.

Study’s have already shown that the duration of immunity for Rabies well exceeds those 3 years and the Rabies Challenge fund (http://www.rabieschallengefund.org/) will prove it.
Even if your area does not accept titers – you can still do it for your own piece of mind if it makes you feel better.

Vaccines can cause a wide range of ailments of which some can be seen almost immediately/within a short amount of time or illnesses down the road. Ever wondered why every other dog seems to get cancer, has allergies, skin issues etc.

Nathalie

[labblab]

For what it's worth, I vaccinated my cushdog against rabies once every three years, which is the requirement by law where I live...

As far as other vaccines are concerned, we vaccinated every three years for a number of years after the completion of the "puppy series" and then my Vet and my husband and I made the decision together about each of the various vaccines on an individual basis -- meaning that we did vaccinate for some dangerous diseases which were prevalent in our area, but not for all of the same diseases that we had routinely vaccinated against for most of his life. So in addition to what the law happens to be where you live, I think that you really have to think about benefits vs risks for your particular dog and then make an informed decision along with your vet.
Cushy, this approach is personally very reasonable and appealing to me. And it is largely the strategy that we plan to follow with our dogs. In this way, individual circumstances, risks, and benefits can be taken into account when tailoring a vaccine protocol that best fits the needs of our dogs.

It does make sense to me to critically re-evaluate the need for continuing vaccination in a senior dog who has previously received vaccine protection. And it definitely makes sense to suspend vaccinations during any time period when a dog is unwell. But I don't believe that Cushing's, itself, precludes a younger dog from being vaccinated once the Cushing's is well-controlled and the dog's health has been stabilized. From my own reading and conversations with my vet, I would want to re-institute a vaccine protocol with my stable Cushpup that offers protection from dangerous diseases from which my dog is most at risk due to geographics, exposure, and lifestyle.

I think there are many factors that contribute to the development of health problems such as cancer, allergies, etc. in humans and in dogs that have nothing to do with vaccination. I do think that vaccination can carry dangers. But I know that disease does, as well. So I agree with everyone here that education is paramount. I also believe that I have a responsibility to try to weigh the risks and benefits for any specific vaccine. Of course, I will feel terrible if my dog develops a vaccine-related ill effect. But my guilt will be no less if my dog suffers or dies from an illness that could have been easily prevented or minimized by vaccination.

Marianne

[acushdogsmom]

I think there are many factors that contribute to the development of health problems such as cancer, allergies, etc. in humans and in dogs that have nothing to do with vaccination.

I do think that vaccination can carry dangers. But I know that disease does, as well. So I agree with everyone here that education is paramount.

I also believe that I have a responsibility to try to weigh the risks and benefits for any specific vaccine. Of course, I will feel terrible if my dog develops a vaccine-related ill effect. But my guilt will be no less if my dog suffers or dies from an illness that could have been easily prevented or minimized by vaccination.

MarianneRight on, Marianne. I agree with you, 100%.

[Nathalie]

At no point did I blame every illness on vaccines - heck there are also crappy commercial diets ....;)

If anybody considders a cushings dog a healthy dog and believes that immunity can actually be boosted ....

Rabies vaccine does carry risks, but perhaps Dr. Dodds got it all wrong and I don't have any vaccine damaged dogs in my house and thousands of $ in vet bills ....

Anyhow, at the end of today all I can hope for is spark doubt and make a few people question this dangerous practice of over-vaccination our mature/senior and unhealthy pets to satisfy some law.

I feel I have provided a lot of info/food for thought and this will be the last post under this thread reg. this topic from me.

Anybody looking for more resources just email me.:)

Nathalie

[Rebelsmom]

Wow I did not know that the topic would spark such a debate. I had just read some info on someones elses thread and I wanted more info. I appreciate everyones opinion and all the links to information that has been given. I have till august to decide for Rebel. I will speak with my vet get her opinion and see how he is doing physically.

Again thank you to all who shared your information.

Melissa

[Rebelsmom]

I'm just gonna lay it all out right now.. First let me say Rebel seems to be doing well.. It's myself I'm concerned about. Since he started showing signs of illness I have done nothing but fret and worry and drive myself insane. I constantly watch him for any thing out of the ordinary, or for anything really. I have become obsessed with every twitch, pant, look or even breath he takes. I mean the dog can't even dream while he's sleeping without me wondering if he's actually dreaming or having a seizure!! I lay awake at night thinking what I would do if I lost him and wondering how I'm going to pay for the next vet visit. I was not prepared for something to happen yet. I know that one day he will cross over but I thought I would have years before I had to think about that. He is not even 8 years old yet!! What I hear the trilo will give me maybe 5 years if I'm lucky!! I log into this forum, don't get me wrong I love all you guys, and I see everyday almost another pup had passed. It's depressing and heart-wrenching and it's terrifying.

I'm so depressed that it takes effort to get outta bed. I can't control my anger nor my tears. Rebel is that man for me that has loved me unconditional and has never left me. I don't know if I'm strong enough to get him through it.

I just needed to let all that out. I know many of you have felt the same way at some point. I don't know if this is all because it's still new for me or what, but for my boy I will continue to on.

Love you all,

Melissa, Rebel, & Sadie

[StarDeb55]

Melissa, there is absolutely no reason for Rebel not to live his normal lifespan as long as his Cushing's is well-controlled. My 1st Cushpup, Barkley, was treated with lysodren for nearly 8 years, crossing the bridge at 15 from medical causes unrelated to his Cushing's.

Believe me, most of us do understand your fear, frustration, & worry. As you gain knowledge & confidence, that Rebel is , indeed, doing well, I feel certain that you will begin to overcome a lot of this upset.

Debbie

[frijole]

Melissa, I totally get what you are saying. I just lost a dog to cushings and am trying to load another and I too am stressed to the point of worrying myself. Couple of thoughts:

First of all - I send a big hug your way. It is normal to protect our babes. Next, you are right - we just lost a ton of cush babes in the last few weeks. It has devastated the group and is probably the worst month ever for losses.

But please know that most of these dogs aren't dying because of the cushings. Cush dogs tend to be older when they are diagnosed so they fail over time. My girl Haley was 16 and 5 months young. Her body just petered out. It hurts like hell but I know I did all I could. Same thing for the others we lost. Phoebe was 18!

I just came back from taking Annie out on a long walk. I had the same thoughts as you regarding stress. I need to change the focus from fighting to get her well to surrounding her with love and fun so she can get well. I dont know if this will help you or not but that is the decision I made just an hour ago.

Also for your own sanity - it's ok not to read threads where dogs have passed. Remember that the people who come here tend to be those having problems with their cush dogs. Those that aren't just give the drugs and don't go online for help. So by no means are we representative of dogs getting treated.

But we are compassionate and very experienced. And we will help you as best as we can even tho we are not vets. So please hang in there and go give Rebel a big hug. Know that what you are feeling is normal. Its OK to stress out but don't let it consume you. Thats where I was this morning and somehow I too have to fight that.

And on that note I am taking Annie to the nursery with me and picking out some hydrangeas to plant. Big hugs and warm thoughts being sent your way. Kim

[Rebelsmom]

Thanks, Debbie and Kim. I tend to read the posts about dogs passing because I want to know why and then I go home and just stare and Rebel. Wondering is he showing this or that symptom?? Driving myself nuts is what I'm doing and he is probably wondering why I'm staring at him like a nut. I just found a bruise on his leg where he has lost some hair this weekend. That sent me on a whole new ride. I know as time goes on I will be able to deal with it better for his sake I hope. I'm so glad I found this amazing group of people.

Melissa

P.S. Happy Memorial Day to all of you. I have to work today unfortunately. Only way I get paid and I got a vet appt coming up. Hope everyone has a great day.

[BestBuddy]

Melissa,

When I first started my cushings journey with Buddy many years ago I didn't want to read about the dogs that had passed away, sort of like sticking my head in the sand. I soon realised that it happened whether I read them or not. I also wanted to support those that had been there for me so I started reading them.

When we have a loved dog with a chronic disease it is pretty normal to obsess about anything concerning them. A lot of things that would not have made me bat an eye in a healthy dog would tip me over the edge with my sick babies and running to the computer for advise and googling what I thought it was.

I must say that although it is really good to be informed and know different possibilities that 99% of the time I was hearing zebras when it was only horses. Meaning that it was nothing to worry about and I should have looked for the simple cause rather than the exotic disease that they now might have.

You really are normal.:D It is important to try to relax a bit and like Kim said give Rebel love and a relaxed time so that he feels good. Happy patients always improve quicker.

Jenny

[acushdogsmom]

Melissa,

I know how sad it can be to read about when one or more of "our" pups passes on, but you have to try to concentrate on the positives in Rebel's own situation.

Rebel is doing well on the trilostane treatment so far, he's already had noticeable improvements, and he has had very good recent ACTH stim test scores, so there's every reason to think and to believe that he will live out a normal lifespan for his breed with an excellent quality of life. Just like my dog did on Lysodren for more than 6 years after he was diagnosed. (He was diagnosed at the age of 10 and he passed away due to a completely unrelated sudden onset condition at the age of 16 and a half)

So please believe me, I've been through it, and the hardest part is getting the diagnosis pinned down, accepting that your dog actually does have Cushing's and then getting the treatment underway and the dog stabilized on that treatment.

It takes some getting used to, but eventually your life and Rebel's should get back to pretty much the way it was before the diagnosis, except that you have to continue to give the medication and test periodically to be sure the dose remains correct. By properly treating and controlling the cortisol production, you are preventing the organ damage that happens in an untreated Cushing's dog from all that overproduction of cortisol, and although they can't live forever, a properly treated Cushing's dog is likely going to die as a "senior citizen", of something completely unrelated to the Cushing's.

My dog's Internist, who sees a lot of different diseases and conditions in cats and dogs every day, once told me that if she had to choose a condition for her own dog to have, it would be Cushing's. Because it is a very treatable condition and because dogs who are properly treated can live a normal life, in spite of having Cushing's. I'm not saying you should be happy about a Cushing's diagnosis, but try to be happy that Cushing's is treatable! There are so many other diseases and conditions that are not as easily treated, if at all.

Anyway, just want to send you some hugs, and some hugs for Rebel too! He is so cute! :D

[Rebelsmom]

Thank you all for your support and understanding. My emotions have been all over the place and I cry over small things. Just reading your responses brought tears to my eyes. I'm such a baby! Lol. Most people around me just don't get it. They say he's just a dog!!! If they only knew.

[acushdogsmom]

We get it, Melissa. Really, we do. :)

Once you've been around here for a while, I think you'll find that there's much more that we have to celebrate about than to cry about. And if/when you ever do feel like crying or ranting, we're here for you.

(((hugs)))

[littleone1]

Hi Melissa,

I've been there many times. However, the success posts about our cushpups far out-weighs anything else that's happened. It's a very difficult and trying time, but with all of the support we get here, it doesn't seem quite as bad as if we had to go through this alone.

[Rebelsmom]

At vets now. He is back getting his u/s. Will post back soon

[Harley PoMMom]

We will be watching for your update and waiting anxiously with you for the results. Sending positive energy your way, Melissa. ;):)

Love and hugs,
Lori

[Rebelsmom]

All went well with the u/s. Liver was good. One adrenal is still larger than normal but that's to be expected. She drew blood and we should have results back on Monday. I asked her a lot of questions. I'll post up tm bout a few things we talked about. I have to say I love my vet she is great. He did have 3 really small stones in his bladder but she thinks he will pass those and we will never know. She just told me if anything changes with his pee!!

I do feel a little better than I did a couple days ago. The u/s had me scared for some reason.

Melissa

[frijole]

Melissa, Big hugs. Kim

[Casey's Mom]

Melissa you are doing just fine. We have all been at the stage where you are now and trust me it does get better.

Love and hugs,

[Rebelsmom]

Thanks Ellen. I feel I'm doing the best I can at the moment. My vet also thought I was doing great with him also. That made me feel so much better. He did gain 1.8lbs though!! I'm trying to get him to lose weight. I have no idea where that came from unless he is sneaking food somewhere! She was not concerned with the gain though, she said that she would be more concerned if he was dropping too much weight. Right now we are just waiting on the blood work to make sure nothing else is going on there. After she gets that back she is going to call and talk to an endocrinologist about his eating still being so ravenous even though his numbers are good.

Does anyone have any idea how a pup that weighs less than 40lbs can put on almost 2lbs in 3 weeks? He is on the Acana food and I'm giving him less than he ever ate of the other food.

She also told me his stomach was full of gas which I believe cause that dog can clear a room!! So he now gets a half a tablet of beano with each meal! Go figure. Maybe that is why his belly still looks a little bloated.

On a quick note I did talk to her about vaccines. I know this is a controversial subject. But I wanted to let everyone know that there is a test that can be run on our pups that lets you know how much of the antibodies they have in there system to fight off a disease if they get it. I don't remember the name of it (I'll ask when she calls again on Monday) but it's not real expensive according to my vet.

That's really all I have for now.

Melissa

[Rebelsmom]

There was one question I forgot to ask while I was at his appt. Can someone tell me the difference between PDH Cushings and A-typical Cushings?

Melissa

[StarDeb55]

PDH is when the cortisol is the only hormone that is elevated. Atypical is when one or more of the associated hormones is elevated, with or without a concurrent elevation in cortisol. I'm not sure, but I believe the term Atypical is sort of falling out of favor, I believe the term that is preferred is PDH or ADH with elevated associated hormones.

Debbie

[Harley PoMMom]

Atypical Cushing's involves only the hormones Estradiol, Androstenedione, 17-Hydroxyprogesterone, Progesterone and Aldosterone. A pup with Atypical will not have elevated cortisol.

PDH is an abbreviation for Pituitary Dependent Hyperadrenocorticism, which means a pup has a tumor of the pituitary gland. The tumor usually grows very slowly. The tumor causes the pituitary to overproduce a hormone that, in turn, stimulates the adrenal glands. Excessive cortisone secretion results.

Hope this helps.

Love and hugs,
Lori

[Rebelsmom]

Ok thanks. I was just wondering if Rebel could have atypical instead of pdh. But I'm thinking not.

Melissa

[Harley PoMMom]

Don't want to confuse you more but a pup can have PDH with elevated hormones, and ADH with elevated hormones. :eek::)

Love and hugs,
Lori

[Rebelsmom]

Well he had elevated cortisol. So that wouldn't be atypical right?

[zoesmom]

Oh, here comes more confusion. Trilostane, it seems, can mess with some of those secondary adrenal hormones. Which is basically the same thing as a dog who has atypical cushings (or whatever they are calling it nowadays.) We've had just a handful of members whose pups had symptoms that did not fully resolve while on trilostane, and but think that was thirst rather than hunger?? But I could be wrong though. Maybe the ongoing hunger is a sign that Rebel's secondary hormones are getting screwed up because of the trilo. How long has he been on the trilo, again? Somebody help me out here. It's been awhile since we've had this discussion in any depth. Sue

PS = Have his thyroid levels been checked?

[Rebelsmom]

Oh, here comes more confusion. Trilostane, in a few dogs, can mess with some of those secondary adrenal hormones. Which is basically the same thing as a dog who has atypical cushings (or whatever they are calling it nowadays.) We've had just a handful of members whose pups had that effect from trilostane, and I think that those same dogs will usually continue to have some degree of cush symptoms - but mostly thirst rather than hunger?? But I could be wrong though. Maybe the ongoing hunger is a sign that Rebel's secondary hormones are getting screwed up because of the trilo. How long has he been on the trilo, again? Somebody help me out here. It's been awhile since we've had this discussion in any depth. Sue

PS = Have his thyroid levels been checked?

Wow yup I'm confused. He has had his thryroid checked and his free t4 was right in the normal range. I do have some news tonight for the first time tonight when he ate he paused a few times while eating. He also didn't scarf it down like he usually does. He still drinks more than my other dog but it's over 95 here everyday.

Maybe if his bloodwork is all normal I'll bring up the atypical to her when she calls. She what she thinks.

[Harley PoMMom]

If Rebel's sypmtoms seem to increase at night then I would ask your vet about doing an UC:CR test. Glynda and Marianne had posted to another member about this test.


Jeanette, the UC:CR stands for urine cortisol creatinine ratio and it is a urine test, not blood chemistry. I don't think you need a blood chemistry panel done at this point. If Princess is still symptomatic at the end of the month, I'd definitely want to determine if she needs twice daily dosing before I set off on a mission to find another cause before ruling out the most obvious ones. If you can't handle Princess' symptoms and dread waiting til the end of the month, you can arrange to have a UC:CR done any time.

P.S. I've copied and pasted an excerpt from an October, 2007 article in DVM Magazine that discusses UC Davis' Trilostane treatment protocol. This excerpt addresses the UC:CR. The entire article can be found at http://veterinarynews.dvm360.com/dvm/article/articleDetail.jsp?id=460965&sk=&date=&pageID=3


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

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

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

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






Hi Jeanette,

Gosh, I am sorry that Princess is still showing symptoms. I agree with everybody else that the post-ACTH result of 5.1 is "good," on the face of it. But as Glynda has suggested, it may turn out that Princess is one of the dogs who would do better with twice daily dosing. The fact that she doesn't seem to be controlled at any time of the day does make me scratch my head a bit, though. I would feel more optimistic about that solving the problem if Princess' symptoms did seem to be controlled during the first part of the day, with recurrence later on. But as Glynda says, the UC:CR is a simple urine test to perform (once you catch the urine sample, that is :rolleyes:). And the results may shed some light.

One cautionary note, though. During a conversation here with one of our members, Dr. David Bruyette, he made the point that a single day's urine collection may not give very accurate results. As an alternative, he suggests collecting the urine on three successive mornings and pooling it together prior to testing. If you take a look at this set of back-and-forth questions on his thread, you'll see what I'm referring to. There is a reference to actually performing an ACTH test at the 24-hour mark, right before the next day's dosing, in order to find out how high a dog's cortisol has risen over the course of a day. That would be the most accurate gauge, but not many people have that done. So the UC:CR is the simpler, less expensive alternative. Here's the conversation with Dr. Bruyette:

http://www.k9cushings.com/forum/showthread.php?t=543&post#2

Bear in mind that if you DO switch to twice daily dosing, you are not doubling her total daily dose -- you are instead splitting it in half, or increasing it just a little bit before halving it...

Marianne

Now, IMO, if you have tried all of this and Rebel's symptoms are still not controlled but his cortisol is within the required range, then I would look into the UTK panel but for true results from the UTK panel Rebel would have to go off the Vetoryl for a few weeks. So this is a very tough decision to make. You see, Vetoryl/Trilostane always increases 17-hydroxyprogesterone and frequently increases estradiol and androstenedione as well. If a pup is not off the Vetoryl/Trilostane when tested then the Lab can't distinguish if the pup's elevation in hormones is due to just the Vetoryl/Trilostane.

Love and hugs,
Lori

[mypuppy]

Hi Melissa,
Wow, I am just as confused as you here since we are both having the very same issues with our pups. I knew that pups with atypical cushings had the issues with the other elevated hormones but I didn't know that a pup with pdh, as ours, the trilo can also affect those other hormones. This is just so insane. I mean at what point do we stop all this constant testing and figure out the problem and stick to a normal treatment schedule. Well, I certainly hope you figure out soon what your next step is with Rebel so you can relax a bit. Wishing you both the best. Xo Jeanette

[zoesmom]

. . . if you have tried all of this and Rebel's symptoms are still not controlled but his cortisol is within the required range, then I would look into the UTK panel but for true results from the UTK panel Rebel would have to go off the Vetoryl for a few weeks. So this is a very tough decision to make. You see, Vetoryl/Trilostane always increases 17-hydroxyprogesterone and frequently increases estradiol and androstenedione as well. If a pup is not off the Vetoryl/Trilostane when tested then the Lab can't distinguish if the pup's elevation in hormones is due to just the Vetoryl/Trilostane.

Love and hugs,
Lori

OK, so this is what's always confused me too, even tho' I corresponded with Dr. O about it (because tho' it did improve, Zoe's PD/PU didn't totally resolve on trilo**). If a dog is on trilo bid & his cortisol is under control but he's still showing some symptoms, then UTK does recommend stopping the trilo 30 days before getting the UTK panel - for the reason Lori mentioned.

But if a PDH dog did NOT have pre-existing atypical, then stopping the trilo and getting the panel done should show that all those secondary hormones are normal, right? So then you put him back on trilo, presumably, and then the trilo again messes up the secondary hormones enough to cause ongoing symptoms, even with controlled cortisol. But that would be strictly an assumption. Because really . . . HOW would you know that for sure unless you also tested those other hormones when the dog is ON the trilo. I read and read the UTK stuff and yet I could not understand that part.

So like you Jeannette, I finally decided to forget about it. I felt like . . . . enough with the tests already. :rolleyes::rolleyes: That's why it probably make more sense to go for the FULL UTK panel initially, during the diagnostics. Then you will have the answer about both the cortisol AND all the intermediate hormones BEFORE your dog starts on any treatment. But for many of us, our dogs are already on trilo when the subject crops up. Hence, the dilemma.

I did also discuss melatonin with Dr. O. because Zoe was on trilostane and I had then added melatonin (as an addition to her antiseizure medicine.) Knowing that melatonin was also used to treat atypical, I asked if giving her the melatonin with the trilo might have some beneficial effect, if by chance the trilo WAS significantly messing with her other hormones. I will have to go to my other computer to copy his answer so I can post it. Sue

**A couples years later, Zoe was put on the mild antibiotic tylan/tylosin for intestinal issues (small intestinal bacterial overgrowth or SIBO) and much to mine and her vet's surprise, that is the thing which finally brought her PD/PU under complete control. Her drinking dropped from an average of 10-14 c/day to 3 - 7 c. per day, almost at once. So in retrospect, I'm thinking maybe hers was a urinary issue, or an infectious one, all along . . . rather than a hormonal one.

[mypuppy]

Hi Lori,
I do understand the full adrenal panel is a great test to have, however as you pointed out "tough decision" to stop the pup's treatment temporaily and risk a setback with treatment. That would be my biggest fear right now since Princess's cortisol levels are normalized. I wished I would have done the utk prior to starting Princess's treatment. Take care and thanks. tight ones Jeanette


the trilo affects the other hormonesUOTE=Harley lPoMMom;32376]If Rebel's sypmtoms seem to increase at night then I would ask your vet about doing an UC:CR test. Glynda and Marianne had posted to another member about this test.





Now, IMO, if you have tried all of this and Rebel's symptoms are still not controlled but his cortisol is within the required range, then I would look into the UTK panel but for true results from the UTK panel Rebel would have to go off the Vetoryl for a few weeks. So this is a very tough decision to make. You see, Vetoryl/Trilostane always increases 17-hydroxyprogesterone and frequently increases estradiol and androstenedione as well. If a pup is not off the Vetoryl/Trilostane when tested then the Lab can't distinguish if the pup's elevation in hormones is due to just the Vetoryl/Trilostane.

Love and hugs,
Lori[/QUOTE]

[Harley PoMMom]

IMO :eek: I think it would be pretty unusual for a dog that has PDH and not have elevations in one or more of the intermediate hormones. Now whether the elevation/s are the culprit of the dogs unresolved symptoms is where it gets difficult.

I think all possibilities of why the dog's symptoms have not improved should be ruled out before having to take ones pup off the Trilo/Vetoryl to perform the UTK.

If one has exhausted all possibilites of why their pups symptoms have not resolved and the only one left is the UTK panel, well, the treatment then usually switches to Lysodren and if you've already stopped the Trilo/Vetoryl for the UTK panel then you can probably start treating with Lysodren right away.

Love and hugs,
Lori

[zoesmom]

Here's what Dr. O wrote me a couple years ago:

Me: Can a dog have both pdh AND atypical??

Dr. O: A dog can have both pituitary-dependent hyperadrenocorticism and adrenal-dependent H. The atypical refers to hormones other than cortisol being elevated, and this can come from either a PDH or an ADH condition.

Me: I ask this because from the time we got Zoe as a 4 month old street orphan, she has been incontinent (finally controlled with proin) and has had ongoing PD/PU, frequent uti's, and consistently low USG's. But then she also began to have elevated ALP's many years back (and often elev. lipase, too.) I'm wondering if maybe this means she's had one or more of the adrenal hormones off balance her whole life. Could elevated estradiol, for instance, have contributed to her incontinence?

Dr. O: This could be the case. It's unusual for a young dog to have adrenal disease, but if they have defective enzymes in the adrenal pathway from birth (congenital defect), then some of the intermediate steroids in the adrenal pathway could build up, and these could then be converted into estradiol. We do see dogs with incontinence that have high estradiol levels. This is unusual in that estrogens are often used to treat urinary incontinence (e.g., diethylstilbestrol or DES).

Me: If it's that or merely a matter of the trilostane now throwing off some of these other hormones, then would it make sense to have the adrenal panel done there at UT??? And if so, should it be done while she's on her normal trilostane dose? Also, if this were only connected to the trilostane usage and we switched to lysodren (something which I've been considering lately), I assume the effect on the intermediate hormones be reversible?

Dr. O: Trilostane does increase the intermediate steroids (see item #8 of our Treatment Option sheet attached). I think that UT is the only place that you can get the full adrenal panel run. Lysodren does lower all of the adrenal steroids in our adrenal panel with the possible exception of estradiol (see item #4 of our TO sheet). And to monitor Lysodren's effect, you only need to monitor the cortisol. When Lysodren lowers cortisol to 3 to 5 ug/dL (30 to 50 ng/ml), then theother steroids will be within normal limits (again, possibly not with estradiol). If the adrenal panel is done while the dog is on trilostane, the effects noted in item 8 of our TO sheet will be present.)

Me: Zoe - diagnosed cushings at age 9 & did fine for the first six months on an average trilostane dose for her size. But as I mentioned, we've had a hard time controlling her cortisol for the last 15 mos. in spite of the ever-increasing doses she's getting. I thought maybe she has a slowly growing macrotumor, but now I really wonder if perhaps it's connected to estradiol or one of the other hormones. Have ruled out doing an mri because of cost and the fact I wouldn't pursue radiation, but perhaps the adrenal panel would shed some more light on her resistance to treatment.

Dr. O: I think it would be worthwhile switching to Lysodren, but note that you should give a "wash-out" period before doing so. The trilostane will make Zoe more susceptible to Lysodren's effects, and an addisonian condition would be caused if the switch were made immediately. Probably a month off trilostane is needed. You could go longer if you wanted to be extra safe.

Me: Maybe I'm way off base here, since she has had neuro symptoms (seizures began at age 6 but are now under control on bromide + the melatonin.) Plus, based on what you’ve said, it seems like the melatonin I've been giving for the last 15 mos (because of seizures) should have had at least a minor affect for the positive on the cushings. (she gets 1 mg am, and 3 mg. pm.)

Dr. O: Those are fairly low doses, so it may be that you just needed to give more of the melatonin (or switch to the melatonin implant - item 3 on the TO sheet).

Me: Also, she's never had fur/coat/skin issues to speak of (just a furless belly since an an u/s done last April.) But her life-long urinary symptoms (named above)have always been a big puzzle to me. I would get the adrenal panel if you thought it would help sort out what's going on now? (And which exact test would be best, if warranted?)

Dr. O: I'd suggest going off the trilostane for 4 to 6 weeks, and then do our Adrenal Panel-ACTH Stim - for dogs. Our cost to veterinarians is $135.00, but they will charge you more for doing the test procedure plus paying for shipment to our lab. I hope that helps. Regards, Jack.

In particular, read item 8 on our Treatment Option sheet with regard to trilostane usage. Also, my abstract from the June, 2007 meeting of the ACVIM meeting in Seattle at www.vet.utk.edu/diagnostic/endocrinology

In another e-mail . . .

Dr. O: First, regarding melatonin and trilostane. If anything, melatonin and trilostane together would be more effective in lowering cortisol. They both inhibit different enzymes in the pathway to cortisol formation. I don't know of too many people that have tried using melatonin together with trilostane, so I'm not sure what kind of response that you get with that combination; except that I would expect the two given together to have an additive effect on lowering cortisol levels. Some dogs seem to reach a point where the clinical signs of Cushing's return over time. I think this is due to the build-up of intermediate steroids that always occurs with this drug. You can check out our website, which has considerable information on treatment.

So…..In the end, I increased Zoe’s melatonin (3 mg am & 3 mg pm), and decided not to get the adrenal panel, because of having to stop the trilo for so long to do it.

Links:

http://www.vet.utk.edu/diagnostic/endocrinology/treatment.php

http://www.vet.utk.edu/diagnostic/endocrinology/pdf/TreatmentInfoAtypicalCushings201005.pdf

(The above sheet has been slightly revised from the copy I had and the numbers on the sheeet that Dr. O kept referring to are different. Trilostane is now #7, not #8.)

[zoesmom]

I think all possibilities of why the dog's symptoms have not improved should be ruled out before having to take ones pup off the Trilo/Vetoryl to perform the UTK.


Love and hugs,
Lori

And on Lori's above comment, I totally agree. In the case of PD/PU, you could easily rule out things like diabetes insipidus, DM, hypothyroid and other causes depending on the symptoms first. I just couldn't see stopping Zoe's trilo for so long and having all her symptoms return full force during that time - not to mention the additional trauma and cost of more tests (and the waiting.) That said, I do understand why some of our members strongly lean towards recommending the UTK panel be the test done for diagnosis - if it's done up front before tx begins. Sue

[Rebelsmom]

Ok I have Rebel's blood work back. I haven't spoken with the vet yet, but had them fax me a copy. bare with me as they have a different format and I'm still deciphering.

ALP 286 (20-150) still high but lower than it was

ALT 247 (10-118) again still high but lower

AMY 688 (200-1200) normal What is this?

TBIL 0.3 (0.1-0.6) What is this?

BUN 10 (7-25)

CA 11.6 (8.6-11.8) I think is the calcium

Phos 7.3 (2.9-6.6) little high, cant remember what it was before. Have to go back and look

CRE 1.3 (0.3-1.4)

GLU 106 (60-110)

NA 147(138-160) anyone gotta guess on this one?

K 4.8 (3.7-5.8) again anyone know what that is?

TP 6.8 (5.4-8.2) again??

Glob 2.3 (2.3-5.2)??

WBC 6.9 (6-17)

HCT 42 (37-55)

PLT 318 (200-500)

It says that he has abnormal WBC distribution, slide review advised. Does anyone know what that means.

I'm sure my vet will enlighten me on their abbreviations, but I'm not sure when she will call. She is waiting on a endocrinologist to call her back about some of Rebel's symptoms.

Melissa

[Rebelsmom]

I just wanted to post a quick update on how Rebel is actually doing. He seems to be eating a little slower and is taking breaths betweens bites again. His drinking has subsided some also. Exept last night he woke me up in the middle of the night drinking. I keep a bowl of water in my room in case he needs it. He usually doesn't touch it all night, but last night he drank almost the whole thing. He didn't drink as much after his walk yesterday so I don't know if he was just thirsty or if there is still something going on. He was also restless last night, but was fine this morning. He is playing more, running around and has that light back in his eyes. I'm still waiting to here back from his vet about his bloodwork and to hear what she found out from the endocrinologist.

[Rebelsmom]

Can anyone tell me if starting Rebel on Flaxseed will cause any problems or interfere with the Veteroyl?

[StarDeb55]

Melissa, I'm sorry I did not see your post about Rebel's lab results. If you ever have labs for me to review in the future, please PM, or contact one of the mods or admins to get in touch with me. Anyway, regarding some of your questions:

AMY= amylase
t.bili=total bilirubin
Ca=calcium
Na=sodium
K=potassium
TP=total protein
glob=globulin

Abnormal WBC distribution probably indicates that the analyzer that is used to the complete blood counts on saw some type abnormality in the types or numbers of the specific kinds of white blood cells that are present, so this needs to be confirmed by double checking a peripheral blood smear under the microscope.

Hope this helps.
Debbie

PS- Regarding the flaxseed oil, you are now dealing with hormones that are made in minute quantities, so you really don't want to randomly start giving in meds, even the more homeopathic products that would do something with these hormones without clearing it with you vet first.

[Rebelsmom]

Thanks Debbie. I had figured most of it out. All and all both my vet and I were happy with the results of his blood work.

Regarding the flaxseed she had briefly mentioned it during our conversation this morning. She is still waiting on the endocrinilogist to call her back first.

Melissa

[Rebelsmom]

Has anyone had issues with little cysts growing on your pups head? I had one removed a couple weeks ago, but he has another growing on the side of his head now. I put in a call to his vet, but thought I would see if anyone has had anything similar.

Melissa

[zoesmom]

Zoe was plagued by little growths on her head and face - and a few other places. I don't know if they were actually cysts or not. (My daughter's dog just had a cyst that ruptured on the back of her neck and had to be removed surgically. Had it most of her life and it was much bigger, like the size of a jawbreaker.) Zoe's growths were smaller, black, and kinda waxy looking - about the size of a . . . uh, how about a large peppercorn. None ever got much bigger than that. At first, I'd have them removed, whenever she was having dental or other procedures, but they'd always pop up somewhere else in no time at all. One actually regrew in the exact same spot. So I finally gave up and we lived with them.

[mypuppy]

Hi Melissa,
Princess developed what seemed like a cyst several months ago right under her lower chin. I asked her IMS to please check it and she told me just to rub bacitracin on it. It hasn't grown and not oozing, but I am watching it. Then right before her last stim she developed what looked like another cyst at the side of her one eye. IMS looked at it again and said it was a "phlebaritis", and prescribed neo poly dex antibiotic eyedrops. The darn thing popped after a few days on the eyedrops and although the swelling has gone down I can see it is still there. Will watch that one as well. Never a dull moment. Hope yours is nothing. Take care and warm regards....xo Jeanette

[Rebelsmom]

Thanks for the replies. I don't really think it is anything, but who knows anymore right? Just enjoying having my pup back. I uploaded 3 new pics of my boy if anyone wants to see them.

Melissa

[mypuppy]

I hear ya Melissa, LOUD and CLEAR! Cute pics. I simply love the belly up ones. Soooo adorable. XO Jeanette licks from Princess

[Rebelsmom]

Rebel started twice a day dosing about a week ago. I'm hoping this will help the rest of his symptoms.. If not he has to be tested for A-typical...

Melissa

[labblab]

Hi Melissa,

I've taken the liberty of moving your reply from our "Checking In" thread to your own thread here about Rebel. This way, we can directly exchange thoughts or feedback about how he's doing. :)

Can you please remind us when he was most recently given an ACTH test and what the results were? Also, what trilostane dose was he on prior to your switch to twice daily dosing (and how much are you giving him now?). I've checked back in your thread for several pages, but missed finding the ACTH/dosing info. Thanks so much in advance for refreshing our memories (and it's great to hear from you guys again!).

Marianne

[StarDeb55]

Melissa, as a reminder, since you are considering the UTK panel, trilo will almost always elevate one or more of the intermediate hormones. It may be hard to tell what is a true elevation vs. an elevation caused by the trilo. IMO, to get an accurate UTK panel result, Rebel may have to be taken off trilo for a period of time. I would suggest you e-mail Dr. O to see what he has to say about all of the above.

Debbie

[Rebelsmom]

Melissa, as a reminder, since you are considering the UTK panel, trilo will almost always elevate one or more of the intermediate hormones. It may be hard to tell what is a true elevation vs. an elevation caused by the trilo. IMO, to get an accurate UTK panel result, Rebel may have to be taken off trilo for a period of time. I would suggest you e-mail Dr. O to see what he has to say about all of the above.

Debbie

Thanks, Debbie. I will speak to my vet about it if we go that route. She has been in contact with the endocronologist with Dechra. I think I might seeing some changes with him however since we started the twice a day dosing. Crossing my fingers..

Melissa

[littleone1]

Hi Melissa,

Corky has had two complete adrenal panels done while he was on the Trilostane. Dr. Oliver did e-mail me and also spoke with me about some of the intermediate hormones being elevated because the Trilo. When he wrote comments on Corky's results, he did say that he felt the elevated levels were due to the Trilo.

I'm glad that you might be seeing some results with the twice daily dosing. Corky has been on twice daily dosing for just about 4 months now, and it really has helped him.

Terri

[apollo6]

Dear Melisa
Welcome, my Apollo started Vetoryl, on June 25,2010. Had his first retest ACHT STIM July 6, 2010( cortisone went down a lot)He is doing better, but his new August 4th,ACHT STIM TEST showed his coristone is somewhat higher, but still within range. He also had a full blood panel, which showed elevated numbers are going down(read the ending pages on my thread), also urinalysis.
I started Apollo on a lower dose then what the vet wanted and am glad I did.
He has hind leg weakness is still going on. I was told it can take up to 6 months before see major improvements.
As far as the heartgard goes, ask your vet, our cushing babies immune system is weaker.

[lulusmom]

Hi Melissa,

I had some questions for you but realized that Marianne already asked. You may have missed her post so I have cut and pasted it below.


Hi Melissa,

Can you please remind us when he was most recently given an ACTH test and what the results were? Also, what trilostane dose was he on prior to your switch to twice daily dosing (and how much are you giving him now?). I've checked back in your thread for several pages, but missed finding the ACTH/dosing info. Thanks so much in advance for refreshing our memories (and it's great to hear from you guys again!).

Marianne

Looking forward to receiving this information. Thanks.

Glynda

[Rebelsmom]

Hi Melissa,

I had some questions for you but realized that Marianne already asked. You may have missed her post so I have cut and pasted it below.



Looking forward to receiving this information. Thanks.

Glynda

His last stim test was in May he was at 3.1 and 3.2 pre and post. He was on 60mg just in the mornings, he is now on 60mg now doing twice a day dosing. So same dose just split.

[Rebelsmom]

I am happy to say that I am starting to see some changes since Rebel started twice a day dosing. He is drinking less and even looks up at me a couple times while eating. He urinates in smaller amounts and it's not so diluted. He also has more energy in the evenings and plays more with my other pup Sadie. He really enjoys his walks/sprints in the evening. We are working on getting him to drop a little bit of weight.

[littleone1]

Hi Melissa,

I'm glad that Rebel is showing improvement with the twice daily dosing. Some furbabies definitely do better with this.

[mypuppy]

Hi Melissa,
So glad to hear of Rebels progress. Thinking of both of you. Xo
Jeanette and Princess

[Rebelsmom]

Hi Melissa,
So glad to hear of Rebels progress. Thinking of both of you. Xo
Jeanette and Princess

Been thinking of you and Princess also. I hope all is well. It is such a relief to see Rebel slowly getting better. He has actually started to eat slower and he now pauses and looks around between bites. I was so excited I almost peed myself...lol

Melissa

[mypuppy]

Melissa,
Thanks, Princess is doing pretty good these days aside from dry eye condition which she is finally recovering from. Her next stim is in about a week and curious to know her levels. She is still on the 60mg once a day. I hope it stays that way. Glad Rebel is doing well still and yes the excitement in them getting better makes us wanna tinkle all over. Lol. Warm regards and tight hugs. Xo Jeanette

[Rebelsmom]

Melissa,
Thanks, Princess is doing pretty good these days aside from dry eye condition which she is finally recovering from. Her next stim is in about a week and curious to know her levels. She is still on the 60mg once a day. I hope it stays that way. Glad Rebel is doing well still and yes the excitement in them getting better makes us wanna tinkle all over. Lol. Warm regards and tight hugs. Xo Jeanette

Glad she is doing better. Wishing you luck with the next stim test. We are gonna keep Rebel on the twice a day dosing till early Oct and then stim him and see where he is at. He seems great though! Lately he just wants to stare at me when I give him his food. I have to say go ahead and eat baby. then he takes a few bites stops looks at me wags that nub of a tail, melts my heart then eats more. He is no longer eating like I'm starving him, he takes breaths in between bites. His playfulness is just astounding lately. I have a video but I'm not sure how to post it.

[Rebelsmom]

Here is a link to the video. It's the only way I could figure out how to post it. Let me know if it doesn't work


http://s136.photobucket.com/albums/q165/jittrbugg/?action=view&current=199.mp4

[Franklin'sMum]

Hi Melissa,

The link worked great for me :) The kids sure look like they're enjoying themselves :) I just love it when pups "happy growl" :D
Belly rubs to Rebel and Sadie,
Jane, Franklin and Bailey xxx

[Rebelsmom]

Quick update. rebel is doing great. Here is a new video of tug of war.

http://s136.photobucket.com/albums/q165/jittrbugg/?action=view&current=IMG_0320-1.mp4

Melissa

http://i136.photobucket.com/albums/q165/jittrbugg/th_IMG_0320-1.jpg (http://s136.photobucket.com/albums/q165/jittrbugg/?action=view&current=IMG_0320-1.mp4)

[labblab]

Melissa, I'm so glad that Rebel is doing so well!!!!! :) :) :) :)

We've just changed the security settings on our home computer so right now your video is being blocked for me :( -- but I'm sure it is a wonderful sight!!! ;)

Please keep those updates coming,
Marianne

[Rebelsmom]

Melissa, I'm so glad that Rebel is doing so well!!!!! :) :) :) :)

We've just changed the security settings on our home computer so right now your video is being blocked for me :( -- but I'm sure it is a wonderful sight!!! ;)

Please keep those updates coming,
Marianne

Thanks Marianne. I just can't get over the how much the twice a day dosing has helped him! It's amazing. Everyone that sees him now is blown away with how different he is from just months ago.

Melissa

[labblab]

Rebel is living proof that there is no "cookie cutter" formula that works the same way for every dog ;). Terri's Corky is another pup here who has done a lot better with twice-daily dosing. I'm so glad for both of you that this is a dosing pattern that has worked out better for your babies. And kudos to you both for being such great moms and hanging in there until you found the right solution...!

Marianne

[Rebelsmom]

Rebel is living proof that there is no "cookie cutter" formula that works the same way for every dog ;). Terri's Corky is another pup here who has done a lot better with twice-daily dosing. I'm so glad for both of you that this is a dosing pattern that has worked out better for your babies. And kudos to you both for being such great moms and hanging in there until you found the right solution...!

Marianne

It has been such an up and down battle I never thought we would win. Keeping my fingers crossed that at least for now we have won this battle, I guess the war is never over..

I had a friend in town this past week who saw Rebel about the same time last year and he couldn't get over how much he had changed. That there told me that I am not imagining things!

My boy is a fighter...

Melissa

[mypuppy]

Hi there Melissa,
first off, loved the tug of war video. So awesome to watch them play isn't it. I am so happy your little Rebel is doing so great with the new dosing. it is amazing and so joyful to have them back. BTW, funny you should mention, we had family over the weekend and Princess was going happily crazy over everyone and greeting them with jumps and toys. As your Rebel, they could not believe how excited she was acting and interacting. I love it. So glad we are both in the same happy place together again with them. I hope this feeling never ends. Thinking of you with love. Tight hugs and belly rubs to Rebel and Sadie. Xo Jeanette

[Rebelsmom]

So glad to hear Princess is doing well also. I'm with you on hoping this never ends.

[Rebelsmom]

I have a couple questions to anyone out there that might have exp with a couple things. I was thinking of putting Rebel on Melatonn and I'm not sure what dose to use. He is 40lbs (chunky) and I have 3mg tablets at home. Do I just start with 1 a day? I also have a question about the Veteroyl. I have seen some people post about compounded versions. Is there a difference between Veteroyl and Trilostan?

He has also been losing a lot of hair it seems. His only bald spots are on his elbows on front legs and he is still a little bare where he was shaved for the u/s. I read that some cush dogs will blow there coat?? How long should I expect that to last?

Also how long should it take for his belly to start getting smaller? And how do I get this dog to start losing weight???? If I cut his food anymore he won't have enough to take with his meds!! He also thinks he has outsmarted me. He decided one day that he just didn't like the dry food anymore and started refusing to eat. SInce he has to eat to have his meds I had to give in. He now gets a half tablespoon of can food, I put sprinkle his had capsule of veteroyl over that then add the dry food on top. He eats just fine now. He is rotten!

[jrepac]

Here is what UTK recommends:
" Typically, a total dose of 3 mg is given q12hrs (BID) for dogs <30 lbs; a total dose of 6 mg is given q12hrs (BID) for dogs > 30 lbs."

BID = 2x a day...so in your case, it would be 2 3mg tabs twice a day for Rebel.

Be sure to use regular melatonin, not rapid or extended release...it should be just melatonin (no other herbs/additives in it)

Melatonin is supposed to help w/coat problems.

Vetoryl (brand name)= trilostane (generic name)

as I understand it, you can get trilostane compounded into capsules at the dosage level you need more cheaply than buying the pre-packaged Vetoryl; am sure others can comment on this

as cortisol gets lowered some of your symptoms should improve (related to coat, skin and belly)

in terms of weight control relative to hunger, maybe try adding some veggies to his daily diet (raw or cooked) and cutting back on the regular food...I've done this and found it helpful...(avoid onions, however)...usually the green ones and carrots are OK...

Jeff

[Rebelsmom]

Here is what UTK recommends:
" Typically, a total dose of 3 mg is given q12hrs (BID) for dogs <30 lbs; a total dose of 6 mg is given q12hrs (BID) for dogs > 30 lbs."

BID = 2x a day...so in your case, it would be 2 3mg tabs twice a day for Rebel.

Be sure to use regular melatonin, not rapid or extended release...it should be just melatonin (no other herbs/additives in it)

Melatonin is supposed to help w/coat problems.

Vetoryl (brand name)= trilostane (generic name)

as I understand it, you can get trilostane compounded into capsules at the dosage level you need more cheaply than buying the pre-packaged Vetoryl; am sure others can comment on this

as cortisol gets lowered some of your symptoms should improve (related to coat, skin and belly)

in terms of weight control relative to hunger, maybe try adding some veggies to his daily diet (raw or cooked) and cutting back on the regular food...I've done this and found it helpful...(avoid onions, however)...usually the green ones and carrots are OK...

Jeff

Thanks Jeff. Rebel's cortisol has been normal since April, but he was still having some symptoms. We switched him to twice a day dosing about 2 months ago. This has helped a lot. I know when going to twice a day it says to up the dose by 1/2 or 1/3. I wasn't comfortable upping his dose yet. So we kept him at the same dose I just halved it for morning and night dosage. He has done extremely well with that. He is going in for a STIM test on Oct 7th to see where he is after just half a dose 4 hours later. Does that make sense or did I ramble. All in all he is doing great. The only little things still present are the coat issue (hoping melatonin might help) and his weight and belly. At this point I don't know if his belly is just big because he is fat or if it's still a symptom... My boy used to be lean and trim it's hard seeing him so chunky..

When they say that trilostane is compounded what exactly does that mean? Is he getting the same amount of meds he needs that he would be getting if I bought the prepackaged veteroyl?

Should I start him on maybe just 6mg of melatonin a day just to see if he handles it ok?

[zoesmom]

YIKES - did you say you sprinkle his vetoryl over his food?? That's a big no-no. It should stay contained in the capsule until it hits the stomach and could be causing throat problems if continued.

Yes, trilostane is the generic form of vetoryl. Many of us get the compounded version. So much cheaper than the brand name - which I had to buy for the first couple years of Zoe's tx - from the UK. I had no complaints with the compounded version, once it was available here in the States. Shopped around for price and settled on pethealthpharmacy.com in AZ. You have to send them a hard copy of the rx the first time (or they will call your vet's office), but then you can reorder online after that. Very reasonable and good customer service too. Pills always came within 2 or 3 days. I can get you the prices on their trilostane. Be right back. Sue

[Rebelsmom]

YIKES - did you say you sprinkle his vetoryl over his food?? That's a big no-no. It should stay contained in the capsule until it hits the stomach and could be causing throat problems if continued.

Yes, trilostane is the generic form of vetoryl. Many of us get the compounded version. So much cheaper than the brand name - which I had to buy for the first couple years of Zoe's tx - from the UK. I had no complaints with the compounded version, once it was available here in the States. Shopped around for price and settled on pethealthpharmacy.com in AZ. You have to send them a hard copy of the rx the first time (or they will call your vet's office), but then you can reorder online after that. Very reasonable and good customer service too. Pills always came within 2 or 3 days. I can get you the prices on their trilostane. Be right back. Sue

Sue, I get mine from valley vet for $69.95 usually get to me within 2-3 days also. I just wanted to know if there was a difference and to make sure with the compounded he was getting the correct dosage.

My vet contacted Dechra when rebel was still showing symptoms and they gave me the green light to open the capsules as long as I wore gloves. They said it was more harmful to me than him. If I had to buy 2 boxes of 30mg it would probably break me as the 30 mg tablets cost $53.95 a box, so that would be $108 a month instead of $70. I talk to my vet when he goes in for his stim and get her opinion on the throat concern.

[zoesmom]

These prices were a couple years old, but see my last paragraph, re: their price increases.

120 mg. capsules of trilostane x 30 day supply is $48.90

60 mg capsules x 30 day supply is $32.40.

Didn't get the 30 or 10 mg. prices, but really they will compound it into an exact dosage of anything you need. Like 45 or 75 or whatever.

(Of course, you'd have to double the monthly price if your dog takes twice a day)

The price of 175mg x 30 capsules is $64.02. This last price is approximately the same strength I ordered for Zoe. In Feb 2010, I paid just over $260 for 120 caps compounded at 180 mg./capsule. So comparing that to the 175 mg. price (30 caps x 4), that = $256. Based on that, you can see their prices haven’t increased much at all in the last couple years. (S & H is in the $5 range, regardless of qty ordered.)

Note that these above prices are all for 'compounded' trilostane.

Also used melatonin for Zoe, but mainly as an addition to her anti-seizure medicine. Figured any cushings effect would be just an extra benefit. I only gave her 3 mg. bid. Didn't want a zonked dog (she was 80 lbs, generally).

Also, on some of those symptoms, they can take months to resolve. After Zoe had been on trilostane for a year or two, we did an u/s and they shaved her belly. It was almost a year before her belly fur started to regrow. At the time, her cortisol was at the high end of the acceptable range and maybe even a little too high at times. Then we adjusted dose or something and her cortisol came down to around 5-ish and all of sudden - within a couple weeks time - the fur started growing back like crazy. Then she 'blew' her skin more than her coat. It was like her 'old skin cells' started coming off in a major flurry of dandruff. It was ghastly and not pretty at all on a black dog. That all lasted about six weeks but it seemed to correlate directly to bringing her cortisol down to around 5 rather than where it had been running, between six and ten.

Don't know how Rebel would take to these ideas - Zoe would have no part of it. But our new pup Cooky is a year old and always hungry. She will eat raw carrot slices, apple chunks (peeled), and crushed ice is her favorite (and NO calories!). She thinks that's the best treat ever and when she hears the ice maker start grinding, she comes running. I know some others give frozen green beans and peas. And you can get pure dried chicken breat treats. Those are popular and probably not too fattening, given in limited qty.

Mostly concerned about sprinkling that vetoryl on the food though. Probably not good for you either. They say to wear gloves or wash hands after handling the capsules and to be careful not to inhale the powder. Sue

[zoesmom]

Well, that does surprise me that Dechra said it was ok to do that with the capsules. But if it's directly 'from the horses mouth,' then maybe we've been worrying needlessly around here for years. Wonder if Marianne has any info about that?? She's contacts Dechra alot with questions. Sue

[Rebelsmom]

These prices were a couple years old, but see my last paragraph, re: their price increases.

120 mg. capsules of trilostane x 30 day supply is $48.90

60 mg capsules x 30 day supply is $32.40.

Didn't get the 30 or 10 mg. prices, but really they will compound it into an exact dosage of anything you need. Like 45 or 75 or whatever.

(Of course, you'd have to double the monthly price if your dog takes twice a day)

The price of 175mg x 30 capsules is $64.02. This last price is approximately the same strength I ordered for Zoe. In Feb 2010, I paid just over $260 for 120 caps compounded at 180 mg./capsule. So comparing that to the 175 mg. price (30 caps x 4), that = $256. Based on that, you can see their prices haven’t increased much at all in the last couple years. (S & H is in the $5 range, regardless of qty ordered.)

Note that these above prices are all for 'compounded' trilostane.

Also used melatonin for Zoe, but mainly as an addition to her anti-seizure medicine. Figured any cushings effect would be just an extra benefit. I only gave her 3 mg. bid. Didn't want a zonked dog (she was 80 lbs, generally).

Also, on some of those symptoms, they can take months to resolve. After Zoe had been on trilostane for a year or two, we did an u/s and they shaved her belly. It was almost a year before her belly fur started to regrow. At the time, her cortisol was at the high end of the acceptable range and maybe even a little too high at times. Then we adjusted dose or something and her cortisol came down to around 5-ish and all of sudden - within a couple weeks time - the fur started growing back like crazy. Then she 'blew' her skin more than her coat. It was like her 'old skin cells' started coming off in a major flurry of dandruff. It was ghastly and not pretty at all on a black dog. That all lasted about six weeks but it seemed to correlate directly to bringing her cortisol down to around 5 rather than where it had been running, between six and ten.

Don't know how Rebel would take to these ideas - Zoe would have no part of it. But our new pup Cooky is a year old and always hungry. She will eat raw carrot slices, apple chunks (peeled), and crushed ice is her favorite (and NO calories!). She thinks that's the best treat ever and when she hears the ice maker start grinding, she comes running. I know some others give frozen green beans and peas. And you can get pure dried chicken breat treats. Those are popular and probably not too fattening, given in limited qty.

Mostly concerned about sprinkling that vetoryl on the food though. Probably not good for you either. They say to wear gloves or wash hands after handling the capsules and to be careful not to inhale the powder. Sue

Wow Sue thanks, that is a better price than what I'm currently paying. I just ordered a new box so I will wait and go with them on the next go around. Seems like they might have it split for me also.

Both my pups love ice and they also go running when they hear the ice maker. I might try the veggie idea. I know he will eat broccoli some. Dropped one on the floor one day and he ate it up I think before he knew what it was. lol

[labblab]

Wow! I am really surprised, too, to hear that Dechra says it's OK to open the capsules since their written warning is so explicitly different. :confused: I had always figured that there were dual reasons for not opening the capsules: to limit human exposure to the chemical, and also because the medication would not be metabolized as efficiently by the dog if it didn't enter the stomach intact in capsule form. But no, I've never talked directly to Dechra about this. So there you have it!! (Looks like one more question to add to my checklist for the next time I hound them for info...:o ;)).

Melissa, as far as your question about the difference between compounded and brandname medication, here's a post on our Trilostane FAQs thread that gives you more info in that regard:

http://www.k9cushings.com/forum/showthread.php?p=1254#post1254

I am not advocating for one over the other, but this post will better explain the difference and also some current issues surrounding the sale of compounded meds. Although it can be confusing, "compounded" meds are actually not the same thing as "generic" meds. Compounded meds are prepared and sold by individual pharmacies, whereas generic meds are manufactured by pharmaceutical companies under the same FDA guidelines associated with brandname medications. Some vets are willing to prescribe compounded meds for their patients; others are not. But if you want to take the time to read through this post, you'll have a better basis for understanding the differences.

Marianne

[Rebelsmom]

Sue, thanks so much for the info. I called and they can do either 32 mg capsules (60 pills) for $53.85 or 27mg (60pills) for $50.40. That would save me $20 a month, that's $240 a year!! Since I just bought a new box I will get through that and then speak with my vet on which way 32 or 27 she would go. That may be determined by what his stim numbers are. Thanks for the info.

[Rebelsmom]

Wow Marianne. Now I'm really confused... lol

Is trilostane a compound drug? When I spoke with a rep at the pet health pharmacy she said that what they have is trilostane and the brand name comes in tablets. What I have been ordering says on the box veteroyl (trilostane) and it looks just like what I received from the vet when Rebel first started on it... It is capsules.

Is 32mg or 27mg the compounded meds since it is not what it normally comes in ie 30 or 60mg?

I was also worried about opening the capsules not for my sake but I didn't know how it would affect Rebel since it was going right in so to speak. But he has done so well since we started it that it's hard for me to say it's wrong. Make since? I keep an extremely close eye on him and anything different I catch, but so far so good. I like the idea of not having to split it anymore if I go with the new pharmacy. I just want to make sure my boy gets what he needs.

[lulusmom]

I also have a question about the Veteroyl. I have seen some people post about compounded versions. Is there a difference between Veteroyl and Trilostan?

Vetoryl is the brand name and Trilostane is the active ingredient in Vetoryl. There is no generic brand but as others have mentioned, you can get a compounded version. When my two very little dogs were being treated with Trilostane, I had no choice but to get their Trilostane compounded and we had no problems at all. Because some of their symptoms never resolved with Trilostane, I switched them back to Mitotane, a compounded version of Lysodren (brand name), also with no absolutely no problems.

I've used Diamondback Drugs in Scottsdale, AZ for years for all my dogs' meds. I believe a number of other members use them as well. They have a toll free number and they ship anywhere in the U.S. for a flat fee. I usually receive meds within two days.

[lulusmom]

Is 32mg or 27mg the compounded meds since it is not what it normally comes in ie 30 or 60mg?

Yes, these are compounded doses of Trilostane.

[mypuppy]

hey Melissa,
When Princes had her u/s, it also took her a good 5-6 months for her hair to grow in completely. I hated seeing her shaved belly and was so happy when it grew back, so be patient. As for the blowing of the coat, Princess has gone through that twice already within a year. I completely panicked first time that happened because I had never heard of the "blowing of coat"--that was not your normal twice a year shedding for sure. Ugh. It is utterly ridiculous isn't it? I hope he gets over everything soon, by then Princess will be blowing again--lol. I can't help with the melatonin issue because I have never used it. I know Lori, Harleypompom's mom, has used it and she may be able to help you greatly with any questions--she is wonderful too! Good luck on Rebels next stim on the 7th and let us know how he makes out.
on another note, I caved in and placed the order for Princess's lower dose of Vetoryl. I was stuck between a rock and a hard place with that. I'm not 100 percent happy but for now it's all I've got. I will let you know how it all goes. Belly rubs to the kiddies and talk soon. Xo Jeanette

[Rebelsmom]

This is me banging my head against a wall... lol :confused:

[mypuppy]

Marianne,
What are the dangers/side effects if one comes in contact with the Vetoryl powder inside the capsules? I have little ones in the house and am extremely careful, but one never knows. I guess for myself as well since I don't really used rubber gloves when administering to Princess. yikes. Xo Jeanette



Wow! I am really surprised, too, to hear that Dechra says it's OK to open the capsules since their written warning is so explicitly different. :confused: I had always figured that there were dual reasons for not opening the capsules: to limit human exposure to the chemical, and also because the medication would not be metabolized as efficiently by the dog if it didn't enter the stomach intact in capsule form. But no, I've never talked directly to Dechra about this. So there you have it!! (Looks like one more question to add to my checklist for the next time I hound them for info...:o ;)).

Melissa, as far as your question about the difference between compounded and brandname medication, here's a post on our Trilostane FAQs thread that gives you more info in that regard:

http://www.k9cushings.com/forum/showthread.php?p=1254#post1254

I am not advocating for one over the other, but this post will better explain the difference and also some current issues surrounding the sale of compounded meds. Although it can be confusing, "compounded" meds are actually not the same thing as "generic" meds. Compounded meds are prepared and sold by individual pharmacies, whereas generic meds are manufactured by pharmaceutical companies under the same FDA guidelines associated with brandname medications. Some vets are willing to prescribe compounded meds for their patients; others are not. But if you want to take the time to read through this post, you'll have a better basis for understanding the differences.

Marianne

[labblab]

Marianne,
What are the dangers/side effects if one comes in contact with the Vetoryl powder inside the capsules? I have little ones in the house and am extremely careful, but one never knows. I guess for myself as well since I don't really used rubber gloves when administering to Princess. yikes. Xo Jeanette
Jeanette, here are the warnings that are printed with the U.S. and U.K. Product Data Sheets for Vetoryl. As you'll see, there are a few differences between the two. Here's the U.S. warning:


HUMAN WARNINGS:
Keep out of reach of children. Not for human use. Wash hands after use. Do not empty capsule contents and do not attempt to divide the capsules. Do not handle the capsules if pregnant or if trying to conceive. Trilostane is associated with teratogenic effects [birth defects] and early pregnancy loss in laboratory animals. In the event of accidental ingestion/overdose, seek medical advice immediately and take the labeled container with you.

Here's the U.K. warning:


Operator warnings: Trilostane may decrease testosterone synthesis and has anti-progesterone properties. Women who are pregnant or are trying to become pregnant should avoid handling the capsules. Wash hands with soap and water following accidental exposure and after use. The content of the capsules may cause skin and eye irritation and sensitisation. Do not divide or open capsules: in the event of accidental breakage of the capsules and contact of the granules with the eyes or skin, wash immediately with plenty of water. If irritation persists, seek medical advice. In the event of accidental ingestion, seek medical advice immediately and show the package leaflet or label to the physician. People with known hypersensitivity to trilostane or any of the excipients should avoid contact with the product.

It's due to the U.K. warning about skin irritation that I've thought it possible that sprinkling the contents on food might result in mouth or throat irritation in dogs...

Marianne

[labblab]

Wow Marianne. Now I'm really confused... lol

Is trilostane a compound drug? When I spoke with a rep at the pet health pharmacy she said that what they have is trilostane and the brand name comes in tablets. What I have been ordering says on the box veteroyl (trilostane) and it looks just like what I received from the vet when Rebel first started on it... It is capsules.

Melissa, I'm sorry if I made things even more confusing for you! I think Glynda has already answered several things you were asking about. But just to clarify about the above...

Dechra is the only company in the world that is licensed to produce and market the brandname medication, Vetoryl. And Vetoryl is sold only in the form of capsules. So if a box is labeled with "Vetoryl" or Dechra, it contains the only form of the medication that is currently FDA-approved. As Glynda has said, trilostane is the name of the active chemical ingredient in Vetoryl. If you buy compounded "Trilostane" from an internet pharmacy, it will not be labeled "Vetoryl" and it will be outside of FDA approval. It will contain the same active ingredient as Vetoryl, but the product will have been prepared and packaged by that individual pharmacy and not by Dechra. It may come in any form that the pharmacy chooses: capsule form, chewable tablet, etc.

Due to legal issues, most compounding pharmacies are not marketing their compounded versions of "Trilostane" in the same strengths as brandname Vetoryl. Since Vetoryl is sold in 10 mg., 30 mg., 60 mg. and 120 mg. capsule strengths, you are unlikely to find those exact dosages available in a compounded version of the drug.

Hope this clears up a bit of the confusion that I created...:o

Marianne

[Rebelsmom]

I did a little more research and found pretty much what you said. The pharmacy that Sue said they could do a 27mg or 32 mg for him to take twice a day depending on what my vet wanted to do. I will speak with my vet when he goes in for his stim test early Oct. I will she if she is ok with it or not. I just figured 1. this would save me some money and 2. it would eliminate me from have to open the capsules. Depending on his stim results he might do better with the 32 mg since his dose is being split.

When I do open the capsules it get mixed in with can food and he swallows that whole! So I'm not too worried about it irritating his throat. I'm not sure he even tastes the food.

I wanted to say thank you Scott for recommending the frozen veggies. I tried broccoli last night and both pups loved it. I will pick up some carrots also so they can have variety. lol

[Rebelsmom]

I forgot to add that I started Rebel on the melatonin last night, just one 3mg tablet. Is there anything I should watch for? Would there be any problems if he doens't tolerate it?

[Squirt's Mom]

Hi Melissa,

The melatonin may make Rebel a bit sleepier than normal as he adjusts to it. Squirt has been taking it as part of her Atypical treatment for over 2 yrs now. It has made her hair much thicker and her nails grow long very fast plus they have become quite thick. Her nails have to be taken care of just about daily now via filing. I don't clip them any more as they have a tendency to shatter all up the shaft now so the vet usually trims them for us. I love Squirty's wild hair so that doesn't bother me at all but I do worry about her nails.

This is my 2 cents worth concerning our experience with melatonin! :D

Hugs,
Leslie and the girls :D - always

[Rebelsmom]

Thanks Leslie. I'm hoping for his coat to recover mostly.

[addy]

Hi,

I thought I would share what I have been through with my Zoe's melatonin. She is so sensitive to everything and she was to get 3mgs twice a day. I started with one mg in the evening until I saw how it affected her and slowly added 1 mg until we got to 3mgs each evening. It made her tired at first and she did get sick in the car once in the beginning. I took her for a ride after giving the pill. Now I give it before bed. Once she seemed to tolerate it I started again with 1mg at a time on the morning dose. She did get tired and spacey but she adjusted each time. We did have 2 accidents in the house when I first increased her a.m. dose but I am not sure if that is because of the melatonin but it happened right after upping her dose to 3mgs in the a.m.

Glad Leslie reminded us about the nails, I should check hers. We started this melatonin with lignans beginning of August and she is just now been on the full dose for 3 weeks. Her hair seems to be fuzzzier but it is still thin and her rat tail is still bad but it can take 3-4 months to see improvement.

Hope that helps,
Addy

[Rebelsmom]

Thanks Addy. I gave it to him last night and he seemed to tolerate it well, but I will keep an eye on him.

[gpgscott]

Hi Melissa,

Most tolerate the melatonin well, I hope you see some improvement using it.

Scott

[apollo6]

Just checking in to see how you and Rebel are doing.
Hugs Sonja, licks from Apollo

[Rebelsmom]

We are doing well. Rebel is spunky and happy. He is still only taking 3mg of melatonin at night, bout a week now I guess. I'm thinking of upping it to 6 if he keeps tolerating it well. I had to reschedule his STIM test to Nov. I just have too much going on financcially in Oct. (speeding ticket after rescuing a dog) I would like to switch him to the compounded veteroyl but have to get through the new box. On a happy note Rebel will be celebrating his 8th birthday on Oct 1st!!

[apollo6]

Glad to hear some good news.
Happy Happy Birthday Rebel:p
Wishing you lots of good treats for your birthday.
Licks from Apollo and hugs from Sonja

[labblab]

Happy Birthday, Rebel!!!!!!!!!!!!!!!!!

Happy Eighth Birthday, sweet boy! (And in celebration of this special day, I'm going to edit your thread title, as well!! ;) :p).

I hope that you and your mom and Sadie have a wonderful day. You all deserve it so many times over! :) :) :)

With hugs and best wishes,
Marianne

[gpgscott]

Happy,happy from us also!!:D

[addy]

Happy Birthday To You

Hope you get a big bone

Addy

[Rebelsmom]

Thanks for the birthday wishes.. He got and extra treat this morning and will get a bone tonight!! Here's to hoping there are many more to come. Happy Birthday to my baby boy!!

[sunimist]

HAPPY BIRTHDAY SWEET BOY!!! :D

Shelba and Suni~~

[Casey's Mom]

HAPPY BIRTHDAY REBEL!!:D:D:D

Lots of belly rubs from us,

[Harley PoMMom]

Happy Birthday REBEL!!

Love and hugs,
Lori and Harley

[Franklin'sMum]

Happy 8th Birthday, Rebel :D

Jane, Franklin and Bailey xxx

[mypuppy]

Happy Birthday to you, cha cha cha ;)
Happy Birthday to you, cha cha cha :)
Happy Birthday dearest Rebel, cha cha cha :D
Happy Birthday to you, cha cha cha:p

Enjoy your day and bone. We love ya. Tight bday hugs from Jeanette and licks from Princess:D:o:)

[Spiceysmum]

Happy 8th Birthday Rebel.

Hope you are having a great day.

Linda

[Rebelsmom]

New video for Rebel's birthday.

http://s136.photobucket.com/albums/q165/jittrbugg/?action=view&current=IMG_0442.mp4

[mypuppy]

I love the stubby tail going a mile a minute, and I think Sadie feels it's her bday celebration as well--lol. Thanks for sharing. Xo