Marley tested positive for Cushings yesterday

[trander27]

My 10 year old boxer/terrier mix Marley was diagnosed with Cushings yesterday and already your wonderful forum has proved invaluable. I have been in Cushings immersion mode for the last 24, neglecting work and scouring the net.

I went to my Dr today to talk about treatment and because of this forum I knew the dose of trilostane he was talking about was twice what I expected him to suggest. I know there is some controversy regarding the dosing and that it seems like most people on this forum consider UC Davis as the gold standard ? I mentioned this to him and asked about the dosing. For a 70lb dog it would be cost prohibitive for me to spend the $320 a month with the dosage he suggested. However I could afford the 1mg/kg dose recommended on the posts. I want the best for Marley and he agreed to go ahead and dig in a research it further before we move ahead with treatment.

I am still confused as to what medication is best and it seems that trilostane is supposed to be less destructive but it has many of the same negative side effects of lysodern.

Anyway I learned today that even long drawn out posts like this are the best thing that can happen because they allow newbee's like me to learn.

I am still totally confused but I know from other episodes that if I start losing it and feeling overwhelmed I only start to cause my beloved slightly neurotic puppy to feel worse and literally cry with me. So I am putting all my energy into reading as much as I can to help her receive the best possible treatment.

Marley is 10 years old in July. I have always felt something was not exactly right and I have had Dr do every Thyroid test I knew to ask for. At 3 years of age she was getting pot bellied, less hair on her belly, pigmentation, she has always been crazy with food, her coat was dry and she had low energy. She had ear infections and UTI's the minute she got a little stressed out. Her thyroid test sometime came back borderline low but nothing they suggested treating. At about 6 yrs she had a seizure like episode and I again felt like it was thyroid. Not knowing what I should have been saying was endocrine. My vet said it could not be and that it was super rare and sent me to a neurologist. $2000 later that proved wrong yet they had me keep her on phenobarbital. The neurologist thought pancreatic tumors, isolimina or Addison's after I had her run a full panel too. Nothing fit, nothing made sense ! Now almost 4 years later ! Now I know her night time restlessness and crying was not a aurora to a seizure but a typical Cushing sympton.

I feel badly and like I let her down a little by not pushing. Sometimes I was just so happy to hear them tell me nothing was wrong I did not push and it was not like she was super sick. Just so easy to let them tell me older dog blah, blah, blah.

OMG so many signs from such an early age and 7 years later I get a diagnoses from a Vet that just graduated school on 5/20 ! When he called me and said I think there is something more here after reviewing her new test and her history I could have kissed him.

Anyway my problem now is that I am not sure what medication and dosage to put Marley on. Should I push to use the level of trilo mentioned here or put her on Lysodern. Do I need more tests ? I am confused about the ATCH stimulation test. Do I need one before I treat ? I know it is used to test efficacy and see if they are loaded but...

She was diagnosed from the low dose dex test and her long medical history and symptons.
Cortisol Pre - 1.9
Cortisol 2 - 1.4
Cortisol 3 - 3.3

Values from her Chem Panel
Alkaline Phosphate 509
ALT (SPGT) 145
T4 -.05

Any help and thoughts would be helpful, I promise that once we make it through this journey I will pay it forward.

Tracy
Marley Mom. * Note she was Marley before there was a Marley and Me. Named after Bob.

[apollo6]

you will get a reply from the senior members. I am new my self and went through a lot of what you went through. My dachie is 11years old and when I know look back the beginning symptoms were there years ago. check the HELPFUL RESOURCES also. will help as to tests you should do.
I had an ACHT STIM TEST
URINE CULT TEST
BLOOD PANEL
ULTRASOUND.

[zoesmom]

Hi and welcome, Tracy and Marley -

You are off on the right foot......reading and educating yourself, so already you are two steps ahead of the game!! But do not blame yourself for not catching things sooner. A good majority of us here also went thru the same thing, knowing something was not quite right but unable to put our finger on it and worse, unable to get answers. Cushings has so many symptoms, some can be vague and slow to progress. Months before my Zo was dx'd, I remember telling my daughter that she must just be getting old because her head looked so skeletal. Little did I know that could be a symptom.

As far as my Zo's other symptoms, she followed a similar progression as your Marley over the years. But rather than eating alot like Marley, she drank and peed a lot. Then at age six, seizures, and + for hypothyroid and 3 more years went by until she was dx'd with PDH at age nine - the tip off finally being her almost constant uti's and her rising liver enzymes. It's hard to say when her cushings really began and the same for your Marley. A lot of the symptoms mimic other conditions. So even for some vets, it's tricky to put all the pieces of the puzzle together in timely fashion, and for us owners, almost impossible. But the impt. thing to focus on is - cushings is a slow-progressing disease AND you have a diagnosis now.

So two questions. What dose of trilo was your vet recommending for your 70 lb. girl. AND, was an abdominal u/s done? Sounds like a no on the ACTH. Some vets will do that one before tx begins to give you a reference (starting point) for how well they are doing on tx. Plus, it can provide add'l confirmation of the diagnosis. But it isn't absolutely essential. Still, I'd recommend one or the other - u/s or ACTH. Personally, I think you get more bang for the buck with u/s as they can look at all the main organs - and learn alot.

Both trilostane and lysodren are good for treating cushings. Lysodren - been around for awhile. Trilostane - a more recent option.
They do work differently, as you've probably read. Trilostane can cost more, over the course of tx, simply because it's used daily. Lysodren requires a daily loading dose for approx. 3 - 10 days, and then it is given on a weekly regime. Before we could get Zo's trilo here in the states, it was costing an arm and a leg. Nowadays, there are numerous online compounding pharmacies where you can buy it & their prices - much better. Zoe - at 80 lbs give or take - took an exceptionally large dose/day and the cost for her trilo was running about $130/month at the end (180 mg bid). Most dogs of about that size would probably not be taking near as much. There's no sure way to tell for a few weeks or even months. If he ends up on a rather typical dose of 60 or 90 mg., the cost would be much less than the above. We got ours from the cheapest place I could find and that was pethealthpharmacy.com in AZ. They will e-mail you a quote. But you and your vet need to come to an agreement first on what is right for Marley. Generally, I always say, "start low and go slow". Nowadays, low might be 1 mg/lb or 2 mg/kg. So something like 45-60, possibly 75 mg as a start.

The other tip I think is most helpful with trilo in the beginning is this: order smaller strength capsules so that you can adjust the dose up or down as needed, for awhile, depending on how Marley does. Some dogs can take a couple of months or more to settle into the proper dose for them. So capsules of 30 mg and 15 mg would give lots of options for combining to get different doses. It's a little pricier that way, but once he's stable on the right dose, THEN you can order the exact strength capsule you need. As to lyosdren, I'll let those who use it tell you more about it. Keep reading and asking those good questions! Sue

[Harley PoMMom]

Hi Tracy and welcome to you and Marley from me and my boy Harley! I've posted my replies to you in blue. :)



My 10 year old boxer/terrier mix Marley was diagnosed with Cushings yesterday and already your wonderful forum has proved invaluable. I have been in Cushings immersion mode for the last 24, neglecting work and scouring the net.

Sounds like me and a whole bunch of other parents of these precious pups that have this disease.

I went to my Dr today to talk about treatment and because of this forum I knew the dose of trilostane he was talking about was twice what I expected him to suggest. I know there is some controversy regarding the dosing and that it seems like most people on this forum consider UC Davis as the gold standard ? I mentioned this to him and asked about the dosing. For a 70lb dog it would be cost prohibitive for me to spend the $320 a month with the dosage he suggested. However I could afford the 1mg/kg dose recommended on the posts. I want the best for Marley and he agreed to go ahead and dig in a research it further before we move ahead with treatment.

Actually you can go with UC Davis 1mg/kg or with Dechra's 1mg-3mg/lb. One of our members talked with Dr. Allen, a vet who is one of their technical reps, and he is personally recommending that people start at the lowest end of the Dechra range, which is 1 mg. per pound.

I am still confused as to what medication is best and it seems that trilostane is supposed to be less destructive but it has many of the same negative side effects of lysodern.

Trilostane/Vetoryl and Lysodren/Mitotane work very differently...I will provide some links for you to read. :eek:

Anyway I learned today that even long drawn out posts like this are the best thing that can happen because they allow newbee's like me to learn.

I am still totally confused but I know from other episodes that if I start losing it and feeling overwhelmed I only start to cause my beloved slightly neurotic puppy to feel worse and literally cry with me. So I am putting all my energy into reading as much as I can to help her receive the best possible treatment.

This Cushing's Disease can be pretty hard to get ones head wrapped around. But we are here for you; we'll supply links for you to read, answer your questions, at least try to answer them the best we can, and we will hold your hand and support you throughout this journey. ;):)

Marley is 10 years old in July. I have always felt something was not exactly right and I have had Dr do every Thyroid test I knew to ask for. At 3 years of age she was getting pot bellied, less hair on her belly, pigmentation, she has always been crazy with food, her coat was dry and she had low energy. She had ear infections and UTI's the minute she got a little stressed out. Her thyroid test sometime came back borderline low but nothing they suggested treating. At about 6 yrs she had a seizure like episode and I again felt like it was thyroid. Not knowing what I should have been saying was endocrine. My vet said it could not be and that it was super rare and sent me to a neurologist. $2000 later that proved wrong yet they had me keep her on phenobarbital. The neurologist thought pancreatic tumors, isolimina or Addison's after I had her run a full panel too. Nothing fit, nothing made sense ! Now almost 4 years later ! Now I know her night time restlessness and crying was not a aurora to a seizure but a typical Cushing sympton.

Other non-adrenal illnesses have some of the same symptoms of Cushing's. Non-adrenal illnesses also can create false positives on Cushing's tests. That is why a thorough dx is vital before any treatment is started.

I feel badly and like I let her down a little by not pushing. Sometimes I was just so happy to hear them tell me nothing was wrong I did not push and it was not like she was super sick. Just so easy to let them tell me older dog blah, blah, blah.

You have not let her down, get that thought out of your head.

OMG so many signs from such an early age and 7 years later I get a diagnoses from a Vet that just graduated school on 5/20 ! When he called me and said I think there is something more here after reviewing her new test and her history I could have kissed him.

Anyway my problem now is that I am not sure what medication and dosage to put Marley on. Should I push to use the level of trilo mentioned here or put her on Lysodern. Do I need more tests ? I am confused about the ATCH stimulation test. Do I need one before I treat ? I know it is used to test efficacy and see if they are loaded but...

IMO, An ACTH stim test is a must before starting any treatment, one needs to know where their pup's cortisol is at, sort of a starting point. I would also recommend an ultrasound being done on her. This diagnostic tool will show many of her internal organs but the ones in particular are the adrenal glands.

She was diagnosed from the low dose dex test and her long medical history and symptons.
Cortisol Pre - 1.9
Cortisol 2 - 1.4
Cortisol 3 - 3.3

Values from her Chem Panel
Alkaline Phosphate 509
ALT (SPGT) 145
T4 -.05

Could you get us the reference ranges and the units of measurements (U/L, mg/dl) for these values, please.

Any help and thoughts would be helpful, I promise that once we make it through this journey I will pay it forward.

Tracy
Marley Mom. * Note she was Marley before there was a Marley and Me. Named after Bob.

Remember Tracy, we are here for you and Marley always.

Love and hugs,
Lori

Here are some links that I think you'll find interesting.

Comparing therapies for canine hyperadrenocorticism (Hoskins on Feldman)
http://www.k9cushings.com/forum/showthread.php?t=223

Trilostane/Vetoryl Information and Resources
http://www.k9cushings.com/forum/showthread.php?t=185

Lysodren loading Instructions and related tips
http://www.k9cushings.com/forum/showthread.php?t=181

[trander27]

I asked my vet about the baseline for ACTH and he said it was not needed. That they had her cortisol reading ?

It did not make sense to me and I got confused. hence long dramatic post :)

I believe he recommend 2.mg ? The clinic will price match what I find I just think maybe we got our wires crossed $320 would be a whole lot of Trilo for a 70lb. He is a brand new vet and very open to listen, part of me wants to pull Marleys care for someone with more experience but yet he just spent hours with Marley, poured over her records and he found the diagnosis when so many did not. He actually listens and will do research. He is calling the head of UGA endocrinology on Monday to talk about the trilo dosing. I think if we can agree like you mentioned to go low, I would feel better.

That is great help about the ultra sound and exactly the kind of advice I am desperate for. This would make me feel better too and I will call tommorrow and get it scheduled.

Yep on hour 36 and I realize this is just one tricky insidious disease and your post helped me let go of the why we did not catch it.

A lot of great advice !

Thank you so much !

Thanks

[trander27]

Update to Marley Value w/ Ranges

Thanks this is all new and I am not sure how to post test results.

You all are wonderful !

Cortisol Pre - 1.9 ug/dl
Cortisol 2 - 1.4 ug/dl
Cortisol 3 - 3.3 ug/dl

Normal- cortisol level less then 1.4 ug/dl 8 hours post dex

Values from her Chem Panel - I only listed the abnormal values
Alkaline Phosphate 509 - Reference Range 5 - 131 U/L
ALT (SPGT) 145 - Reference Range 12 -118 U/L
T4 -.05 - Reference Range 1.0 - 4.0

[Harley PoMMom]

Ok a baseline is not what I was actually refering to...we want to know the pups post draw numbers most importantly. When one gets an ACTH stim test done a pre and a post is done in the diagnostic stages. That post number is telling how much cortisol reserve the pup has, very important to know. During monitoring of treatment most of us, unless the pup is having some unusual symptoms, don't have the pre (baseline or resting) draw done.

Since Marley's thyroid value is low this could be a possibility of Cushing's called Euthyroid Sick Syndrome. Usually then a Free T4 by equilibrium dialysis is done to differentiate between true hypothyroidism from the sick thyroid syndrome. Was a Free T4 by ED done? Here is a link to an article that explains this well: http://http://www.lbah.com/canine/hypot4.htm

Hope I'm not confusing you more. :eek:

Love and hugs,
Lori

[zoesmom]

Thanks, Kathy -

Marley's T4 is also pretty low. Your vet may be thinking that is because of the cushings - a condition called sick euthyroid which could possibly improve once cushings is under control. It might well be that. But some dogs have low levels which continue, even when their cushings is controlled. Your vet may want to wait a few weeks into cush tx and then retest the thyroid levels to make sure Marley doesn't need thyroxine, too.

So do you think the vet was suggesting 2 mg of trilo per lbs or kg of weight? That would be reasonable. To get your dog's weight in kg, you'd divide the lbs. by 2.2. In Marley's case, that would be about 32 kg. Depending on the formula used, the most conservative dose would likely be 30 mg of trilo (UCDavis' formula of 1 mg/kg.) Again, 45 or 60 mg is not outrageous either. I'd probably opt for the middle ground at 45 mg, if it were my dog. Which is what my Zo finally tolerated in the beginning. Later, that had to be raised until hr cortisol responded adequately.

Ideally, an u/s and an acth would be next. But if cost is a big factor, and you have to pick, I would definitely vote for the u/s. The adrenals and the liver, on u/s, will give further evidence of cushings. If the adrenals are equal (normal or enlarged) that would indicate PDH. If one is larger than the other, that's usually a sign of adrenal cushings caused by a tumor on one of them. Liver is also enlarged in most cush pups. Plus, they can look at gall bladder, pancreas, intestines, kidneys, heart, and spot other potential problems. Sue

PS -Lori, maybe I'm wrong but I had the impression that Kathy's vet didn't do an acth and is not recommending they do one before tx begins. If you can afford it, Kathy, it's a good thing to have those numbers before starting tx. ACTH is a stim test with two numbers (pre and post) and will show how much excess cortisol Marley is producing (the pre number is before the stim drug is given and the post number is after.) And you are right - it is the test that will be used to monitor Marley on tx.The test he apparently had is the LDDS - a suppression test with 3 numbers (baseline, a 4-hour number and an 8 hour number), used strictly for diagnosing.

[Harley PoMMom]

I was just thinking if you are going to get Marley's thyroid checked again then I would have her samples sent to Dr. Dodds. Here is some info about her testing:


The main reason for sending Dr. Jean Dodds / HEMOPET the serum samples instead of having the testing done locally, is that HEMOPET is the only group routinely offering expert clinical interpretive diagnostic comments that take into account the age, sex, and breed type of the animal. This often means an expected normal reference range for an individual pet that differs from the test lab's generic broad reference range. Practitioners usually are unaware of these differences, which have been established by published research and Dr. Dodds' many years (46 years this year - 2010) of clinical and research experience

http://www.itsfortheanimals.com/HEMOPET.HTM

Here is a link to a very interesting article about Thyroid Disease, Diagnostic and Treatment Misunderstandings written by Dr. Dodds.

http://www.k9cushings.com/forum/showthread.php?t=1627

Love and hugs,
Lori

[trander27]

No she has not had a recent T4. I had them pull one again in 2007 since I have always felt she had thyroid issues. It came back with low normal values and my vet did not think treatment was called for. In 2004 in Denver Almeda East she had the T4 come back low and we did treat her with thyroxine, with retesting her values came up but there was no improvement at all in her symptoms. It left me very confused but that is a good point and I will go back through her charts and then keep an eye on that level.

So it could be two conditions is that what your saying ?

Medication Trilo Dosage - I think my vet and I just got our wire crossed and I was overwhelmed. He told me the cost of her medication would be $320 plus a month and after I researched the cost and expected it to be around $150 at max does for her weight or so I assumed he was suggesting a much larger dose. I will call him tommorrow and get clarification on dosage. It may be that the clinic just has a high mark up although they say they will price match. I can deal with the $150 but just was not ready hear that her medication would be just slightly less than my car payment each month.

I am going to call and get the ultra sound and the acth done. From reading all your wonderful posts and information it sounds like that this testing may help us avoid mistakes and better manage her care. I am going to take a breath, get the test run and make sure we are making the right call for Marley.

You all are like that AMEX add.
Predisone Pills $19.99
Canine Cooling Mat $99.00
Help from wonderful people at k9 Cushing - PRICELESS !

[Casey's Mom]

Hi just wanted to welcome you and Marley - gotta love the name because I too love Bob!

I like the sound of your vet, even though he doesn't have all the experience he is up on the latest and wants to learn all he can about your dog and the diagnosis. Sometimes with a more experienced vet they may not want to learn as much. He sounds keen and he will probably be willing to listen more.

You have come to the right place, just keep asking questions!

Love and hugs,

[zoesmom]

Ah, sorry Lori. ;) I thought you were asking for the ACTH #'s but now I see you were just explaining them. I shouldn't try to read and post while I'm watching Dateline! :rolleyes: Sue

[Harley PoMMom]

No she has not had a recent T4. I had them pull one again in 2007 since I have always felt she had thyroid issues. It came back with low normal values and my vet did not think treatment was called for. In 2004 in Denver Almeda East she had the T4 come back low and we did treat her with thyroxine, with retesting her values came up but there was no improvement at all in her symptoms. It left me very confused but that is a good point and I will go back through her charts and then keep an eye on that level.

So it could be two conditions is that what your saying ?

The T4 and the Free T4 by ED are different tests, and according to Dr. Dodds the reason you want the Free T4 by ED is:"because freeT4 is the biologically active tiny fraction [0.1 %] of
total T4."

If Marley has sick thyroid syndrome then treatment with supplemental thyroxine is not needed.



I am going to call and get the ultra sound and the acth done. From reading all your wonderful posts and information it sounds like that this testing may help us avoid mistakes and better manage her care. I am going to take a breath, get the test run and make sure we are making the right call for Marley.

You all are like that AMEX add.
Predisone Pills $19.99
Canine Cooling Mat $99.00
Help from wonderful people at k9 Cushing - PRICELESS !

Breathe, take deep breaths! :p;):) Cushing's is a slow progressing disease so taking your time to make sure that Marley is dx'd properly is very important. You are doing a wonderful job taking care of your precious girl and I am so glad that Marley has someone as loving and devoted as you as her mom.

Love and hugs,
Lori

[trander27]

I called this am and the trilo dosage he suggested was 120mg. From the post this would be high ?

[zoesmom]

Hi again Kathy -

Yes, I do think that's high based on UC Davis' recommendations for starting dose. If you go by Dechra's formula, the 2 mg/lb - smack in the middle. So Marley at 70 lbs. x 2mg/lb = 140 mg/day. However, from my own experience with Zoe and from the experiences of more than a few others around here, I can only say . . . I wouldn't start that high. I wouldn't go much over 60 mg - or 75 max - as a starting dose. We've just seen too many dogs started on too high a dose who wind up in trouble.

That's not to say that Marley won't eventually NEED 120 mg/day for full control. But for some reason, starting low and working up gradually seems to help avoid early problems. Sometimes I think it's just that their systems need to adapt, more slowly, to this powerful drug. That was certainly the case with Zoe. Initially, she became very ill on 180 mg/day. Day 3, severe diarrhea in the house :eek:. Took a 4 or 5 day break and down to 90 mg or some such. Then again . . . on Day 3, more bad diarrhea and vomiting. After another break or two, she was cranked down to just 45 mg/day (And she weighed just over 80 lbs then). That 45 mg dose was ok with her digestive tract! Over the weeks, she was increased back up to 120 mg and there were no more problems. In fact, she eventually took 180 mg twice a day - double the amount that had first made her so sick. I'm not actually sure that Zoe's repeated bouts of diarrhea were a sign of too-low cortisol but may have had to do more with the IBD and the suddenness of the drop in cortisol (which had previously acted as an anti-inflammatory for that condition).

Not only that, many dogs just go into a sort of depression-like state as their numbers come down. They don't necessarily drop clear into an addisonian state (with too low cortisol), but can become very listless and blah when all that excess feel-good cortisol suddenly is withdrawn. Speaking of which, many dogs - Zo included - who've previously shown no sign of arthritis will develop it once they are on cush tx. So all in all, with all the possible effects, I just think it's so much safer for and easier on the dog to 'bring them down slowly.' And way less stressfful for us moms and dads!!!! And by the way, that u/s you are now planning to get should warn of any thing like IBD or pancreatic issues which could also flare up with symptoms similar to those of too-low cortisol.

Just looked up the prices I was quoted from www.pethealthpharmacy.com two years ago. Their prices haven't gone up much at all, based on the last price I paid for Zoe's pills in Feb. '10. Anyway, 30 caps of 60 mg was $32.40. (That would be a months' supply unless a dog ends up on twice a day dose which does happen.) I didn't get the price for 15 or 30 mg. but as I mentioned, those are handy for adjusting doses up and down. PHP's price for 30 x 120 mg caps was $48.90. If your vet is going to match the best price you can find, you should definitely contact this place because I found them to have THE best prices and I had checked out 3 or 4 other places. You can find them online easily. Sue

[trander27]

Just wanted to thank you again. Marley and I are going for her ultra sound today and I am actually printing out part of this post for my Dr to read. He does not seem to be understanding why I want a lower dosage of Trilo to start.

I don't understand why if I am willing to pay for more acth test as we slowly take her up to efficacy he is hesitant.

But because of this forum I feel more confident to question things to make sure I have a comfort level and I am sure in the end up with the best treatment for Marley.

THANK YOU !

[marie adams]

Hi Kathy,

Welcome, I am fairly new to the group since February. I treat with Lysodren so I cannot give much advice on Trilo. What I can give is I had a vet who was too conservative, thought they knew more than they did about the numbers/dosing--etc; and wouldn't work with me so it lead to Maddie's numbers going up and reloading--we are now really just starting a true maintenance program. I think I paid close to $160+ for a 30 pill supply of 500mg of Lysodren and she needs 2000mg a week for her maintenance dose--I split the 2000 up 4x for the week.

If it wasn't for all the knowledgeable people here I would be very lost and still frustrated and confused. They are PRICELESS!!!:):)

[trander27]

So during her ultrasound they found a suspicious mass in her spleen and possible her liver, the Dr called me at work very concerned and wanted to take xrays. He did the xrays while I googled and tried not to panick very unsuccessfully.

He called back with better news that at least her chest and heart xrays where clear. He seemed less concerned about the mass in the spleen which confused me given his comments earlier. He said it was a concern but the main thing was to get Marley started on treatment for Gushing. At this point she was not a candidate for surgery with her Cushings out of control. I asked him on a scale of 1 to 10 how concerned should I be at this moment about the suspicious masses and he said a "5".

So long story short I went against what my plan was of giving Marley a lower does of Trilo and she took 120 mg yesterday morning. I felt like I needed to get her Cushing under control quickly to address what ever else might be lurking.

She took it yesterday and had a great day, her normal Marley self. This morning she woke me up panting and agitated, not so rare but... Then she looked at her breakfast and whined, did not eat ? My heart lurched :(

Ok 2 days ago this is the dog that stole a paper plate full of food right off my grandmothers lap mid bite and hightailed it across the lawn with the paper plate delicately balanced as to not loose a morsal.

Whining and not eating scared me, I moved her bowl to the living room and 1/2 later I heard her crunching, what a lovely sound !

But I am nervous, she did eat, so should I give her medicine. I will call the vet and see but... Would you give your dog the next dose ? Am I just being a freak ?

On a side note he called me at home after I left to tell me that he forgot to mention that on one xray they saw what they thought was a tack, push pin thing in her colon ? For the love of .... They felt it was in a safe place and it should pass w/o issue but just as a precaution to feed her some pumpkin to coat her bowels. So after a hellish day I am trying to find pumpkin at 8pm at night out of seasons. Well yams had to do and she ate an entire xtra large can with out even blinking.

Sorry for the long posts ! Thank you again for all your help

[AlisonandMia]

I always think that if in doubt don't give the pill in situations like this. Missing one day unnecessarily shouldn't do any harm while giving a dose when you shouldn't have can have serious consequences. Lack of appetite can definitely be a sign of low cortisol and if you are seeing low cortisol after just one dose I'd be worried about what a second dose could do. What was Marley's appetite like before the Cushing's - was she ever picky or slow the eat in the past or is this quite unusual for her.

A big dose of trilostane won't necessarily get the Cushing's under control any faster and I'd worry that too high a dose could actually slow things down by causing an adverse reaction which could lead to having to stop treatment for a while and then restart on a lower dose - although I sure understand your wanting to get her to the point that surgery is possible.

It is possible to do surgery on an untreated Cushing's dog although it is preferable to wait until the cortisol has been lowered with treatment, if the operation isn't super urgent.

Good luck and keep us posted.:)

Alison

[trander27]

Thank you for your reply. It is rare for Marley to hesitate with food. She is on Hills R/D, we switched over about a month before she got the rash that I initially took her in for. She does not love that food but even if I had not given her the Trilo I would have been a little unusual to see her wait to eat.

She did not hesitate with the cheese and then she busily went about her morning barking at squirrels and chewing on a toy.

I really wish Dechra would revise the dosing quidlines. I have new vet and we went back and forth on this and I was pushed over the edge by the thought of it taking months to get her up to a therapuetic levels. Your point on too high a dose makes sense as well. Ugghhhh so confusing !

I had already given her the dose before I read this :(

If she even has a moment today that seems abnormal or does not wolf down her food I will stop.

My Mom is home with her today, I have called twice. She was barking for a treat while I was on the phone. We have the predisone on stand by.

Thank you for your advice and support.

[zoesmom]

Sorry Tracy. I called Marley a 'boy' earlier :o:oand I see now she's a girl . . . and a very cute one, at that!

Glad you've got the prednisone on hand as I am a little concerned that the 120 mg dose might be too high to start - especially since she normally has a voracious appetite and then hesitated after just one dose. Just watch her like an eagle in the upcoming days. Having your mom there with her is a good plan and I presume you've filled her in on exactly what to watch for? Will be looking for your updates. Sue

PS - I hope your vet told you to always give the trilostane with food. Better to give after they eat, not before, or on top of or with - just to make sure they don't balk on eating at the last minute. If they surprise you and turn their noses up at eating, which could indicate low cortisol, then you can't take back the pill you've just given them.

[trander27]

I highlighted the Addison Crisis symptoms and I have it posted on the fridge and the Predisone out on the kitchen table.

We are totally code orange cushings alert, defcon 4 status at my house.

She hesitated again last night and that was it for me:(
She also took a 1/2 hour again to eat this morning.
Otherwise acting normal, maybe a little more panting and clingy.

I called the Dr this am and told him I was skipping her dose today.

I told him if she eats with out hesitating tommorrow morning then I would give her 1/2 the dose at 60mg. He still does not think the 120 mg dose is high but he did admit each dog responds differently and agreed that would be fine.

So funny that I find it hard tell the vet what I want to do when I am so used to counting on their advice as the experts. I learned from my mistakes though and you guys are so right in that we are thier voice !

[lulusmom]

Good job, mom!!

[trander27]

Marley seems to be tolerating the lower does pretty well but she is barking a lot. Has anyone had that happen on trilo ? She was always a little vocal but this is to a new level. She will just walk over to me, stand and bark. She used to do this a little bit when she wanted to play or go outside. She does not seem disturbed but when I try to play with her or take her out or give her affection, it's clear that is not what she wants. It's like she is just enjoying the sound of her own ear shattering vocals. She will still play and be affectionate but just this weird random barking sessions. Not sure if it's like help I feel badly ? or whoo hoo I am feeling better and a little frisky ?

[zoesmom]

Hmmmm, that's a new one. And that's exctly what .mMy Zo did that after she began taking bromide for seizures. In her case, it was apparently extreme hunger brought on by the drug. Maybe Marley IS just feeling better!

How many days has she been on the trilo now. Looks like at least a week, but I know you skipped a day. Or maybe more? Have you scheduled an ACTH yet to see how her cortisol level is doing? One should be done about 10-14 days into treatment, if there are no concerns before then. It should be done 4 - 6 hours post-pill and the pill given with a very light meal on test day. I'm hoping this is just Marley, feeling her oats! Sue

[trander27]

Marley had her ACTH stim test on Friday but the Dr has been out. I just could not wait a second longer and begged them for the results w/o my Dr review.

Cortisol Pre - 4.00 ug/dl
Cortiol 2 - 1.8 ug/dl

Post Lysodern - Pre and post cortisol levels after loading or while on maint should be between 1-5 ug/dl.

I went and searched for clarification and found the Dechra Site suggested the POST ATCH Serum Cortisol between 1.45 and 5.4 ug/dl - Continue on the same dose.

So I guess that means the dosage has the Cushings under control ? At the low end and maybe too under control ? Is there such a thing ?
So glad you all helped me and I did not keep her on the 120mg

She is eating, has not missed a meal but does not wolf it down, sometimes will eat 1/2 and then finish it a little later, like a skinny girl not that intrested in food ! It is shocking to me ! She waits for my mom who's visitng to feed her dog to see if the menu's better.

Is this just Cushings starting to be controlled or should I worry ?
My vet told me not to worry as long as she is eating and having no other Addison Crisis symptoms.

She seems ok but seems to have days where she is a little more lethargic and then days were she is jumping on the couch again. Could be the hip dyplasia and I will ask the dr about pain control now that she is not self medicating on mass cortisol.

[labblab]

Marley had her ACTH stim test on Friday but the Dr has been out. I just could not wait a second longer and begged them for the results w/o my Dr review.

Cortisol Pre - 4.00 ug/dl
Cortiol 2 - 1.8 ug/dl

Hi Tracy,

I'm sorry I've not had the chance to post to you before this, but I wanted to give you a couple of quick thoughts about Marley's ACTH results. I've searched through your thread, and it looks to me as though this is the first ACTH that's been done? I see that a low dose dex test was performed as a pretreatment diagnostic, but I'm not seeing any results for a pretreatment ACTH.

If that is true, then we don't know exactly how much Marley's cortisol has been lowered during these first ten days of treatment. But Dechra usually advises that cortisol levels can continue to drop throughout the first 30 days of treatment even if the dose remains unchanged. So although you are right -- Marley's post-ACTH result is currently within the desired therapeutic range -- it is near the bottom end of the range and you really don't want it going lower. Your vet may decide to actually lower her dose a bit. But if not, you'll want to continue to watch her very closely (which I know you're already doing!) for Addisonian-type symptoms. Seeing a decrease in a previously-voracious appetite is a good thing in a Cushpup, but not wanting to eat at all would be a huge warning sign. And I'm thinking you'll definitely want to retest her in another couple of weeks when she reaches that 30-day mark to make sure her level is still OK.

One other thing...I see that her pre-ACTH result was significantly higher than her post-ACTH number. I truly do not know whether that much difference in the numbers is an issue or not. I used to get all hot-and-bothered when I saw a higher "pre" result due to some warning language that was included in Dechra's literature re: "non-stimulatory test results." But after talking with one of Dechra's technical representatives, I'm not sure that it is an issue as long as both the pre and post results are greater that 1.45. But that may be another question that you want to keep in mind when you do talk to your vet -- is the higher "pre" number any cause for concern?

Marianne

[trander27]

Thanks that is really helpful. So it is a little odd to see the pre value much higher than the post ?

I just googled it to try and get a better idea of the concern and found this from Texas AM Dept Vet n blue. A little worried since both results are not at least above 2 ug/dl ?

Your point about not wanting it going lower is well heeded and that with such a huge change in eating habbits has me a little on edge.

I will be sure and talk in detail about this with my vet and have him research it more. He is just out of school but is happy to consult with his proffesors at UGA and the other Dr in the practice. I will find out her pre treatment values, I had a scare with her ultra sound and was so freaked out I guess I never even asked for the results. We were onto chest xrays and other such nerve racking tests after they saw the mass in her spleen.

Would a non stimulatory test be no change in the values ? Like she did not react to the injection ? All so new to me. I try and read through all the threads not to continue to ask questions already posted but ...

I just can not thank you all enough for your help.


9. I recently rechecked a dog on VetorylR. The post ACTH stim cortisol
concentration was lower than the pre value. What does this mean?
There are several explanations for discordant results, i.e., those in which the baseline
cortisol is greater than the post-ACTH value. These include laboratory error, mislabeling
of samples in the clinic, interference by exogenous steroids, and use of an ineffective
ACTH product.
If the patient is clinically well and both results are between 2 - 5.4 ug/dl, it is appropriate
to continue VetorylR at the present dose and recheck as usual. If both values are below 2
ug/dl or above 7.5 ug/dl, or if the dog is not clinically normal,

[labblab]

Thanks that is really helpful. So it is a little odd to see the pre value much higher than the post ?

I just googled it to try and get a better idea of the concern and found this from Texas AM Dept Vet n blue. A little worried since both results are not at least above 2 ug/dl ?


Would a non stimulatory test be no change in the values ? Like she did not react to the injection ? All so new to me. I try and read through all the threads not to continue to ask questions already posted but ...

It IS a little odd to see a signficantly higher pre number, but it does happen. In my own mind, I had always interpreted "nonstimulatory" results in just the same way as you are thinking: a test with no change in values, or when the "post" number is lower than the "pre." But after my conversation with the Dechra representative, I'm no longer sure that my understanding was correct. And as I say, if I'm relaying the info correctly, the main issue is just that the values should ideally be above 1.45 (the lowest end of the therapeutic range), regardless of which one is higher. I'm wondering whether the "2" was just being given by A& M as an approximation? And in addition to the possible explanations that they've given for a lower "post" number, I wonder whether it might simply be the case that a dog was more stressed at the time of the first draw?

But this is the good thing :). Here's the contact info with the telephone number for Dechra's U.S. office. The technical rep with whom I spoke is Dr. Allen, and he is a vet himself. He is more than happy to talk with pet owners and/or treating vets. So if either you or your vet would like to get more clarification about the test results from Dechra's perspective, I'd definitely suggest that you give him a call.

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

Please don't worry unduly about this prior to having the chance to talk it over in more detail with your vet. I just wanted to throw it out there as something for you to be aware of. You are doing a fantastic job of watching out for Marley, and being her very best advocate!!

She is very lucky that you are her mom...:o :)
Marianne

[trander27]

Thanks so much, I won't worry too much. I have learned from my mistakes. I am taking it one day at a time, enjoying her crazy antics. She is very busy right now playing alpha diva dog & setting up a chew roll sting on my mom's clueless cocker spaniel. :D

So glad you all care to throw things out and your past exp can make all the difference in helping her get the best care possible. I hope I can pay all this kindness forward.

Thanks for the number, I will be calling for sure. I won't be able to help myself.

Good point on the stress, she hates the vet now and was very agitated the morning of the test.