Apollo fought with grace and dignity to the end, My little angel warrior

[apollo6]

My little 11 year old dachshund was just diagnosed with Cushing diseases. My holistic vet has Apollo on Cushex, and supplements, and said I should get the Ach test, etc. test to make sure he has cushing diseases, which he has. I know I have to decide on a treatment.
The specialists is strongly suggesting Lysordern. I have also heard of Anipryl, and Tri (not sure of spelling will have to look up)
Would like to know what other pet owners have used to help their dogs with cushings. Pretty overwhelmed right now.
Any suggestions would be appreciated.
from San Diego, ca.

[frijole]

Don't worry - we all came here overwhelmed. It is normal. You have taken the best first step you could by researching the disease.

Your vet is correct in that you must confirm the diagnosis. It is often misdiagnosed. So in order to help you it is important we know what tests were done so far. If you have the results that helps us too.

We all wish that holistic medicine (example those cushex drops) were a miracle cure but frankly - they don't work. Anipryl is often used with older dogs that cant handle lysodren or trilostane. Without doubt lysodren and trilo are the most frequently used now. Which is best is really dependent upon your vet's experience/knowledge as well as what type of cushings your dog has. Do you happen to know if it is pituitary or adrenal or atypical?

I'm going to link you to our reference section - start reading the general info and come back and hit us with questions. Don't worry... we will help you thru this. Glad you found us. Kim

http://www.k9cushings.com/forum/forumdisplay.php?f=10

[littleone1]

Corky and I want to say hi and welcome you and Apollo to a very wonderful group of very special people. I think all of us were overwhelmed with the diagnosis of Cushings.

Corky was over 12 years old when he started being treated for Cushings. He is taking Trilostane. As Kim mentioned, holistic medicine is not the answer for treating Cushings.

You'll get very good information and support from our members, as they have a great deal of experience and knowledge in dealing with not only Cushings, but also other medical issues that occur in our cushpups. They have helped me through some very rough times.

Take a deep breath, and learn as much as you can.

Terri

[Nathalie]

Welcome to you and Apollo!:)

11 years is still quite young for a dog of Apollo’s size. So if it does turn out that you are getting a confirmed diagnosis of cushings, with proper treatment he can have many more happy years with you.
Cushings can be a bit difficult to diagnose as the symptoms overlap with the symptoms of other conditions such as diabetes, hypothyroidism therefore it is important to take your time and do all the necessary testing to get a firm diagnosis and rule out others.

My dog Phillip (Collie/Beagle) was 11.5 years old when I started treating him with Lysodren and 1 year later he is doing well on it and has not had much difficulties tolerating it – he will be turning 13 in September.

Lysodren and Trilostan has the best track record and due to costs and his vet not having any experience with Trilostan I decided to treat with Lysodren.

As far as I know there is nothing other then conventional drugs that will bring the cortisol down.
That does not mean you have to abandon a more holistic approach. Many of us supplement for various reasons eg. Milk Thistle to help the liver,
L-Glutamine to help recover lost muscle mass. Some people switch to fresh homemade diets to provide optimum nutrition tailored to their dogs specific needs. But first the cortisol must be controlled.

The best advise I can give you is to educate yourself to be the best advocate and partner in your dogs treatment.
Ask questions. It’s the unknown we tent to fear the most.

Looking forward to learning more about your pup.
Nathalie

[marie adams]

Welcome, We were new in February and really nervous about loading with Lysodren at first, but everyone here helped me through the whole process. They are still helping me--now on our second loading, but that is because my last vet was too conservative; which I was okay with in a way, then with all the knowledge these wonderful people shared with me being conservative isn't the best way. Learn all you can about the disease and the medicine and just keep askint questions. You will calm down.

Good Luck with everything!! :)

[SavingSimon]

My little 11 year old dachshund was just diagnosed with Cushing diseases. My holistic vet has Apollo on Cushex, and supplements, and said I should get the Ach test, etc. test to make sure he has cushing diseases, which he has. I know I have to decide on a treatment.
The specialists is strongly suggesting Lysordern. I have also heard of Anipryl, and Tri (not sure of spelling will have to look up)
Would like to know what other pet owners have used to help their dogs with cushings. Pretty overwhelmed right now.
Any suggestions would be appreciated.
from San Diego, ca.

Oh, I remember when I felt like you did, sometime over a year ago - just absolutely overwhelmed and terrified. I found out Simon had Cushing's earlier than most owners (Simon is my best friend and a twelve year old Jack Russell Terrier) I also have six other dogs, (all Simon's fault, but that's another story. I also discovered there was "no advantage" to knowing early once I found out his Cushing's was pituitary dependent, like 85% of dogs with the disease. I took him to twelve vets besides the two I have known and trusted him with his entire life. Specialists, internists, etc. etc.. Every vet except the two I knew and trusted told me there was no downside to trylostane, to my surprise even the holistic vet I took him to said this (and I'm not much for holistic stuff for people or dogs, just so you know but I was willing to try ANYTHING). What I found in my quest for knowledge is that the University of TN has a Veterinary Endocronologist named Dr. Oliver who is THE MAN when it comes to Cushing's disease. To try and make this long story as brief as possible, let me just say, thank God I trusted the vets I trust instinctually and didn't just go with the opinion of those with more experience with Cushings that were really pushing trilostane. Before we started the trilostane, one of the vets did suggest I do some lab work on Simon, and find out how the cortisol was distributing itself in his blood. This test cost somewhere a little over a hundred dollars I think. But it saved me from making the biggest mistake I almost made in my life, and it saved Simon's life. It turned out, according to Dr. Oliver that Simon has "atypical Cushings" and that trylostane would have hurt and or possibly killed him. That is NOT the case in all, or even most dogs, but it is in some, and they are learning more and more every day that shows trylostane is not really much safer than the older medication lysodern. What Simon's bloodwork showed was that his cortisol is mainly being absorbed by the hormone estradiol in his system. Dr. Oliver told my vet that the best solution was flax seed hull for Simon. It mimicks estradiol, and therefore the flax lignans will absorb a lot of the cortisol that would normally be absorbed into his system and start making him a lot more symptomatic. He also recommended melatonin twice a day to prevent hair loss and thinning skin. Simon also takes Sam-E once a day for his liver, and milk thistle twice a day, for the same reason. For his little pot belly, he was originally prescribed Hills RD, but I have read a lot of research that says that ID is a better choice for dog's with Cushings. His disease has not progressed, and since we have just worked out his treatment plan within the last month, all I can say is I am already beginning to see some changes for the positive. I cannot tell you how surprised I am that holistic type treatments are the right answer for him. And I cannot recommend enough that your vet gets the test kit from the University of TN. Since I was about to cave in and try trylostane, against the better judgement of me, and my most trusted vets, because of all of the other "experts" I had taken him to, I really feel that this test saved his life. It is worth every cent. Simon's symptoms ranged from a newly ravenous appetite, when he used to be a "picky" eater. A "pot belly", and weakening of his hind legs (he was a Jack Russell with "springs in his legs" before the Cushings became noticeable.) He pretty much has all of the symptoms, except for only a slight bald spot on his tail instead of a large bald patch, and the one symptom that most owners notice first - the drinking too much and frequent urination are the main symptoms he does not have. The only way I knew he had Cushings was his Alk Phos level had doubled in six months, and it really wasn't terribly high. It was enough for my vet to mention it, and me to ask what it could mean. He said it could be Cushings, but he doubted it, because Simon was not having the symptoms most owners notice first and because it is very debatable how accurate an indicator alk. phos. levels are for Cushings - there are many other things that can cause it to rise and fall. But after his Dex suppression, and the other test (can't think of the name at the moment -ACTH stem?) there was no doubt that Simon was in the range of Cushings disease. That combined with his symptoms made deciding to treat or not to treat and how to treat if to treat an absolute nightmare. I feel your frustration, confusion, and depression that comes with this diagnosis. But trust me when I tell you it is not as dire as it seems at first. Simon also has some more rare symptoms, like licking the furniture until it is soaking wet, and some other things I can't think of now, but have confirmed are rare signs of Cushings. It is just unusual that he is missing the more common symptoms. Regardless, catching this early did not help other than it gave me time to figure out the best treatment, and to find the best diagnostic test to decide what that would be. I cannot recommend enough that you have your vet get in touch with the UofTN Veterinary Endocronologists and find out how the cortisol is distributing so that you can figure out the safest and most effective treatment for whatever stage of Cushings your dog is dealing with. There is so much more hope than I originally thought. There are so many treatments that are not so radical that they can cause your dog to get Addison's or crash. Read everything you can. Flax lignans help people with hormone problems also. Try the website flaxhulls.com and read about how they may help your dachshund. But first make sure they will help by getting that bloodtest. It is also good to get an ultrasound every 3to 6 months to see how your dog's liver and other organs are doing, because there are other medicinal and dietary aids. Your dog can live out it's full life span with this disease if you keep it in check and do everything you can. I am not saying that WILL happen for sure, but I am saying that there is a lot more hope than I was originally led to believe, and there are advances being made all the time in treatment. The most important thing to do is get all of the basic testing done, the stuff your vet will know to do, and then to be sure and send bloodwork off to the University of TN. I am honestly not here to promote any product, or endorse any person, or University, or anything like that at all - I am just telling you what I wish I would have known from the beginning. My vet was so excited about this news, and I have to say I am too - I am already seeing a change for the better. Exercise helps too to keep your dogs leg muscles from getting any weaker, and to strengthen the abdominal muscles. If you are like me, you will do any and everything for your best friend to have the longest and best quality life possible. If the time comes that Simon develops more symptoms (which may or may not, according to my understanding of the disease) trylostane is NOT an option for him, even though it is considered the safer option for many dogs with Cushings. Without the lab work at the University I would not have known that. I will keep you and your dachshund in my prayers - I know this news can be absolutely devastating, and yet after over a year I found out that there are answers that are kind of "outside the box" that really do work after all. I hope this helps you, and others that are depressed and discouraged over this diagnosis. I wish you and your dog many more happy healthy years together, and a year ago I thought my boy might not still be here - but I am thrilled to tell you, not only is he here, he is getting visibly better. Just be careful to do everything through your vet, and be sure that you get the advice and labwork of an endocronologist, preferably the one that is so well known for what he does, who is Dr. Oliver at the University of TN. Oh - and a quick note - I don't live anywhere near TN, but the bloodwork can be shipped out, and you should have results within a week of the best course of action for your dog.
Wishing you and your dog the best, and really hoping that my experience gives you hope and answers. :)

[frijole]

Apollo's mom/dad is trying to navigate how to post and sent me these test results earlier today. Sorry for the delay as I just got home to post them.

Kim


ACTH STIM TEST:cORTISOL SAMPLE 1-6.9UG/DL CORTISOL SAMPLE 2-37.0
URINALYSIS-Antech-NEGATIVE, SPECIFIC GRAVITY 1.017, OKAY I guess
Waiting for URINE CULTURE MIC RESULTS.
LAST BLOOD PANEL FROM 5/23/10-IMPROVED Amylase-1611(still high but in Sept was 6675
Lipase-improved 2776(still high but in Sept was5969)
Neutrophilis improved 6468(still high in Sept was 14168)
Lymphocytes went up 1176 was 966
WBC IMPROVED WAS 16.1 NOW 8.4
AST(SGOT) 88, ALT -827ALKALINE PHOSPHATASE-854, GGT-131( WERE WITHIN NORMAL RANGE IN SEPT
BUN/CREATINE NOW 62 WAS 34, PHOSPHORUS NOW 6.3 WAS 5.4-nOT SURE IF THIS HELPS. THANK YOU

LIVER OKAY, GALL BLADDER OKAY.

[Harley PoMMom]

Hi and a belated welcome from me and my boy Harley. I see from Apollo's ACTH stim test that his pre is 6.9 ug/dl and his post is 37 ug/dl. Now, his lipase and amylase levels are elevated also, which I do see that these numbers are coming down, but non-adrenal illnesses can cause false positive results on Cushing's tests. Elevated lipase and amylase levels can be indicators of pancreatitis in our furbabies. The cPL/cPLI test can confirm pancreatitis in ones pup, was this test done on Apollo? Please ask your vet/IMS about this.

Love and hugs,
Lori

[apollo6]

Originally Posted by apollo6
ACTH STIM TEST:cORTISOL SAMPLE 1-6.9UG/DL CORTISOL SAMPLE 2-37.0
URINALYSIS-Antech-NEGATIVE, SPECIFIC GRAVITY 1.017, OKAY I guess
Waiting for URINE CULTURE MIC RESULTS.
LAST BLOOD PANEL FROM 5/23/10-IMPROVED Amylase-1611(still high but in Sept was 6675
Lipase-improved 2776(still high but in Sept was5969)
Neutrophilis improved 6468(still high in Sept was 14168)
Lymphocytes went up 1176 was 966
WBC IMPROVED WAS 16.1 NOW 8.4
AST(SGOT) 88, ALT -827ALKALINE PHOSPHATASE-854, GGT-131( WERE WITHIN NORMAL RANGE IN SEPT
BUN/CREATINE NOW 62 WAS 34, PHOSPHORUS NOW 6.3 WAS 5.4-nOT SURE IF THIS HELPS. THANK YOU

LIVER OKAY, GALL BLADDER OKAY.

[frijole]

We have a member here who is a lab tech with over 20 yrs experience. If she sees this she can give you some input. The acth test does indicate high cortisol and could mean cushings. Did you do any other tests for cushings? Normally in addition to the acth test a low dose dex suppression test (LDDS) is done. It is an 8 hr blood draw test. I would recommend doing that to make sure it is cushings.

High ALK PHOS levels are signs of liver issues which could be cushings.

Lori asked about the lipase and amylase levels which can mean pancreatitus. Has Apollo had upset stomach/vomiting? Please share all you can about the symptoms. Thanks!! Kim

[StarDeb55]

I'm the lab tech that Kim mentioned. There are a couple of things that pop out on Apollo's lab results. The BUN/Creatinine, I assume is the BUN/Creatinine ratio, could you please confirm that? I also need to know the individual values for BUN & creatinine. All of these tests including the phosphorous are used to evaluate kidney function. The ratio is extremely high, but I can tell more if you will post the individual values.

I agree with Lori that in light of these serious elevation of lipase & amylase a cPL/cPLI test is very much in order to see if Apollo is dealing with pancreatitis. Acute pancreatitis can be life threatening, if severe enough, so you don't want to mess around. An elevated neutrophil count is a sign of possible bacterial infection. Pancreatitis might be one explanation for it, or even something as simple as a UTI. The urine specific gravity of 1.017 is at the low end of normal (1.015-1.045). This is kind of unusual in a Cushpup as they can't concentrate their urine & a specific gravity is usually pretty low, <1.010, as their urine is more like water. ( Water has a specific gravity of 1.000). Apollo does have elevated liver enzymes which is common with Cushing's, but in light of the possibility of pancreatitis, kidney disease, or some type of bacterial infection, Cushing's may not be the only explanation for the elevated liver function tests.

Hope this helps.

Debbie

[apollo6]

thanks will ask.

[apollo6]

Yes it is the Bun/creatinine. He doesn't throw up, but he seems more tired, gurgling going on. Still waiting for urine Culture Mic,
Bun:31,Creatinine:.5, the Phosphorus 6.3, Glucose 109, Calcium 9.9, Magnesium 1.9, Sodium 151, Potassium 5.4, Na/K Ratio 28 , Chloride 104, Cholesterol 278, Triglyceride 75, Amylase 1611( was 6675 in September 2009)
Lipase 2776( was 5969 in September)
Neutrophilis is 6468(Was 14168 in September 2009) hope this helps, thank you so much
Sonja

[apollo6]

thank you will read your posts.

[apollo6]

thank you for the input

[apollo6]

My Apollo is having the weakness in the hind legs. It kills me to see him go through this. On lighter side, I was born in Toronto, ONtario.
Thank you for your input. Will pray for your angel.

[apollo6]

Thank you for taking the time for the post, will read. helpful to know I am not alone in this.

[StarDeb55]

Are you in Canada? If so the reporting units on Apollo's labs may be different than what we are used to seeing in the US. Could you post the reporting units for the BUN, creatinine, phosphorous, & all other chemistry tests that you have posted. These will be something like mg/dl, nmol/L, etc., normal ranges for tests are also for helpful. I really can't offer valid input on labwork without these items.

Debbie

[Harley PoMMom]

Hi Sonja,

Hope this helps:


I thought I would "bump up" this thread since there are so many active discussions going on right now re: trilostane/Atypical Cushing's/the UTK adrenal panel.

For anyone who is considering requesting the UTK panel for their dog at any point in their treatment, I strongly encourage you or your vet to first correspond with Dr. Oliver at UTK in advance. Thus far, Dr. Oliver has always been very willing to talk directly to pet owners in addition to vets. There can be so many variables involved in each dog's situation. Dr. Oliver can best tell you whether the UTK panel might be helpful to you, and if so, what the best timing would be (e.g., must the trilostane treatment be suspended, and if so, for how long a time).

Here's a link providing general contact information for Dr. Oliver:

http://www.vet.utk.edu/faculty/oliver.php

Dr. Oliver's email address is: joliver@utk.edu.

Marianne

Love and hugs,
Lori

[apollo6]

Please help, I am so overwhelmed got back urinalysis cult no infections. He is panting now is that a sign? the thirst, the hair loss is somewhat stable, the pot belly is there, the skin infections are more like ingrown hair with pus, the hind legs are weak. I have been told to get information from University of Tn, Dr. Oliver. Medications, Lysodern, new one Vetoryl, Trilosine, etc. will see one vet on June 17th, feel like I should go sooner. I am crying all the time now. think I should get Dex test in addition to Ach test, blood panel and ultrasound had. Told should let Veterinarian endocrinologist.

[Harley PoMMom]

First, lets just take a deep breath here, ok? I know this Cushing's Disease can get quite overwhelming but lets try to take some steps here to figure out a plan of action.

Debbie asked for the reference ranges for the chemistry panel results, could you get those for us.

If a non-adrenal illness, like pancreatitis or diabetes, is present in a pup while a cushing test is being performed then a false positive result could happen. So with Apollo's lipase and amylase being elevated, these are pancreas enzymes but not specific to the pancreas only, I would have him tested for pancreatitis first.

You wrote you already got an ultrasound? Exactly what did it say? Anything on there about the adrenal glands?

Panting is normal in our cush pups so don't let that alarm you.

We are definitely here for you...you are not alone on this journey, ok.
;):)
Love and hugs,
Lori

[zoesmom]

Sonja - Don't despair yet. I think it would be a good thing to see a veterinary Internal Medicine Specialist (some specialize in endocrinology, but any IMS should be fairly well versed in cushings). You've had the ACTH and it suggests possible cushings as do Apollo's symptoms. But it can be a tricky diagnosis and I wouldn't treat, based on that alone. The recommendation for a pancreatic enzyme test is a good one, too, based on what you've said and it's something an IMS could also do, if you are moving on from your gp vet, as sometimes we have to do.

Has any other recent labwork been done on Apollo, other than those results that were posted? Anything to rule out diabetes or low thyroid. If you are considering the adrenal panel through the Univ. of Tenn/Knoxville, a vet should contact UTK to get instructions on how to submit a blood sample for the full adrenal panel. (Those are also posted online, but your vet may wish to actually speak to someone first hand, regarding the testing that can be done thru UTK.) The full adrenal panel is always a good test to do - especially before making any treatment decisions.

I know that some contact information for UTK/Dr. Oliver/labs there have been recently posted in two or three other threads. In 'questions and discussions', check Rebelsmom's thread and O'Riley's thread and go to their last two or three pages, to read more. In those threads, look for the 'page numbers' - at the top or bottom of ech page - and then click on 'last' page and then you can work backwards in the pages from there. Sue

P.S. Here's a link providing general contact information for Dr. Oliver:

http://www.vet.utk.edu/faculty/oliver.php

Dr. Oliver's email address is: joliver@utk.edu

[zoesmom]

Thanks, whoever just added those links for Dr. O and UTK !:p:p:p:p

Duhhh, I see Lori posted the info on the previous page, too!!! Can't hurt to have it posted on every page, I guess. :)

[StarDeb55]

Sonja, trilostane & vetoryl are the same thing, trilo is the brand name, vetoryl is the generic. I'm in agreement with Lori, you really need to have the pancreas checked prior to proceeding with any further Cushing's testing. Non-adrenal illness can give you false positive results on Cushing's test, but that is less likely to occur with an ACTH, I believe. Cushing's is extremely difficult to diagnose as its symptom can overlap with several other conditions. This is why it's very important to get any positive result such as an ACTH or low dose dex test confirmed by a 2nd test.

I really do need those normal ranges that I asked for in my earlier post. It's possible that there may be a kidney function issue in play with Apollo, but I can't tell for sure without seeing those normal ranges.

Debbie

[apollo6]

He doesn't throw up, but he seems more tired, gurgling in stomach area going on.
Bun:31,Creatinine:.5, the Phosphorus 6.3, Glucose 109, Calcium 9.9, Magnesium 1.9, Sodium 151, Potassium 5.4, Na/K Ratio 28 , Chloride 104, Cholesterol 278, Triglyceride 75, Amylase 1611( was 6675 in September 2009)
Lipase 2776( was 5969 in September)
Neutrophilis is 6468(Was 14168 in September 2009) hope this helps,
Urine cult showed no infections.
thank you so much
Sonja

[StarDeb55]

Sonja, I don't need the results again. There are units of measurement associated with each result such as mg/dl, ng/L, etc. I need those units of measurement, along with the normal ranges for the test you have posted.

Thanks,
Debbie

For Example: In a person, the normal range for a blood glucose is 70-110, with the units of measurement being mg/dl. Each of the results you have posted should have the information posted in a column right next to the results

[Harley PoMMom]

Hi Sonja,

I think we may be confusing you about giving us the normal ranges, so what I am going to do is post here some of my boys chemistry's results with the units of measurements and normal ranges, ok? The numbers in parenthesis () are the numbers that fall into the normal range.

Harley

BUN 22 mg/dl (6-25)-normal range
Glucose 98 mg/dl (70-138)
Creatinine .8 mg/dl (.5-1.6)

Hope this makes sense!

Love and hugs,
Lori

[apollo6]

Please advice on how to get info to Dr. Oliver, I sent email and this is his reply
>>>If you've made the diagnosis already of increased adrenal activity, then you need to discuss the treatment with your veterinarian. I can't make medical recommendations on a patient I haven't seen, and I also don't see patients. Our website has treatment information that can be discussed with your veterinarian. See www.vet.utk.edu/diagnostic/endocrinology. That's the best I can so for you. Regards, Jack.
Did you go there ?

[labblab]

Hi Sonja,

I saw that you had started a new thread, hoping to get some feedback about contacting Dr. Oliver. However, I've gone ahead and added your post to your original thread about Apollo. In the long run, this will make it much easier for the rest of us to offer you feedback that is helpful, and also to keep track of everything that is going on with Apollo.

Of course, I cannot speak for Dr. Oliver. But I'm guessing that this is what he is meaning to convey to you in his email reply: Since Apollo has already had an ACTH test performed which showed an elevated cortisol level consistent with Cushing's, treatment for the elevated cortisol would take precedence right now over other testing that Dr. Oliver's lab could perform. Dr. Oliver does not directly treat dogs -- you will need to consult with a local vet in your own area about which Cushing's treatment is most appropriate for Apollo.

I'm not sure from reading your earlier posts whether or not you already have a consultation lined up with a veterinary specialist? If so, I think that's your best "next step." If it were me, I'd be most interested right now in following up on the testing for pancreatitis that has been recommended by Lori and Debbie, and also in having an abdominal ultrasound performed.

It does sound as though Apollo suffers from several classic Cushing's symptoms. But acute pancreatitis should be ruled out, as should any other major organ issue that may be complicating his situation. Blood testing and an ultrasound can help with both of those questions. And an ultrasound can also be very useful in confirming a Cushing's diagnosis on the basis of the appearance of the adrenal glands.

So at this stage, if it were me -- I'd take Dr. Oliver's advice and move on to consulting locally with a specialist who is in your area. Do you already have an appointment set up with somebody?

Marianne

[apollo6]

thanks
ULTRA SOUND WAS TAKEN JANUARY 21,2010
Findings
Adrenal glands: both adrenal glands are generally enlarged with normal shape and echogenicity. The caudal pole of the adrenals measures left+ 7.0 mm, the right=6.9mm.
liver and gallbladder: the liver is generally enlarged and hyper echoic.There are no hepatic riodules or masses. The gallbladder contains a small amount of echogenic debris.
Kidneys and urinary bladder: Both kidneys have decreased corticomedullary definition. The urinary bladder was is mildly thickened.

Gastrointestinal tract: there is mild diffuse thickening of the small intestinal walls with prominence of the muscularis layer.
Pancreas: The pancreas is enlarged and hyper echoic. The surrounding mesentery is hyper echoic.

the remaining abdominal structures including the spleen, abdominal lymph nodes and peritoneal space are with in normal limits.
Conclusion:
1. Bilateral adrenomegaly. Rule out pituitary dependent hyperadrenocorticism and normal variation.
2. the appearance of the pancreas is consistent with acute on chronic pancreatitis.
3. diffuse thickening of the small intestinal walls. Rule out IBD and enteritis.
4. Hyper echoic hepatomegaly. Rule out steroid hepatopathy, hepatitis and less likely diffuse infiltrative disease.
5. Gall bladder sludge is a common incidental finding in a fasted patient. Other causes such as biliary stasis and cholecystitis are considered unlikely.
6. The appearance of the kidneys is consistent with chronic or previous inflammation. Clinical correlation is necessary to ascribe significance to this finding.

Recommendations:
Recommend adrenal function testing. If clinical signs are persistent despite medical management of pancreatitis/enteritis consider an GI panel +1- intestinal biopsies.

[apollo6]

Dr Oliver emailed me back this morning saying he would be happy to talk to my vet about they do. So he seems to be very nice to take the time.

[labblab]

Sonja, thanks for posting all the info from the ultrasound performed in January. I now understand why pituitary Cushing's is strongly suspected given Apollo's symptoms, the bilateral enlargement of his adrenal glands, and his elevated ACTH test results. In your very first post, you mentioned that a specialist has recommended treatment with Lysodren. Did this same specialist perform the ultrasound and also the ACTH testing? You mention an appointment on June 17th -- is that with this same vet?

Hopefully others who may be more knowledgeable about testing results will also stop by to comment. But from quickly glancing through the ultrasound report, I think that the bulk of the results would not be surprising for a dog with untreated Cushing's. I am still concerned whether or not there are further plans for testing for pancreatitis, however, since the report does talk about evidence of either chronic or acute pancreatitis.

We're kind of back to your initial question, however, which is whether or not Lysodren (as recommended by the specialist) is an effective Cushing's treatment. And the answer to that is "yes." And we have many members here who are treating their dogs with Lysodren. So if there are no other acute medical issues that need to be addressed beforehand (such as pancreatitis), I understand why the specialist is recommending that you proceed with Cushing's treatment. Once again, can you tell us who Apollo has the appointment with on the 17th?

Marianne

[apollo6]

Bun/creatinine ratio 62-range 4-27
Bun:31,- range 6-31
Creatinine:.05-range .5-1.6
the Phosphorus 6.3-range 2.5-6.0
Glucose 109-range 70-138
Calcium 9.9-range 8.9-11.4
Magnesium 1.9- range1.5-2.5
Sodium 151-range139-154
Potassium 5.4-range 3.6-5.5
Na/K Ratio 28-range 27-38
Chloride 104-range 102-120
Cholesterol 278- range92-324
Triglyceride 75-range 29-291
Amylase 1611( was 6675 in September 2009)-range 290-1125
Lipase 2776( was 5969 in September)-range77-695
Neutrophils is 6468(Was 14168 in September 2009) -77% range 2060-10600
Lymphocytes-1178 14% range 690-4500( was 966 in Sept 2009)
Monocytes -672 8% range 0-840(was 966)
WBC-8.4 RANGE 4.0 -15.5( WAS16.1)
URINE CULTURE
NO INFECTIONS NO GROWTH ON SOLID MEDIA
SPECIFIC GRAVITY 1.017 RANGE 1.015-1.050
PH 6.5 -RANGE 5.5-7.0
PROTEIN,GLUCOSE-STRIP, KETONES, BILLRUBIN , OCCULT BLOOD- ALL NEGATIVE.
INTERNAL MEDICINE VET NOTATION: because Apollo t4(ed) NORMAL rule out hypothyroidism. says suggest pituitary dependent Cushing but ultra report says no. this is were I am very concerned with conflicting conclusions.
hope this helps,

[apollo6]

Yes
I posted results of Ultrasound -enlarged adrenal glands both sides,
Test I had were
Sept 2009 Blood Panel
Jan 2010-Ultrasound
May 2010-blood panel
May 2010-Urine Cult
May 2010-another ultrasound-only comment was gall bladder has slug which is normal
May 2010-ACHT STIM TEST
MAY 2010-BLOOD PRESSURE
POSTE SOME OF RESULTS
THANKS

[apollo6]

I HAVE UPPED THE APOINTMENT FOR June 9TH WITH MY VET WHO HAS BEEN TREATING APOLLO FOR A WHILE. He is a DVM specializes in acupuncture, but is the one who got me started on getting the test. He feels I should be going to a specialist.He referred me to an internal medicine Vet who did the Ultra sound, she wasn't open to any options other then Lysodren. I have some who are closer to where I live and are specialists in endocrinology.
I would need his referral to go there. On Wednesday I will be going over all of this with him.

[labblab]

INTERNAL MEDICINE VET NOTATION: because Apollo t4(ed) NORMAL rule out hypothyroidism. says suggest pituitary dependent Cushing but ultra report says no. this is were I am very concerned with conflicting conclusions.
hope this helps,
I know the language of these reports can be so confusing! But my interpretation of the ultrasound report is that the appearance of the adrenal glands actually IS consistent with pituitary Cushings:


1. Bilateral adrenomgaly. Rule out pituiary dependent hyeradrenocorticism and normal variation.

What this means is that both adrenal glands appeared to be larger than normal. One possible explanation would be pituitary dependent Cushing's. The other would be the possibility that Apollo's adrenal glands are normal for him, but just look a bit bigger than would be expected. You'd have to do further testing to rule out one or the other explanation. The way that you would look for confirmation that the adrenal glands truly are enlarged as a result of Cushing's, would be to perform either an ACTH or LDDS diagnostic blood test.


Recommend adrenal function testing.

And that's what was done when the ACTH test was performed last month. The fact that it was also consistent with Cushing's means that BOTH of those test results -- the ultrasound and also the ACTH test -- are pointing in the same direction: that Cushing's is the cause of the enlargement of Apollo's adrenal glands.

Marianne

[labblab]

I HAVE UPPED THE APOINTMENT FOR June 9TH WITH MY VET WHO HAS BEEN TREATING APOLLO FOR A WHILE. He is a DVM specializes in acupuncture, but is the one who got me started on getting the test. He feels I should be going to a specialist.He referred me to an internal medicine Vet who did the Ultra sound, she wasn't open to any options other then Lysodern. I have some who are closer to where are live and are specialists in endocrinology.
I would need his referral to go there. On Wednesday I will be going over all of this with him.
I think your vet is giving you really good advice by recommending that Apollo be followed by a specialist at this point. So if you don't feel comfortable with the IMS who performed the ultrasound, I do think you'll want to get a referral for another specialist promptly. One word in advance: Lysodren and trilostane (brandname Vetoryl) are really the only two generally effective treatments for Cushing's. Some vets do have a preference for one over the other, based upon their own personal experience and the results that they have witnessed with their patients. So no matter who you end up seeing, it may be the case that they will strongly recommend one medication over the other to treat Apollo. But you do want to find a vet with whom you can feel free to discuss options and concerns. I'm assuming this was not the case with the first specialist...

Marianne

[Harley PoMMom]

Hi Sonja,

Thanks so much for posting the ultrasound report as it does help alot. I believe it is critical that Apollo get his pancreas tested. It is a test called the spec cPL.

Here is a link about it: http://www.idexx.co.uk/animalhealth/laboratory/speccpl/
Here is a link about pancreatitis: http://www.cvm.tamu.edu/gilab/research/Pancreatitis.shtml

Dr Oliver had told my vet with my boy's pancreatitis that it had to be under control before any testing could be done. If you need more information about the spec cPL test please let us know, ok.

Love and hugs,
Lori

[StarDeb55]

Sonja, thanks for posting the remaining info. I agree with Lori, the pancreatitis most definitely needs to be addressed first, prior to doing any further Cushing's testing. Now, the one thing I am concerned about is Apollo's kidney function because of the severely elevated BUN/creatinine ratio, & the slightly elevated phosphorous. IMO, you should ask the specialist or which ever vet your seeing about these tests & what this means for Apollo's kidney function. Either issue may affect any further Cushing's testing, so I would address these 2 things first.

Debbie

[apollo6]

I will discuss with vet on Wednesday . He doesn't throw up and is not losing weight.

[apollo6]

The internal medicine doctor only discussed Lysodren, because she works with it the most and felt it was the best option.

[apollo6]

I think I already posted the ACH STIM TEST
Cortisol Sample 1 6.9 range(1.0-5.0 pg/dl

Cortisol Sample 2 37.0 range (8.0 -17.0 pg/dl)

[Harley PoMMom]

I will discuss with vet on Wednesday . He doesn't throw up and is not losing weight.

If you are referring these symptoms to pancreatitis, my boy Harley was not displaying any signs of pancreatitis when it showed up in the ultrasound and then it was confirmed with the spec cPL test that I mentioned to you. In fact when his spec cPL results were 464 (0-200) his lipase and amylase were both in the normal ranges. This is why the spec PL test is very important to have done whenever pancreatitis is suspected. Pancreatitis can be life-threatening to a pup.

Best of luck with your appointment on Wednesday.

Love and hugs,
Lori

[apollo6]

I went to vet, June 9th, 2009. Says Apollo does need treatment, the challenge to find the right one. Feels, Apollo has PHD cushing's, doesn't think horomone based. But he wants me to go to specialist(endocrinology) ask the specialist to do the ACTH STIMULATION TEST W/SEX HORMONES. Like some members have suggested to send to UNIVERSITY of Tennessee, to determine which would be the right form of treatment. Then specialist can advice me .
My vet said this would be important in so far as treatment consistent with results, to determine which medication will be the bests for Apollo.
with increase in sex hormones treatment with Lysodren.
if just increase in cortisol treatment with Trilostane.
Scared because Gem's mom posted her dog was not doing well on Lysodren.
After getting referral to specialist, found out she is on maternity leave until August( fell to long to wait) . will have to call my vet to get another referral. This is so hard and scary.

[marie adams]

Hi Sonja,

I just got Maddie's results back from the vet today from 2nd loading in a month. We are using Lysodren--was afraid of it in the beginning, but after the help from everyone here not so bad. Each type of treatment (Lyso or Tri) from my reading has good and bad points like anything in life does when it comes down to medicine. Is it frustrating? OH YES!!! :mad: Is it SCARY? OH YES!!! :eek: I told my daughter on Monday evening after getting Maddie's stim test done that I can't do this any more because I feel like I didn't go long enough on the loading which will mean her numbers will come in high again, but then on the other hand I feel like I might have given too much because she was shaking more in her hind legs---what a roller coaster.....:confused::confused:

Now I am relieved since her numbers are good Pre 2.5 Post 3.2 these are in the range of of 1-5.

Hang in there!! You will get through it and everyone is here to help and the internet is very helpful along with the links this site has for you.

Take care!!!:):)

[Harley PoMMom]

Hi Sonja,

If used within their own protocol's, both Trilostane and Lysodren are life-saving drugs for our cush pups. IMO, When one has an experienced and knowledgeable vet/IMS, and has educated themselves on Cushing's Disease and the medicine of choice, then this Disease and the medicines that treat it become less scary.

What did the vet say about Apollo's kidney function tests and the pancreatitis? Both of these questions should be answered before starting treatment, especially the kidney function tests. Both of these have to be taken in consideration if treatment is to be started.

Love and hugs,
Lori

[apollo6]

trying to get courage to make appointment with internal vet specialist, will ask about both pancreasis and kidney function.
To put my little guy through this tears me apart. But my vet said if untreated Cushing causes more complications. will keep you posted.

[lulusmom]

Sonja,

I have two dogs with cushing's, one is 4.5 lbs and the other about 7 lbs. Both have treated with Trilostane and Lysodren and did well on both treatments with no adverse side effects. Both started on Lysodren, then switched to Trilostane and back to Lysodren. The reasons why all the switching is too long to go into but I justed wanted you to know that all sizes of dogs do extremely well on both drugs. The key is having an experienced vet/ specialist direct the treatment and you do your homework on whatever treatment you decide on. There's plenty of reference material here on both drugs in our Helpful Resources section. I've included handy links below for your ready reference.

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

http://k9cushings.com/forum/showthread.php?t=181

Please know that we're here to hold your hand and help you learn so that you become an excellent advocate for Apollo. Consider us to be Apollo's back-up advocates while you get your footing and of course, we're your boy's hooten and hollerin cheering section. :D:D:D

[apollo6]

Well I made the appointment with the veterinary specialist, internal medicine and background in endocrinology. Will be taking Apollo on June 17th. They will get all tests done from the other vets.
Bringing my Mom for support.
will keep you posted. And thank you for the input and support.

[Casey's Mom]

My Casey has been treated with Lysodren for the last year and a half, has gained back her muscle tone in her back legs and at 14 is doing wonderfully. You will have our support and knowledge to help you through this as well as the vets.

Your little Apollo is such a cutie and you will do fine.

Love and hugs,

[apollo6]

Thanks all for the support and the encouragement it helps allot.

[mypuppy]

Hi Sonja,
I cannot offer any advice on lysodern treatment b/c I treat with trilo. I just wanted to say what a cutie Apollo is. He is just adorable. I wish you a smooth and successful treatment. Tight hugs and kisses. Jeanette and Princess

[apollo6]

thank you, so is yours

[apollo6]

I go on Thursday to the specialist to get maybe one more test to make sure on the right treatment. I am crying all the time. Every Time I read about one of your angels passing, it just tears me apart. I am so afraid of this appointment and pray to God, I am guided to do what is best for my little rascal.
Once again thank you for your support and input.

[mypuppy]

We all understand what you are experiencing right now, specially the tears part--God knows we have had our fair share of those since our babies were diagnosed. I assure you as frustrating and overwhelming this all is, you will reach a better place once you feel a bit more confident with treatment. I look forward to some good updates and that all goes smoothly for your precious baby. Warm regards. Xo Jeanette and Princess

[apollo6]

Thanks so much.

[StarDeb55]

I noticed that you asked on Chloe's thread about starting the melatonin & flaxseed oil. You really need to wait until you have a definitive diagnosis as cortisol, along with the associated sex hormones, produced in the adrenal glands are made in very, minute quantities. You do not want to be giving anything that can disturb the production of these various hormones until you have a definitive diagnosis, & any medication, including the homeopathic ones are cleared by your vet.

Debbie

[apollo6]

Thanks for the input . I thought so.concerned about the skin sores, and now a lump on the underside of his tail.

[apollo6]

I am really having a hard time with this. I see the specialist on Thursday. I am obsessing so much, going on the Internet and getting overwhelmed by all the input. Am I doing the right thing by Apollo. Getting the right treatment is the challenge. I read how you and your angels have to struggle through this. I need to be more positive for Apollo's sake. Any input from the rest of you would greatly be appreciated.

[frijole]

Your fear of the unknown is normal and born out of your love for Apollo. You are doing everything right! You have done your research and gotten up to speed. You are to the point where you know enough to be your dog's voice in this and question when you need to. And you know that there are many here willing to help you.

So you are ready for this journey! You just don't know it yet. ;):p Hang in there. Kim

[apollo6]

I can not thank you enough. Will let you know after Thursday.
Thank you .

[marie adams]

Hi Sonja,

I remember in the beginning I didn't know this disease existed. I finally found a link to Cushings; I was the one who told the vet what Maddie had. They did all the testing and said I was right, but they didn't know much about the disease. I found the Cushings link on a Friday night, in less than 2 weeks I started loading Maddie, then I found this site. I was all alone in the decision making of which drug to use. I had wanted the Trilo in the beginning, but I went with Lyso because it would treat both types of tumors without doing more testing and stress on Maddie. I just wanted her to get better and the sooner it started the better.:D:D

I was nervous, scared, stressed in the beginning--without the help of the vet:mad:, but all the help from everyone here I got through the first go around:). They have all been here for this second go around also. They still go through the same emotions we are going through and then we get to give a little support back.

You will get through this, just be positive, and you will be surprised how much you understand when you talk with the specialist.;)

[Roxee's Dad]

Hi and a very belated welcome from me. I haven't posted as I had nothing of value to add to the great advice you have been given.


Any input from the rest of you would greatly be appreciated.

You have taken the first step, getting the education, :)you are in the process of the 2nd step, getting a proper and thorough diagnosis. :)Together with the education and diagnosis, you will be an excellent advocate for Apollo. Lastly, stay positive and continue to inquire and ask any questions here and of your vet. Remember, cushing's is treatable and with proper care, your Apollo can go on to live a wonderful and happy life. :) He will need you now more than ever.

[apollo6]

I am so grateful for the support . I think in addition to the ACHT ?TEST , should also get the LLDS?(LOW DOSE DEX TEST) and the test from DR. Oliver(University of Ten) on the hormones.
In reading I read the LLDS test can differentiate better between whether PHD OR Adrenal cushing's?

[zoesmom]

Deep breath . . . you are doing fantastic and seeing the IMS/endocrinologist is an excellent idea.

So you've already done the ACTH. And an u/s and general labwork - and am sure the IMS will be looking at those results.

I'm guessing he'll recommend an LDDS (8 hour diagnostic test) and, I hope, suggest doing the spec cPL (test for pancreatitis, given Apollo's elevated lipase/amylase #'s) He may want to do that one before doing the LDDS, to make sure there's nothing going on that will skew the LDDS results (false positives or negatives).

IF he wants to send off a blood sample to UTK (at Dr. Oliver's school), then you can combine the cushings tests using just one blood sample . . . those can include the secondary hormones (which can also cause some cushnoid symptoms), along with an LDDS ( a cortisol suppression test) and (I think) also an ACTH (a cortisol stimulation test). That way, you'd not have to get a separate LDDS test and you'd be covering all the bases before starting tx. But I'd go with what the IMS thinks - as you've already had the one acth done. One reason you might want to do the UTK tests is to determine if any of Apollo's secondary hormones are screwed up (in addition to the cortisol) before you start discussing any cush drugs (Trilostane is not usually the best choice if a dog has some of those secondary hormones out of whack). Why not write out your list of questions before you go on Thurs. That way, you won't forget anything you want to discuss - because of stress. Sue

[apollo6]

Great suggestion on all your input. Will do a list . Tomorrow go to specialist. Will keep you posted.
Thank you all.

[frijole]

Go get 'em! We are cheering you and Apollo on. Hugs, Kim

[mypuppy]

Sue,
We discussed this before, but have another question for you or anyone else who would want to reply. Comsidering Princeess's symptoms have not yet resolved but stim nos are great, are you saying elevation of those other secondary hormones can cause the cushings symptoms anyway? If so, oh boy! As previously mentioned we unfortunately did not perform the full a. panel and at this point is that the only sure way of knowing whats going on with those hormones which I am still torn because I DO NOT want to interrupt treatment. Appreciate your reply. Warm regards. Jeanette

[labblab]

Jeanette, I'm not sure whether you've already had the chance to look over the discussion in the following thread, so I'm going to include the link here:

http://www.k9cushings.com/forum/showthread.php?t=1896

And I'm thinking that you'll want to look it over, too, Sonja. As Glynda points out in her reply on the thread above, it is likely to be a given that a dog with elevated cortisol will also exhibit elevations in intermediate hormones as well. Dr. Oliver additionally tells us that trilostane, itself, inevitably elevates some of the intermediate hormones. But the big question is whether or not those elevations are, or will become, clinically significant for any given dog in terms of producing symptoms. And I'm afraid that until more research has been completed, the jury is still out as far as understanding how the pieces of the big picture are connected.

Since Apollo has already exhibited elevated cortisol per an ACTH test (and both adrenal glands are enlarged on ultrasound), it may or may not be the case that the new specialist will feel that running the UTK full adrenal panel will be all that useful at this time. As stated above, even without the UTK testing, we can already predict that Apollo will also exhibit some intermediate hormone elevations as well. Some specialists may feel that knowing about the specific pattern of the intermediate elevations can be important prior to deciding which medication to use to treat the elevated cortisol. But other specialists do not feel that this is the case. And I don't know that anybody can yet say for certain that there is a proven "right" or "wrong" answer in that situation. Right now, I think there is more general agreement as to the value of performing the UTK panel for a dog who is symptomatic, but for whom elevated cortisol has been ruled out via an ACTH or LDDS -- in other words, if elevated cortisol is not the issue, then what is? But in Apollo's case, we already have a "positive" ACTH indicating elevated cortisol.

Jeanette, again this is just my personal opinion, but I think you are still at the stage where I'd first be ruling out all other causes for Princess' ongoing symptoms before going the route of testing the intermediates. For instance, perhaps she is a dog who needs to have her cortisol maintained at a level that is at the lower end of the ideal therapeutic range rather than at the higher end (5+), since all of her symptoms DID resolve back on the first go-round of trilostane (when she dipped too low). But hopefully we'll know more after her next stim test.

Sonja, good luck with your visit to the specialist! We'll all be really anxious to hear what you find out.

Marianne

[mypuppy]

Thank you Marianne. I will read the link tonight when the little ones are in bed. And yes, I do understand we must do further work up on Princess to rule out any underlying problem, and will address those when we return from our vacation 2nd week in July. Taking the Princess to the Outer Banks--beach here she comes. We wanted to give Princess a very well deserved vaca. We can't wait. So happy to hear from you as always. Luv ya bunches. Xo Jeanette

[apollo6]

Please excuse me for such a long post, but I wanted to check in with you for input on my appointment.

Appointment/consultation with Dr. John Hart
1. Explained all issues with Apollo, the lump under his tail, the sores, the weakness in hind legs, all test done, tests wanted.
2. Took over an hour to talk to me.
3. Took temperature-normal, checked eyes out with special glass to see if blindness starting-eyes look good other then age related? Checked Apollo’s prostate(didn't know they did that)
4. Asked about taking dose of Prednisone home, said give safe doses so would not need it, if crisis would have enough time to go there and get?
5. I asked about the UTK TEST and the LLDS test, said if I wanted to could do, but based on the findings, both adrenal glands similar enlarged, and the ACHT STIM TEST coming back with high cortisone results, likely PHD Cushing . Said could still do after Cushing symptoms are controlled?
6. If Atypical ACHT STIM test would have shown cortisone as normal? Is this so? Then the ACHT STIMULATION TEST W/SEX HORMONES IS DONE?
7. Concern about thickening in intestines, but because Apollo has gained about a pound and not throwing up or having diarrhea considers this a good sign.And some of his vitals improved was also a good sign?
8. Concern about liver values up-Alt -800, put did not suggest the SEP CPL TEST,
9. Also took biopsy of lump under Apollo tail to test.
10. Conclusion: most likely PHD starts with Trilostane (Vetoryl) at 30mg. Once a day in morning with food. Continue other medications and supplements as prescribed. Order medications on line suggest 1-800petmeds.com. Monitor for vomiting, lethargy, loss of appetite.
11. Call Doctor in a week to check how Apollo is. If need to come in early if problem do so. Don’t change his diet right now until he adjusts to medicine. May have to lower or go higher depending on how Apollo reacts to medicine. Prefers Trilostane over Lysodern, because not as lethal in destroying adrenal glands and can always stop if adverse effect on Apollo. Get an ACHT STIM test 10-14 days after on medication this long. Said I could do with my Vet if I wanted to. But feel if he is doing the monitoring shouldn't’t he have the report. Then said if all is well done every 6 months or longer.
12. Apollo has always had a big appetite, so there is no difference from before, but the drinking a lot more, the weakness in the hind legs, and sores, and hair loss are new in the last year. The hair loss is stable right now.
13. Asked if could go on trip with Apollo, once stable within 4 weeks would be okay.
I have not started the Trilostane.
Now my brother emails me a friend of his Vet/chiropractor,Nancy and Meagan have had some remarkable success treating dog's with Cushing's using homoeopathic .
This just got me more overwhelmed.

[apollo6]

thank you for your input. I started a new thread showing what the specialist said in point form under :Apollo Trilostane(Vetoryl)
And he is of the same opinion as you stated.
Waiting for all your input on the visit.

[frijole]

Hi there! You did it! I really can't help regarding the trilo and hope someone can help make sure that dosage amount seems right for Apollo.

But I can say that the vet sounded really thorough, spent a great deal of time with you and none of his responses surprised me. I think you found a good one. :)

Regarding the miracle cure you mentioned at the end... I've been here for four years and haven't seen one come true yet. If its those miracle cush drops tell them not to waste their money. I would love to hear the information but understand that unless they can prove that cortisol levels went down (by doing tests) I won't give it any credit. Please know you are doing the right thing with doing exactly what you have. So no worries my friend. Trust me... you are doing great! Kim

[apollo6]

That really make me feel better, getting your input. Now starts the journey. Trying to be positive and praying God will help.

[AlisonandMia]

Hi Sonja,

I have merged your old thread with this new one - but kept the new title.:)

Good luck with the treatment - we are all here for you and Apollo!

Alison

[labblab]

Hi Gloria,

I'm so glad that you feel good about your appointment with the specialist! And everything that he has told you about the Vetoryl treatment and testing schedule sounds very good to me :) -- having prednisone on hand, what you need to watch for, checking in with him, and having the follow-up ACTH performed soon. The only remaining question I have in that regard is: how much does Apollo weigh? Initial dosing goes by the dog's weight. So once we find that out from you, we can give you more feedback about the Vetoryl dose.

The only other question I have is whether or not you had the chance to discuss the possible pancreatitis with the specialist? It sounds as if no other tests are being recommended at this time, so I am just wondering whether the vet said anything specific about Apollo's pancreatic lab values?

Marianne

[apollo6]

Apollo weighs 10.6 lbs but is usually 9.8 to 10lbs. I have not started the dosage yet, because I am concerned 30mg. capsule might be to high for him. He is very sensitive.
The vet asked if there was mucus or blood in the stool , I said no.
But He still has gurgling in his stomach. so not sure if should pursue on pancreas. Noted that Apollo has had previous episodes of pancreatitis.

[apollo6]

thank you, wasn't sure what to do.

[labblab]

Darn! I, too, would be concerned about starting Apollo at 30 mg. :(

The most recent recommendation of Dechra, the company that makes Vetoryl, is to start dogs off using a formula of 1 mg. per pound. So in Apollo's case, that would be 10 mg. of Vetoryl instead of 30. I found this out by talking directly to one of their technical representatives in their Kansas office. He is a vet, and his name is Dr. Allen. Either you or your vet can call him directly, as well, to get this updated information:

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

Your vet is probably following Dechra's published dosing "table," which does recommend 30 mg. for dogs weighing between 10 and 22 pounds. But if he would be willing to call Dr. Allen at Dechra, they could talk about Dechra's revised recommendation. And Vetoryl is sold in 10 mg. capsules, so obtaining it in that dose will not be a problem. Plus, if it does turn out that Apollo needs a higher dose, it will be easy to keep adding on additional 10 mg. increments.

I know it may not feel too comfortable "questioning" your specialist about the dosing. But hopefully he will also think it is a good idea to call the Dechra rep in order to have a direct conversation about their new dosing recommendations. Dr. Allen is really nice and happy to discuss questions with both owners and vets.

Marianne

[mypuppy]

Hi Sonja,
I would definitely take Marianne's recommendation very serious. My IMS started my pup on Dechra's old guidelines before they modified it to a more conservative one, and not to frighten you but my pup's cortisol dropped extremely low on the higher end dose which for her was 120mg per day. She is now on 60mg. I hope this helps, and as Marianne pointed out you can increase need be slowly. BTW, if and when you decide on treatment. Here are prices for the vetoryl from valley vet.com against petmeds. It's a huge difference and free shipping.

Valley
10mg/30 tabs - 43.95
30mg/30 tabs - 53.95
60mg/30 tabs - 69.95
Petmeds
10mg - 79.99
30mg - 84.99
60mg - 99.99

[apollo6]

I will do so. My gut feeling was this is too high for the little guy. And my mother the old world Austrian said she felt it was to high for him and ask the doctor. She is the granddogmon. I am still waiting for the results on his biopsy on his tail and now his right eye has discharge, looks like an infection is somewhat red. I kept wiping gug out of it every few minutes. So I am not going to jump into the dosage. I read also 1mg per kilo? So this really concerns me.

[apollo6]

Thanks, will do so. Scares me that the vet prescribed such a high dose.

[apollo6]

thanks for the information on where to buy. But will check on dosage, like LAB/ said it is too high.

[apollo6]

I did call the vet. Said 30mg is what he start 1mg per kilogram. But if I want will prescribe 20mg(using two 10mg capsules) feels if I start Apollo on 10mg will cost more and take longer to get him increased. I don't care about the cost, I care about what Apollo has to go through. Feel very frustrated.

[zoesmom]

I definitely vote with you and Jeanette and Marianne on the dose. The 10 mg would be a much better starting place. And then you can add 10 more mg. to that, later, based on how he responds. We usually suggest that there be NO dose increases for at least the first 30 days, since the numbers can continue to decrease, even after the first ACTH at 10-14 days. It's your doggy and if you don't mind going slowly and possibly an extra ACTH test or two, then there's no reason for your vet to hurry things along. Sue

[apollo6]

thank YOU. If I look in the past every time he got vaccinated or had medications he was throwing up. He has a very sensitive stomach.
specialist said Prednisone is only to be given with Lysodern. If Apollo got sick enough would want to bring Apollo in, would not want want me to wait out .
The lump on his tail has no fluid in it , vet says looks like some kind of deep bony inflammation should go to regular vet for x ray. Always something.
While walking with Apollo he fell ( guess the weakness in the hind legs) got home and found a new little cut on his front paw. Is this all part of the effects of the Cushings. Looking into best price for Trilostane, got on website meant for vets, was shocked at the mark up. Eg. 10mg for $30.00 versus regular pet med site $43.95 and up to as much as $60.00.

[frijole]

It is recommended that patients prescribed trilostane also be given prednisone to have on hand in case of emergency. If you want proof of why then simply start at the beginning of Lulu's thread and read the story. I logged on one Saturday night and Lulus dad posted that she was in distress. She had gone too low. He had no prednisone. I told him to go to the ER room right away with the dog. Sure enough - they gave him prednisone. Read that thread. There is a link with info you could share with your vet. Alot of vets are not aware of this and don't worry about cortisol going too low because of the way it works. I am not trying to scare you because you probably will never have to use it. But if it were me I would demand it.

I also agree that starting low is WAY better with trilo. This is based on reading here over 4 years. My dogs used lysodren. Hope this helps. Kim

[apollo6]

I am open to all your input . Will try again to talk to the doctor with this information. We learn and help each other.

[mypuppy]

My first IMS refused to prescribe the prednisone for my pup when she started treatment even though I insisted after reading on this forum how important it is to have it, so I called my gp and he prescribed it for me, no problem. I feel a bit more at ease now. Hope you will be able to get it somehow. And you must share the site you found with that phenomenal low price on the vetoryl. That's the lowest Ive seen thus far. Wow! Take care and soft belly rubs for Apollo. Xo Jeanette

[apollo6]

Thank you. I will try pursits about the predisone. Apollo does so love his belly rubs.
xox Sonja and Apollo

[apollo6]

this is the site that has Trilostane at $30.00. The trick is that it is for veterinarians only. So if you have a good vet maybe they will do for you.


http://www.shopmedvet.com/product/15779/rxv?r=gmc-feed-mvi&gclid=gmc-feed-mvi

[mypuppy]

Thanks for the link Sonja. I'm thinking my IMS may be holding out on me and ripping off her patients if her facility is aware of this website and charging her patients 100.00 per 30 tabs. That is what my IMS charged me when Princess started her treatment --I paid a whopping 200.00 for a months worth of pills only. It is an outrage! Thanks to the forum I am now able to get it for so much less. Thanks again but in my case I think asking my vet to purchase these for me would be asking the world of her. Xo Jeanette

[apollo6]

What disturbs me the most is being aware of a markup of 40-60% vets are charging us to help our angles. I was charged $111.64 for 28 tablets,30mg., only got 15 had to call 4 times to get a credit of $57.19 , so it cost me $54.45 ,$3.63 a tablet.
The IMS said 30mg was the standard to start with, yet as you pointed out on a link for 10lb dog or less it is 10mg.
Most vets are drug happy. These are just some of the drugs Apollo was given over the years, DEXAMETHAZONE, DIPHENPHYDRAMINE, METOCLOPRAMIDE, PREDNISONE(SIDE EFFECTS-RASHES, HIVES, WOUNDS THAT DO NOT HEAL) APOHMOPHINE, METHOCARBAMOL, CHORPHENIRAMINE.
All I know is he was always throwing up had butts of upset stomach(maybe pancreatitis). When I got him away from the drugs he stopped throwing up. But my gut feeling is the long term effects on his little body did the damage. Everyone on this website is trying so hard to save their little angels and many of the vets have this arrogant attitude that they have the degrees and what ever was in the past is to continue. Not bothering to see what has changed in treatment or realizing each case is different, caution, listening to us, being flexible. They should be reading this site for insight on what we parents and our little ones are having to go through. Yet when I read what all of you are going through experience , are they listening to us. Even the one IMS I have is saying I should not be listening to everything I read on the Internet, he is the expert and has been treating cushing's dogs for years with Trilostane. He said I need to trust him. He has called me back every time I call and explains everything. Well, I will continue with this website. You've been there, done it, and are still doing it. These vets aren't there when we see are little ones struggling, in pain.
I did finally purchase the 10mg, Vertoyl, on line. Scared to even start it. I really need your support. I am still upset about the IMS saying , I did not need to get the full Adrenal panel w/sex hormones, did not have a LLDS, nor the SEP/CP ? TEST. Said we could do test latter if needed?
My mother says I need to trust the IMS and God.
On the lighter side, I have to attend to Apollo. On Saturday's he share whip cream with his Mom, she puts it in her coffee, he puts it in his mouth. If I don't give him some he whines very loud. The whip cream is low fat and only a few teaspoons. He deserves something to look forward to.

[mypuppy]

We all can relate to your fear as you begin this new journey with your precious pup. The best possible advice I can give you from my own experience is to educate yourself as much as possible, and yes this forum is one of your best resources. As yours, my IMS denied me the full adrenal panel and I trusted her best judgment and now regret not pushing for it. And I can't well do it now because it would mean interrupting Princess's treatment and risk her cortisols increasing again, so for now I have to wait it out. I did insist on the LDDS because I learned I would be able to confirm which cushings she had, pituitary or adrenal and it confirmed pituitary. I also had an abdominal u/s to rule out adrenal. As for your IMS telling you not to listen to everything on the net is pretty funny. Mine said the same thing whenI told her I belonged to this forum. She blew me totally off and dismissed my questions and concerns as if they didn't mean anything and dr. Is always right. Meanwhile her communication with me was limited, did not reply to my emails and went as far as being downright rude to me when I called her about Princess's test results because she had already given them to my gp and blatantly told me she cannot waste her time talking to both of us. I finally fired her, not to say my new one is a prize but I am trying to be as patient as possible for my pups sake. Sonja I can't say it enough but I would not know where I would be right now without the support and knowledge of this forum. Darn right Im going to hold on to it for as long as possible because it has been instrumental to my baby's health. Now forgive me did you say you are starting Apollo at the 10 or 30mg? I am sure you are already aware of watching for any unusual side effects while on treatment, if not the most important ones are vomiting, diarrhea, lethargy, inappetence, anorexia. I don't want to frighten you in any way but my first IMS never told me them. Ridiculous. Hang in there and I wish you a very smooth and successful treatment and please keep us updated on Apollos progress. you can do this Sonja. You are doing a great job. Warm regards xo Jeanette

[apollo6]

My discharge papers say to monitor for vomiting, lethargy, loss of appetite. Call if notice these signs means Trilostane dose is too high.Apollo's blood panel did show AST, ALT, ALKALINE pHOSPHATASE , GGT- all liver functions( in reading the threads said common in cushing pups?) Also Bun/creative , Phosphorus,amylase,lipase-kidney function.
I want to get him started on milk thistle, L-gua? before he starts the Trilostane? Or should I wait?

[apollo6]

this is the supplements and diet I have Apollo on. Being a dachshund he has back problems, probably arthritis, and supplements for his pancreas.

March 4, 2010 CURRENT MEDICATION REGIMENT
MEDICATION DOSAGE SPECIAL NOTES
CANINE THYROID SUPPORT-100G 1/8 TEASPOON TWICE A DAY

SUPPLE SPINETABLETS- USE ONLY AS NEEDED-½ TABLET TWICE DAILY WITH FOOD

REHMANNIA-TEAPILLS -1 TEAPILL TWICE A DAY

PANCREATROPHIN PMG -TABLETS ¼ TABLET TWICE A DAY

CAINE ADRENAL SUPPORT-25G 1/8 TEASPOON TWICE DAILY

COLOSTRUM POWDER-¼ TEASPOON TWICE DAILY

SOLID GOLD SEALMEAL-MINERALS/VITAMINSPOWDER-1/8 TEASPOON TWICE DAILY

KAL BONE MEAL POWDER-1/8 TEASPOON TWICE DAILY

NORWEIGN SALMON OIL OIL-½ TEASPOON

COSEQUIN DSTABLET-½ TABLET DAILY

CUSHEX(PETALIVE.COM) DROPS 2-3 DROPS,2-3 TIMES A DAY-PROMOTE ADRENDAL GLAND BALANCE


RXBIOTICPOWDER-1 SCOOP DAILY

DIET
A.M-low fat cottage cheese, Greek nonfat yogurt, egg white
, low sodium turkey slice, supplements

NOON- long WHEAT grain rice, cooked chicken, teaspoon canola oil,
Lite salt-potassium chloride
ADDED PURRED BROCOLLI,CARROT

AFTER 4P.M-cooked potatoes with skin, chicken
Nutri Deni minichew or Greenie
Halo-Live N Little skin & Coat treat with Salmon
Slice apple, sometimes blue berries, honey melon

Have alternated with organic baby food-summer veg, turkey with veg, spinach.
Stopped whip cream (on weekends only)
GREENIE/NUTRI DENTAL CHEW-MINI-TWICE DAILY

[frijole]

Sorry but the Cushex drops have not proven to be effective. I'll let Glynda post her response from them when she asked for proof of results. It was very telling.

But anyway,... I am pretty sure that there was something in those drops that should NOT be used with the chemo drugs (lysodren and trilo). Maybe I am confused .... but I had to post just to be safe. I am sure someone will comment.

What are the ingredient in the Cush drops? What are the ingredients in the adrenal support medicine? I worry that some of them will not mix well with the trilo. How long have you been using these supplements and this diet? Because I would not add all of these AND trilo AND a new diet at the same time.. because if something happens you won't know why (diarrhea and vomiting)

Kim

[apollo6]

this is the diet he has been on since September 2009. All are to help Apollo with his pancreas, and support his immune system,and stomach, and the hair loss. For a while the hair loss did stop and grew some back on his tail, and legs, but stopped . The numbers on his Neutrophils and Lymphocytes did improve. But I know this is not a cure , just a support. this is the website showing the ingredients in the other supplements.
http://www.standardprocess.com/display/VeterinaryCatalog.spi?ID=336
ingredients in Cushex-all herbs
Dandelion
Burdock (Arctium lappa)
Astragalus (Astragalus membranaceous)
Arsenicum
Hepar sulph
Merc sol
Sulphur
everything else is Chinese herbs. I did show and give copy to IMS and he said not to change anything at this time?
All was done under supervision of my holistic Vet/acupuncture, who finally said get the tests and treatment.

[AlisonandMia]

Hi Sonja,

I can't comment on the supplements (Cushex etc) but if the IMS is aware of them and not worried then they should be ok.

The one thing that I would worry about with trilostane is the Lite salt-potassium chloride. Trilostane treatment tends to raise potassium levels somewhat and I'm not sure you'd want to be actively supplementing with potassium while using the drug. It might be a good idea to specifically ask the vet about this and make sure that he is aware that you are giving potassium. With medications that have the potential to raise potassium levels there is often a warning about avoiding potassium supplements, "lite" salts, and even foods very rich in potassium (more a problem with humans eating tomatos and lots of banana etc.)

Alison

[apollo6]

thank you so much . I ordered the Trilostane yesterday. But I hardly ever give the Lite Salt, so I can just stop now. But I want all my bases covered before I start this drug.
I insisted on starting only at 10mg. (Apollo weight is normally between 9.8 and 10.2-now 10.6)
I still feel uncomfortable about not getting an LLD and the UNIV TEN. TEST.
I am really going to need your support when I get the medication. It took me two days just to order.
Can I ask, everyone says I should Prednisone on hand for emergency. Why , for what and how much, if I can even get.

The diet my vet put me on was a low fat diet because of the pancreatitis, upset stomach, in September. I noticed someone else was asking about that. I sometimes wonder if the vets even look at what you give them , or hear you.
I plan on going to the ocean(La Jolla, Ca) with Apollo and my mother Sunday to try and switch the worry and obsession with all of this, off for awhile. Watch the seals, listen to the waves, and watch the sea gulls) Makes me think about the poor people in the Gulf-what a tragedy. My husband is worried about how I am handling all this.

[jrepac]

this is the diet he has been on since September 2009. All are to help Apollo with his pancreas, and support his immune system,and stomach, and the hair loss. For a while the hair loss did stop and grew some back on his tail, and legs, but stopped . The numbers on his Neutrophils and Lymphocytes did improve. But I know this is not a cure , just a support. this is the website showing the ingredients in the other supplements.
http://www.standardprocess.com/display/VeterinaryCatalog.spi?ID=336
ingredients in Cushex-all herbs
Dandelion
Burdock (Arctium lappa)
Astragalus (Astragalus membranaceous)
Arsenicum
Hepar sulph
Merc sol
Sulphur
everything else is Chinese herbs. I did show and give copy to IMS and he said not to change anything at this time?
All was done under supervision of my holistic Vet/acupuncture, who finally said get the tests and treatment.

Hi, seems like Apollo is getting well taken care of...the diet is an interesting one...was it recommended by your holistic vet? Re: the Cushex drops, they are meant to help w/the symptoms of Cushings, I'm not sure they do very much to get at the root of it. However, they do contain a variety of herbs that appear to be relevant to the problems experienced, based on what I have read on these homeopathic herbs. I used Cushex for about 6 months, nearly 2yrs ago(?) prior to a firm diagnosis of Cushings..hard to say if they helped or not. I stopped in part because they were expensive (tho' one site sold 3 bottles for the price of 2) and because the dandelion in them actually will make your pup urinate more, not less. The dandelion is meant as a tonic for the liver which is well documented, but it does make 'em pee! I had started treating with anipryl, which seemed to bring some more rapid improvement in symptoms, and then later on added a variety of different supplements, leaving out the Cushex drops, since my Aussie has both cortisol and several other hormones elevated.

Regarding the pricing of trilo, I am sure your vet wants to sell you brand name Vetoryl at full price. If you can get your trilo compounded, you will be better off. Same story w/Anipryl...costs about $80 a month for the brand name to treat a 20lb dog, but generic (selegiline) is only $25/30 a month. You really have to ask around/shop around to get the best price.

and, wonder how your vet has been "treating w/trilo" for years??? it has not been around all that long...only recently approved for use in the US... they are all "experts" until something goes wrong...

good luck!

Jeff

[Harley PoMMom]

But I want all my bases covered before I start this drug.
I insisted on starting only at 10mg. (Apollo weight is normally between 9.8 and 10.2-now 10.6)
Can I ask, everyone says I should Prednisone on hand for emergency. Why , for what and how much, if I can even get.


Hi Sonja,

I think starting Apollo out at 10mg is a great idea. The reason for the prednisone, and this quote comes from Dechra's Product Insert:


PRECAUTIONS:
Hypoadrenocorticism can develop at any dose of VETORYL Capsules.

http://www.dechra-us.com/files/dechraUSA/downloads/Product%20inserts/Vetoryl.pdf

You see, prednisone is a synthetic corticosteroid drug that one can give to their pup when they think that their pup's cortisol has dropped too low...it mimics the cortisol in the pups body. So if one would see symptoms of low cortisol in their pup they would give prednisone and then drive their pup to their vet or Emergency Clinic ASAP.

The standard rescue dose of pred is 0.25mg/kg. To find her weight in kg, divide the lbs by 2.2...then multiply that result (her weight in kg) by 0.25 and you will have the amount for her weight. So Apollo weighs 10.6 lbs / 2.2 = 4.81kg * 0.25mg = 1.20mg of prednisone.

We are definitely here for you and will be here to support you. ;):)

Hope this helps.

Love and hugs,
Lori

[mypuppy]

Hi Sonja,
When Princess was first diagnosed, first thing I researched as treatment was natural remedies and those cushex drops popped up immediately when I googled it, but I too learned they are not effective on cushings. As for the milk thistle, I have never used it and in fact asked several times if I should give just for liver support but no one really responded so I never started Princess on it. perhaps you may run it by your IMS considering Apollo has have issues with pancreatitis. In the meantime please try to take a deep breath with all this, and as Lori said we will be here for you and little Apollo every step of the way. PS: would love to see more pics of your little boy--he's sooo cute! Xo Jeanette and licks from the Princess

[frijole]

Re the milk thistle.. don't know that there is any documented proof of its effectiveness... I can only tell you that I treated Haley with lysodren for 4 yrs. I did not add milk thistle to the mix until 2 yrs after the dx. It was only after I added it that her liver enzymes went from over 2000 down to 700. I was impressed so I stuck with it. And I take it myself. :p

[Roxee's Dad]

Hi Sonja,
I was just reviewing a bit of your and Apollo's thread and this just caught my eye.


DIET
A.M-low fat cottage cheese, Greek nonfat yogurt, egg white
, low sodium turkey slice, supplements

NOON- long WHEAT grain rice, cooked chicken, teaspoon canola oil,
Lite salt-potassium chloride
ADDED PURRED BROCOLLI,CARROT

Broccoli has been know to give dogs bad intestinal gas:eek:


AFTER 4P.M-cooked potatoes with skin, chicken
Nutri Deni minichew or Greenie
Halo-Live N Little skin & Coat treat with Salmon
Slice apple, sometimes blue berries, honey melon

Make sure the potatoes don't have any eye's or the beginnings of a root. The Potato(e) plant itself is not good for dogs.


Have alternated with organic baby food-summer veg, turkey with veg, spinach.
Stopped whip cream (on weekends only)
GREENIE/NUTRI DENTAL CHEW-MINI-TWICE DAILY

Make sure the baby food or any human food you give Apollo does not have any onions in the ingredients. Onions can be toxic to a dog. I don't think whipped cream is good for dogs either, something with the inability to digest the lactose?

[apollo6]

thanks I meant spinach , you are right about broccoli, I know about onions, also grapes are bad , and chocolate is poison.
Apollo does have more gas in this last year. I have to watch in public that people don't look at me thinking I let one(some humor)
I know about the whip cream, will whine him off it. cooked potatoes, doesn't digest the skin, was told to take skin off.
Is Anipryl another treatment for Cushing(thought I read it has been around for a while)
Still worried about not checking for the hormone levels.
I know this sounds silly, but when I take Apollo to the dachshund meet, he will hump any dachshund he meets whether girl or boy. Is he not telling me something(just joking). He is neutered. Dirty old man.

Is there a difference between compounded and regular Vetoryl.


From what I have read , taking these medications is tough on our little guys(size doesn't matter)

As Jake said " they are all "experts" until something goes wrong..."

[apollo6]

Thank you. You are right about the peeing. For a little guy, it seems like a pool of it .

Bother's me I had to insist on smaller dose. Apollo has always had a sensitve stomach. Was always throwing up yellow vial? Hasn't done so in months. Was losing some weight last year now has gained weight.

[addy]

I just finished reading your entire thread. Here you are going through all of this but yet took the time to answer my post and be supportive.
Thank you so very much. My IMS (learned that today) refused to give me prednisone too. Must be a power thing.

I know you and Apollo will be okay. I don't have any experience yet with all of this but I am a good listener :)

Addy

[apollo6]

I talked to my IMS(INTERNAL MEDICINE SPECIALIST?) about having Prednisone on hand. I think I just have to trust him. This was his reply:
Prednisone- in past used as an Antidote for Lysdern( I have read many of you have used with Triolstane reaction), if sick enough, not want me to give, would want to see Apollo. He would give an inject able steroid, Dexamethasone Injection which has a more rapid response, then IV fluid administration as needed, then do ACHT STIM.
If given Prednisone prior would invalidate an ACHT STIM test.

would appreciate input on this.

Said Apollo's kidneys are okay now? will monitor pancreas and liver enzymes.
Also received call from Dr. Tim Allen, Dechra products, Vetoryl 1-913-327-0015 also 1-913-748-4836
Recommends 10mg. for 10lbs and under better to start on low end of dosage range may increase up to 30 mg. latter. Said would gladly talk to my vet. Many vets are not aware there is a 10mg. dosage.

[jrepac]

A few quick hits here...

Yes, broccoli is a gas generator for sure; my Aussie loves cooked broccoli, but watch out a few hours later!:D

Yes, Anipryl is used for cognitive dysfunction and for Cushings, tho' it's effectiveness for Cushings cases may be limited at best (it is very hit or miss).

"compounding" is basically done by a pharmacy that makes capsules to the specific dosage you require (i.e., they are making them up custom for you) ..check out Diamondback pharmacy online...

Milk thistle has a lot written about it in regards to liver function. Vets sell something called Marin, which is the active ingredient from Milk Thistle (silymarin)...likewise they sell Denosyl, which is equivalent to the SAM-e that is also sold to us hu-manz..:)

[labblab]

Hi Sonja,

Actually, what your IMS has told you about prednisone/dexamethasone does make sense to me. I'm relieved that he doesn't seem to be ignoring or discounting the possibility that Apollo could possibly need a steroid "boost" in the event that his cortisol drops too low on the medication, and that he has a specific gameplan that he wants to follow in the event there should be any problem. Also, what he has told you about the effect that the different steroids have on the ACTH testing corresponds with what I've been told is the case, as well. But does his office have 24-hour coverage? As long as he does, I can't argue with his wanting to personally evaluate Apollo if he appears unwell enough to need some help.

And I'm so glad that you did have the chance to talk with Dr. Allen, and that he is reconfirming the Dechra dosing information as we understand it. We'll just keep trying to get the word out there, and encouraging people to let their vets know that Dr. Allen is available for consultation. :)

Marianne

[apollo6]

thank you for the input. The Veterinary Specialty Hospital is 24 Hour Veterinary Emergency and Specialty Care for Your Cat and Dog.

[apollo6]

thanks for all the help.

Sonja and Apollo thank all of you.

[BestBuddy]

Our vet also didn't give us pred when we started trilo. The have a 24hr emergency service and they said they would rather see Bud and maybe do an ACTH test before using pred. so the test would be accurate. The fact that Bud was also diabetic also played into it.

On the other hand the specialist gave me some pred in case of emergency because I think he trusted me and as it was I never used it because the time Bud had his collapse he was just about into a coma and I couldn't have used it anyway, the vet had to give him the shot of dex.

Jenny

[zoesmom]

Sonja -
Another online pharmacy you might want to check for compounded trilostane prices is www.pethealthpharmacy.com (in AZ). You can either call for prices or e-mail them from the 'contact us' link and tell them the strength (10 mg?) and the number of capsules 30, 60, 90, whatever) and they will quote you a price. They may have to quote for 11 mg, since the brand-name vetoryl is sold in 10 mg. size caps. You can either send them the written prescription, postal, or you can e-mail or fax it, and then they will call your vet to verify. I found them to have the best prices, at least for the strength of capsules I was buying.

Don't worry yourself sick over the prednisone question. If you start Apollo off slowly (like the 10 mg), you probably won't need it. If you have quick and easy access to a 24-hour or emergency vet clinic, and he showed any signs of too low cortisol from the trilostane (loss of appetite, diarrhea, vomiting, weakness/trouble standing), then you'd want to take him right in. If you don't have that option, OR if you couldn't get ahold of any vet (but preferably yours) on a weekend, or overnight, then it would be more important to have it. Some vets will give you their off-hours phone number for when a dog is starting on cushings tx. I see you're in San Diego, so if you're not way out in the boonies, most likely there's an emergency vet clinic not too far away. You should look that up and make sure you know how to get there. Very good chance that you won't need it, but knowing where one is located should ease your mind. And we're always here for you if you're unsure of anything. Sue

[apollo6]

Thanks wish I was not so nervous about all this.
This 24 hour hospital is about a 20 minute drive maybe less from my house. This is the same hospital the specialist is at and were they have all Apollo's test records.
I copied the website on compounded Trilostane.
I still am worried about not getting the LLDS AND full Adrenal w/hormone. Should I be based on the tests I already had?

Sept 16, 2009-blood panel
January 2010-ultrasound-abdominal (disc)
May 25, 2010-blood panel
May 28, 2010- (Pet Emergency & Specialty Center-La Mesa)
ACTH Stim Test
Blood pressure
Urinalysis-Antech
Urine Culture MIC
Ultra sound, Focal Abdomen (only gall balder) did not get any report?


or is this enough to go ahead with the medication?

[mypuppy]

Sonja,
It is such a tough call on all levels. I know how overwhelming all this can get and so many decisions to make. IMO I now truly wish I would have had the full panel prior to starting Princess on her trilo. As I mentioned before If I were to do so at this point I would need to stop her treatment and I am not willing to have her regress. Have all your tests confirmed PDH or adrenal? As you, I felt very nervous myself and didn't feel comfortable starting treatment until I did the LDDS to confirm Princess's cushings. After getting those results I was relieved to begin, but again that is just my personal experience. go with your gut and take it one day at a time. keep us updated .warm regards. jeanette

[labblab]

Hi again, Sonja.

Just like Jeanette says, all any of us can do is just offer our personal thoughts and experiences. So here goes from me...

If Apollo were my dog, given all his results, I would be OK with starting treatment without having performed an LDDS test. Both the ACTH and the LDDS have strengths and weaknesses. But you can place greater confidence in a "positive" result from an ACTH than you can in a "positive" result from an LDDS (the opposite is true with "negative" results). In addition to Apollo's symptoms and his positive ACTH, the "icing on the cake" for me is his ultrasound which showed enlargement of both adrenal glands. This is really a hallmark of pituitary Cushing's. So when you put all three of those pieces together, I would feel confident in the diagnosis of PDH. And, in fact, those are the same three pieces that were involved in my own dog's diagnosis.

I am more likely to encourage people to have both an ACTH and LDDS performed if the overall diagnosis seems questionable due to a missing puzzle piece: for instance, if there aren't any abnormalities on the ultrasound, or if a dog with classic symptoms has tested "negative" on the ACTH. In order to get a better sense of the pluses and minuses of the ACTH and the LDDS, take a look at the chart in this link from Dechra's U.S. website:

http://www.dechra-us.com/files//dechraUSA/downloads/Client%20Literature/47901_VETORYL_10mg_Diag_Testing_brochure_4pg_3_1_p s.pdf

The full adrenal panel is a harder call. And since I've talked about it with you in the past, I won't subject you to having to read everything all over again. But here's a shorter version :o. Jeanette is right that if you opt to have the test done later on down the road, you'll most likely have to temporarily stop the trilostane in order to get accurate diagnostic results. But on the other hand, I don't know that the results -- at this point -- will alter your vet's recommendation that you treat with trilostane. I think it's safe to say that the majority of vets starting patients off with trilostane do so without asking to have the full panel performed. Some may just not be familiar with the testing. But others probably feel that there isn't clear research yet to show which dogs, if any, will exhibit symptoms from elevated intermediates as a result of taking trilostane. Since your IMS says that he's had a lot of success with dogs on trilostane and he isn't pushing to have the panel done even though he knows about it, I have to guess that he's not personally seeing a lot of problems that he thinks are being caused by trilostane-related elevated intermediates.

If you really feel as though you want the full panel done, you can certainly push your vet to draw the blood and send it off. But before doing so, I'd want to clarify with him whether or not the results will make any difference in his initial treatment recommendation. If not, then you'll have to decide whether it's worth the time and money to you to have the results on file in the event that Apollo doesn't respond well to the trilostane.

So there's my thoughts for the day! And since I'm not a vet, they're only based on my own experiences. :)
Marianne

[Carol G]

Hi,


I think it's safe to say that the majority of vets starting patients off with trilostane do so without asking to have the full panel performed. Some may just not be familiar with the testing. But others probably feel that there isn't clear research yet to show which dogs, if any, will exhibit symptoms from elevated intermediates as a result of taking trilostane. Since your IMS says that he's had a lot of success with dogs on trilostane and he isn't pushing to have the panel done even though he knows about it, I have to guess that he's not personally seeing a lot of problems that he thinks are being caused by elevated intermediates.

I asked my IMS (also in the San Diego area), who I think is wonderful and who has a lot of experience with Cushings and trilo, about problems with intermediates when we started Winnie on trilo. He said that they rarely see those kind of problems with dogs on trilo. And, he is certainly aware of the panel as he was the one who had it run on the intial visit with McGill (who was diagnosed as Atypical).

Carol

[jrepac]

Hi again, Sonja.

Just like Jeanette says, all any of us can do is just offer our personal thoughts and experiences. So here goes from me...

If Apollo were my dog, given all his results, I would be OK with starting treatment without having performed an LDDS test. Both the ACTH and the LDDS have strengths and weaknesses. But you can place greater confidence in a "positive" result from an ACTH than you can in a "positive" result from an LDDS (the opposite is true with "negative" results). In addition to Apollo's symptoms and his positive ACTH, the "icing on the cake" for me is his ultrasound which showed enlargement of both adrenal glands. Marianne

I think ACTH plus an ultrasound, and a UCCR pre-screen, are going to give you a good read on if Cushings is present.

Even just the UCCR plus ACTH, and the symptoms, are quite indicative.

[apollo6]

Thank you all for the input.
Will the medication is in the mail to me. God am I scared to start it.
I will wait until I get his tail issue resolved.
Wednesday,going to my regular vet to have a bump( size of quarter) on Apollo's tail ( appeared about a week ago)
check,
the cytology aspiration says possible sebaceous gland lesion. respiration is recommended for increased cellularity.He has ingrown hairs and loss of hair on his tail, so don't know if it is an infection from that. will keep you posted

[Roxee's Dad]

Hi Sonja,


Will the medication is in the mail to me. God am I scared to start it.

If you weren't scared, I would be concerned. Being scared or concerned means you will be on your guard for anything out of the norm.

By starting treatment after a confirmed diagnosis, means you will be giving Apollo the best chance at a good quality of life. Based on my experience I will tell you this. When I found out my Roxee had cushing's, we chose not to treat. Only Lyso was available or being offered at the time. Like you I too was afraid. I didn't comprehend the full impact of what cushing's would do to my little girl. I had not found this forum for over 2 years so I didn't have the advantage of all the help, knowledge and experience that K9cushings has to offer. I watched as my little Roxee continued to deteriorate and finally laid to rest.

But you are here now and have the help of many. Stay strong, be vigilant and when in doubt, don't be afraid to post your questions or observations. We are here to help you and Apollo through this.:)

[apollo6]

Thanks will let you know when the meds come.

[SavingSimon]

I just found your thread, and I haven't read it yet but I need to warn you if you have not yet had a full hormone panel done, DO NOT touch trilostane! I just heard from another person that lost their dog two weeks after starting it! Please wait! If Apollo has hormone issues the Trilostane could kill him! I will read your entire thread once I get back from work - I am just really worried after I read what you wrote. See the part in Simon's Test results posts (towards the end of the second one I think) about why Trilostane is NOT an option for Simon, and might not be for Apollo either.If you can, get in contact with Trazee! If Apollo has already had a full adrenal panel and you know it's okay, please ignore my panic - but he MUST - they ALL need a full adrenal panel to determine if Trilostane is a saft option. I remember Apollo sounding a lot like Simon. Dr. Oliver warned that Trilostane could kill Simon because of the interaction with his hormones. I will get you Dr. O's contact info when I get back from work if you need it - I just have to get to work, but I had to warn you first, especiallly after getting a note about another dog most likely lost to Trilostane! I will be back from work in a couple of hours ... please be careful! XOXO, "SavingSimon" and dogs.

[AlisonandMia]

Trilostane will not kill a dog that has atypical Cushing's - although it may not be as effective as hoped! For this reason Lysodren is usually preferred when a dog has significant elevations in many of the adrenal hormones as well as cortisol. Trilostane can be less effective in this situation because it does not address those other hormones and in can fact cause them to increase as a result of the way it decreases cortisol. These other elevated hormones can cause similar signs and symptoms to high cortisol.

Dr Oliver does state that trilostane may not be the best choice of treatment for a dog with other elevated hormones (other than cortisol) but I have never seen him state anywhere that trilostane could be fatal to a particular dog because of increased adrenal hormones. I think you may have misunderstood him on this.:)

The dog that I think that you are referring to who died after taking trilostane almost certainly died of something unrelated to trilostane. She had serious respiratory issues - which may have been connected to her advanced Cushing's (she'd had the disease for several years I believe) or been a separate issue, without a post mortem it is impossible to even start to guess. Respiratory distress however is not a side effect of trilostane. Sometimes it happens that a dog will die or become ill after using a medication and it is very natural and human to want to blame the drug. However if the dog's symptoms are such that it is most unlikely that the drug (trilostane in this case) was in any way responsible for the death then it is not right to blame the drug.

When trilostane (or Lysodren) causes death or illness it is virtually always as a result lowering cortisol and sometimes another hormone (aldosterone) too much. This will cause symptoms like weakness, diarrhea, vomiting, lack of appetite and electrolyte problems if aldosterone is affected. Respiratory problems are not a sign of low cortisol or aldosterone.

Alison

[StarDeb55]

Sonja, with your care & concern for Apollo you having nothing to worry about. You have an IMS who obviously is quite knowledgable & has demonstrated that he has a plan in place in case Apollo runs into problems. You are to be congratulated about learning to be an advocate for Apollo by insisting on starting the trilo at a lower dose.

Any medication, both for people & dogs, has a certain percentage of risk in using it. In Apollo's case, the benefits outweigh the risks by a mile. Treating his Cushing's will allow him to live out his full lifespan with a great quality of life. I say this from experience as my first Cushpup, Barkley, lived with his Cushing's for nearly 8 years, crossing the bridge at 15. I seriously don't think you have much to worry about, just maintain your vigilance when you start the trilo, don't hesitate to contact your vet, if you are the least bit concerned about how Apollo is doing, & we will be here to support you every step of the way.

Debbie

[frijole]

Sonja,

You are doing everything right and your vet is doing fine too. Do not worry so much. I know it is normal but you need to believe. These drugs have saved a ton of dogs - I have been here 4 yrs reading about it. :) I would tell you if you needed to do something different and so would the others.

My dog Haley used lysodren for 4 yrs and lived to 16 1/2. Your dog can have that same chance but you gotta let go of the fear. Dogs have the ability to sense things and so put on the smile, breath deeply and look Apollo in the eyes and say "kiddo we are going to make you feel better real soon". It will make you both feel better.

Troubles arise when owners don't take the time to get up to speed or don't listen to their vets - you don't have that problem. Troubles arise when vets are over their heads - you are fine there. I am fighting like heck right now for the opportunity to treat my dog Annie. I WANT to give her the drug - to give her the chance to live pain free from her symptoms. I know you want the same for Apollo.

So when that package arrives in the mail you are NOT going to throw it away. :D You are going to pick it up and KISS it and say "FINALLY" You are going to help me save my dog.

And we will be here for you. Hugs, Kim

[apollo6]

I got an alarming private post from Saving Sam about not starting the trilostane until she emails me info.

[StarDeb55]

Sonja, please do not go overboard with what SavingSam's parent is telling you. We have a huge number of members whose pups are being treated very successfully with trilo. Even if Apollo's intermediate hormones might be affected, that is a VERY BIG IF. There are a number of treatment paths that can be taken if that might happen. It's not set in concrete that Apollo will have problems with the trilostane. It's quite the opposite, Apollo's health will suffer with his Cushing's being left untreated. If you are truly this uncomfortable starting the trilo, I suggest you make an appointment with the vet, & have discussion with him, telling him your fears & concerns. Prepare a list of questions for the vet before you go, so he has a chance to address all of your fears & concerns.

Let me assure that Dr. Oliver has never indicated that trilostane could cause serious consequences in a pup with Atypical Cushing's. I'm almost certain all that he has ever said is that trilo will elevate the 17-OH progesterone eventually in most pups. Now, whether or not this will cause a problem will vary from pup to pup.

Please Sonja, listen to what the majority of us are telling you. We care very much for both Apollo & you, & we want to make sure that you have many more happy years with him.

Debbie

[apollo6]

thank you. I am still waiting for it in the mail and may call vet before I start.

I have another member who is going to the same specialist and is very happy with him .

[Roxee's Dad]

Dear Sonja,

There may be some minority difference of opinions but as has been posted by a number of well experienced members here. There is a risk with any drug or even homeopathic medications. Every drug advertised has "potential" side effects. But with your education in what to watch for and your diligence in watching Apollo the risk can and will be minimized.

As I very well know the other choice is to let the cushing's run it's course and it will not a pretty site. My memories of Roxee suffering, panting very heavily all night long, not being able to sleep, muscle wasting, always being hungry and stealing food and eating until her belly was about to burst, blindness, ear infections, UTI's all still haunt me. If I had just one do over, I would have given her a fighting chance with either the trilo or Lyso before it was too late.

[apollo6]

I admit reading all this has alarmed me. If the dog is Trazee, I did read the little angel was taking other medications also, I think? Apollo is not on any medications, only supplements.

[apollo6]

Roxie dad, thanks . Will let you all know when I get the medicine.
God bless all of you for being so caring. I will be gone all day Wednesday. So it will be late west coast time when I check in.

[marie adams]

Hi Sonja,

I know how scary it is to start treatment, but both trilo and lyso have been used for some time now; especially lyso. I chose to treat with lyso for the reason it would treat either type without putting Maddie through more tests. I know Trilo is fairly new here in the states, but it has been used outside with much success. My main concern was to start getting Maddie back to a better quality of life. Do I watch every little thing that she does--yep!!! I am not a fan of medicine because of side effects and just not a fan, but when it is necessary I use it. I know it is still too soon for all the symptoms to reside, but many have gotten better. She doesn't have to eat everything in sight and her pee is finally yellow.:) Oh the little things. I do have to take into account Maddie is 11.5 yrs old also. She could have many more years to go, but right now she is still tired--she is a trooper and keeps on going without complaints. Still loves to lay on the cold tile and I just have to let her do what makes her comfortable.

You are doing all the right things, but time is ticking and Apollo needs your help. You have wonderful support in the IMS and all the wonderful people here so go for it!!!:D:D

[mypuppy]

Sonja,
My Princess is finally starting to show improvement with her cushings symptoms on the trilo, and I am extremely happy to experience it. It has taken a little longer due to the lower dose, but the wait has been well worth it. Just yesterday I had run out to the store for a quick errand, and when I came home she was waiting at the top of the stairs to greet me, tail wagging and very excitedly. She has slowed down with the drinking and eating and is finally back in my bedroom sleeping by my side. Ahhhhhhhhh! That is how I want to remember my Princess someday as I know you want to remember Apollo. Watching our pups struggle with these miserable symptoms day in day out is not a good quality of life. I have no doubt you will give him a fair chance at getting your little dog back to a happy medium. You can do this honestly. And yes we are all taking this ride right along with you, no worries. Tight hugs. Xo Jeanette

[StarDeb55]

A number of us are dealing with Atypical Cushing's disease including myself. I have just checked the treatment recommendations sheet from UTK which was revised last month. This quote is from that sheet:


7) Trilostane. Now available in the U.S. as VetorylTM from Dechra Veterinay Products. NOTE: Trilostane always increases 17-hydroxyprogesterone (some cross-reactivity with pregnenolones in assays??), and frequently increases estradiol and androstenedione as well. LysodrenTM may be preferred for Atypical Cushing’s cases. FURTHER NOTE: Care should be used in switching from trilostane to LysodrenTM. Allow adequate time for either drug’s effects on the adrenals to subside before switching treatments. (E.g., one month off drug; normal or increased stim-cortisol levels).

We have had other members contact Dr. O directly concerning the use of trilo with Atypical & he has never told them anything that would come close to saying that trilo can be lethal in these cases. In fact, he has simply said that you can try trilo but be aware of the above, & there may be problems down the road. We have indicated to members who are contemplating switching medication, either trilo to lysodren, or lysodren to trilo, that there is a minimum of a 30 day washout period with no meds. We also have information that indicates that 30 days may not be long enough.

One of our admins, Glynda, has a tiny Pomeranian who has used both drugs. She was on trilo for an extended period, but really never resolved her coat issues. It was discovered that a previous vet had run a UTK panel that show Lulu had an across the board increase in all hormone levels, but this vet had never said anything. Lulu was taken off trilo immediately, the washout period started. At the end of the washout, Glynda successfully loaded Lulu with lysodren & she has been on lyso ever since. All of the above happened with NO PROBLEMS. That is Lulu's story in a nutshell. Hopefully, Glynda will be along & fill in the gaps.

None of are vets, but the administrative staff has done tons of reading & research into this disease, & we do our best to keep as current as possible on the current treatment recommendations. The last thing I will say is that both of you have to keep in mind that Dr. O is in the research side of things, he does not see patients. He can make recommendations about treatment, but he will alway defer the final decision to the treating vet & owner.

Debbie

[addy]

Hi,

I am as frightened as you are about starting treatment. Since I have gotten answers and support from this group I find myself calming down. After reading Roxie's Dad's post, I have come to terms with what I will have to do.

We are all here for you and as someone said, it is the fear of the unknown that rattles us. You are not alone in this. Thankfully, none of us are now.

You can do it !!!!!!! :)

Addy
Zoe and koko's mom

[apollo6]

Thank you so much. It is comforting to get all this support. This little guys ( doesn't matter size) deserve the best. Wish I could wave a magic wand and cure all of them.

[mypuppy]

Hi Addy,
I don't believe I have posted on your thread, but wanted to wish you all the best as well with your treatment, and am so glad you are ready and comfortable. We are here for you as well. best regards, Jeanette

[labblab]

Sonja, if it would make you feel better to have the UTK panel run now, then by all means talk it over again with your vet. However, I just want to make sure you understand that running that test won't change the fact that you'll need to treat Apollo's high cortisol with either trilostane or Lysodren. However, you might end up adding in some other supplements as well.

Depending upon the status of Apollo's other hormones, Dr. Oliver's staff could suggest that Lysodren may provide the better chance for complete symptom relief (per the quote from the UTK treatment sheet that Debbie gave you above). But there are actually no guarantees about this either. As Debbie has said, Glynda (one of our Admins) did end up shifting her dogs to Lysodren from trilostane after realizing that they had elevated intermediates in addition to high cortisol. But they didn't end up with any better symptom resolution after having made the switch.

Again, please do "revisit" the notion of running the UTK panel with your IMS if it will bring you some peace of mind. But just realize that it won't change the fact that Apollo will need either trilostane or Lysodren to reduce his high cortisol.

Marianne

[apollo6]

thanks off to get Apollo's tail looked at. May call IMO again to get reassured.

[SavingSimon]

Sonja, if it would make you feel better to have the UTK panel run now, then by all means talk it over again with your vet. However, I just want to make sure you understand that running that test won't change the fact that you'll need to treat Apollo's high cortisol with either trilostane or Lysodren. However, you might end up adding in some other supplements as well.

Depending upon the status of Apollo's other hormones, Dr. Oliver's staff could suggest that Lysodren may provide the better chance for complete symptom relief (per the quote from the UTK treatment sheet that Debbie gave you above). But there are actually no guarantees about this either. As Debbie has said, Glynda (one of our Admins) did end up shifting her dogs to Lysodren from trilostane after realizing that they had elevated intermediates in addition to high cortisol. But they didn't end up with any better symptom resolution after having made the switch.

Again, please do "revisit" the notion of running the UTK panel with your IMS if it will bring you some peace of mind. But just realize that it won't change the fact that Apollo will need either trilostane or Lysodren to reduce his high cortisol.

Marianne

Dear Marianne,
Thank you for saying this in the way I should have said it in the first place. I did not intend to terrify poor Apollo's Mom. I think it was my own concern and fears for Simon bleeding over onto someone else's thread. Sonja, I cannot apologize enough if I frightened you more, which I no doubt did. I just really wanted to encourage you (not scare you like I did) into getting the UTK panel done, partly because I know you are like me, on a quest for all of the information and tools that you can get, and partly because others had scared me out of Trilostane. I really was just passing on information as I had learned it. If you look at Simon's thread, and his hormones, they are so messed up that I understand why he might be an unusual case in which Dr. Oliver is certain that Trilostane will only make things much worse for him. That does not mean that Apollo is in the same boat, but it is something that I would want to check before I started treatment just in case. I apologize for not having a more gentle and less alarmist approach. Yesterday was a very frightening day of information on Simon, and I think maybe I projected some of my fears for him onto Apollo. I honestly just want the best for you and your adorable boy. I do see from Simon's test results by Dr. Oliver that it is obvious that Trilostane is not an option in his case, but I do know every dog, and every presentation of this disease is different. I am so scary that I scared you during a scary time. You and Apollo are in my prayers, and I know that God will lead you to the right decisions for your boy. I am so sorry for yesterday - it was just a surreal day for me, and not sure how to apologize enough. I just wish I would have said what Marianne said, and left it at that. I'm so sorry. Don't be afraid, you and Apollo are in the loving hands of caring vets and a loving God Who will not lead you astray. I am so sorry for shaking you up yesterday, I was shaken to my core myself, but that is not an excuse, just hopefully an explanation that helps you understand. I will always be here to support, to listen, and to pray for you and your adorable Apollo.
Love,
SavingSimon (Simon's Mom)

[jrepac]

Sonja, if it would make you feel better to have the UTK panel run now, then by all means talk it over again with your vet. However, I just want to make sure you understand that running that test won't change the fact that you'll need to treat Apollo's high cortisol with either trilostane or Lysodren. However, you might end up adding in some other supplements as well.

Depending upon the status of Apollo's other hormones, Dr. Oliver's staff could suggest that Lysodren may provide the better chance for complete symptom relief (per the quote from the UTK treatment sheet that Debbie gave you above). But there are actually no guarantees about this either. As Debbie has said, Glynda (one of our Admins) did end up shifting her dogs to Lysodren from trilostane after realizing that they had elevated intermediates in addition to high cortisol. But they didn't end up with any better symptom resolution after having made the switch.

Again, please do "revisit" the notion of running the UTK panel with your IMS if it will bring you some peace of mind. But just realize that it won't change the fact that Apollo will need either trilostane or Lysodren to reduce his high cortisol.

Marianne

Yes, I think UTK and Dr. O make it clear that Trilo may not be the best choice when Atypical is present, due to the intermediate hormones, but I have never seen any reference made to it actually being HARMFUL to treat w/trilo. Of the 2 drugs (trilo and lyso), adverse affects are easily addressed w/trilo...which is usually to stop giving the drug and maybe, if needed, give a dose of pred. It does not erode the adrenals, as does lyso.

I do not use trilo, but have heard some good things about it from others; but like any medicine, you have to observe your pet carefully and see how she/he responds and make dosage adjustments if needed.

But, by all means, talk to your vet first and see what he says. Every case is different and each pet responds differently to the various drugs.

[apollo6]

To saving Simon- it is understandable. We are all scared. Just want the best for our angels. Thank you all for the input.
Well did go to my regular vet this morning. Did another aspiration on Apollo's tail. Will take about 3 days for results and decide next option.Had a long talk with him explained cushing to me , what the options were and came to the same conclusion. Yes Apollo needs treatment, could live 3 -4 years, it is in God's hands. I just got the medication , while running out the door. I will call the IMO , for questions I have on how to administer, what I need to look for, if all goes well the the followup ACMT test. I plan on starting Friday. I will need all the support I can get from all of you to start this journey. Noticed another bruise on Apollo today, seems his skin is so fragile-is this another side effect of cushing(he gets cuts so easily now). It would be nice to see the little guy have some more energy and a little more joy in his life.

[StarDeb55]

Yes, skin/coat issues are most definitely one of the symptoms of Cushing's.

Sonja, we are here for you when you begin Apollo's treatment on Friday. You can do this because you know, now, that this will help Apollo feel better, & bring the old Apollo back to you. Someone is usually around 24/7, if you need something in the middle of the night. Alison, who is in Australia, is usually available on the overnights.

Debbie

[SavingSimon]

To saving Simon- it is understandable. We are all scared. Just want the best for our angels. Thank you all for the input.
Well did go to my regular vet this morning. Did another aspiration on Apollo's tail. Will take about 3 days for results and decide next option.Had a long talk with him explained cushing to me , what the options were and came to the same conclusion. Yes Apollo needs treatment, could live 3 -4 years, it is in God's hands. I just got the medication , while running out the door. I will call the IMO , for questions I have on how to administer, what I need to look for, if all goes well the the followup ACMT test. I plan on starting Friday. I will need all the support I can get from all of you to start this journey. Noticed another bruise on Apollo today, seems his skin is so fragile-is this another side effect of cushing(he gets cuts so easily now). It would be nice to see the little guy have some more energy and a little more joy in his life.

Thank you for being so understanding and forgiving. I do believe God will lead you to the best treatment for Apollo. And I can never apologize enough, really, because I feel a lot like you do, and the last thing I ever wanted to do was to scare you more, I was hoping to help. Trust yourself and the vet that you have trusted the most with Apollo, and of course continue to trust that he is in God's hands, and I believe that is how you will reach the best outcome possible for him. Is he taking melatonin for his skin? I read your entire thread now, but I don't remember reading that part. I think that the melatonin is one thing that really is working for Simon.
I will be praying for you and Apollo, I can tell he is such a special guy, I think I probably projected my panic over Simon and what we are going through onto you and your dog yesterday, and like I said, you have no idea how sorry that I am. I can tell you are as determined and devoted as I am to doing the right thing for him. You two are in my prayers every day, and often. We will be here to support you and encourage you through this scary time. Please keep us posted on how things are going. One other thing for the skin - and I haven't read anything about it, but maybe someone else has, I just know it has helped other dogs I have had with other skin diseases and problems - does anyone know if vitamin E is helpful (topical?). It cured the lupus on my dog's nose once much to my vet's amazement. I'm not saying you should or should not try vitamin E - I am just thinking maybe someone else reading the thread has some input on that. God bless you and little Apollo.
Love,
SavingSimon

[apollo6]

I am not sleeping, keep wishing this is just a dream.. I have allot going on in my life also, taking over more responsibilities for my 78 year old mom, struggling in our business to just pay our payroll, wondering if we'll be in business by the end of the year, my own health issues. Apollo , all 10lbs of him was my steady constant. Every day it seems he has another sore, bruise , cut from no where. Seeing the muscle weakness in his hind legs, the sweet little face getting bony, the rat's tail. I am obsessed with cushing day and night. But I know if I don't take care of myself, I can't be there for Apollo.

I have the IMO, now my regular vet and my holistic/acupuncture vet in the loop. The reason I have the holistic was of Apollo's back problems and changing his diet and getting off certain medications.

I am waiting for a call back from the IMO on questions I have, and the results of the tail aspiration before I start.
I have got to have faith and trust the vets, that I am doing the right thing.

[mypuppy]

Dearest Sonja,
I am so sorry for all your health concerns and other unfortunate personal obligations. As hard as it is to do, it is IMPERATIVE you tend to your own health and try to take a break from all your concerns related to Apollo's treatment. We have all been where you are and have had many sleepness nights, but I can assure you that once you start seeing the slightest bit of improvement in your little boy you will feel a sense of joy again and get caught up on that sleep deprived being you have become. Look, we all here on the forum agree completely "cushings bites", but this is the card each of us has been dealt, try to accept it as graciously as possible and try to focus on all the positive that could result in beginning treatment as oppose to focusing on the worst possible scenario. You must feel confident in believing you have tried to do everything in your power to make Apollo's treatment go as smoothly as possible and hoping a great success. You have been beating yourself way too hard, and it is time to face this head on. Sonja, again YOU CAN DO THIS, and you MUST believe in yourself, medicine and the God above. We are here for you and with you Sonja. Tight hugs and belly rubs for your precious pup. Xo Jeanette and big licks from Princess

[addy]

Dear Sonja,

Believe in yourself, believe in Apollo, believe in your vets and believe in this group. You will do this and you will do it well. I know you will, I can feel it in my gut :)

We will all check in tomorrow and the weekend for you. Put Cushings in the drawer for the night and take it out tomorrow!!!!

my best wishes for you and your little one
Addy
Zoe and Koko's Mom

[littleone1]

Hi Sonja,

I just read a few of your last posts. I can understand your concern about the treatment. I'm sure all of us have felt the same way. I know I did, but I'm so glad that Corky is on the Trilo. It has made such a big difference in his quality of life.

You also need to take care of yourself in order to take care of Apollo. Excessive worrying isn't helping you. Take it one day at a time. I always say, take baby steps. We're all here for you and with you.

[apollo6]

Thank you for your love and I'll take any licks I can get from the sweethearts. Still waiting for IMO to call back, was told he had a busy day and a lot of procedures, if no call back today, will persist, so I can get started this weekend. Also anxious about the report on his lump on his tail.
Love and hugs, and prayers to all of you.
You are all my guardian angels.
Sonja and Apollo.
He is sleeping in one of many beds I have all around the house for him. I can't spoil him enough.

[apollo6]

will I did get a call back from the IMO, answered all my questions, he know my regular vet says he is good.
So Friday morning , is launch off with Apollo treatment.
I hope I can sleep tonight.
Will need all your support.
God bless.

[apollo6]

I gave Apollo his first treatment of Trilostane, 10mg. this morning. I am so nervous about how he is going to do. Scared out of my mind.
Noticed another little cut on his little rump yesterday. Still waiting on the results on his lump on his tail.

[labblab]

Hi Sonja,

We'll be here and checking in all day. So you just let us know if there's anything you're wondering about. I've got my fingers crossed that Apollo won't have any problems at all, and that you'll soon be seeing some improvement. And also that the lump turns out to be nothing to worry about!

Marianne

[Roxee's Dad]

Hi Sonja,
You and Apollo are on your way, sometimes you will see symptoms like the ravenous appetite and water drinking start to subside in as little as 3 to 5 days.

We are here with you :)

[addy]

Hi Sonja,

Have been thinking of you since I woke up. I am sure you will do just fine. Give Apollo a hug for me!!

If Zoe's poops get under control we'll load in August, I just put in for vacation.

Lots of love and cyber hugs,
Addy

[Casey's Mom]

Relax - we are all here with you.

Love and hugs,

[frijole]

:D Congrats and hugs to dear Apollo!

[mypuppy]

Yehhhhhhhh Sonja! You did it. Good for you and even more for your little boy. I saw total resolution of symptoms in as little as 4/5 days as Marianne pointed out. Of course we mustn't compare because all pups are different in how they react to the meds but I am wishing you the same great wishes and success with your Apollo as I had with my Princess. And as Marianne also mentioned, we are keeping a close eye and checking in constantly to get some updates. We luv ya bunches. XO Jeanette

[apollo6]

You are just the best. I am watching Apollo like a hawk for any syptoms. Got to get back to work. I work at home so I can be there for Apollo. I would like to get away with my husband, our other pup-Karma(the healthy dachie) and Apollo. But my IMO said maybe in a few weeks if all goes well.
Thanks again for all the love, hugs and well wishes.
Xoxo Sonja and Apollo

[littleone1]

Hi Sonja,

Good for you. I started to see Corky's symptoms starting to disappear in just a couple of days. After his second dose, he seemed to be a little lethargic. When I called my IMS, she told me to see how he was the next morning, and to call her before I gave him his next dose. In the morning, he was fine. It's like someone coming off of a high, as the Cortisol level has dropped, and he was so use to it being much higher.

I know you'll do a great job. Hang in there.

[marie adams]

I tried to reply to your message, but I think I sent it to myself..


Yeah, you are on the road to recovery and so is Apollo. :D You will do a great job!! I will not lie--it will be nerve wracking with all the watching and I mean watching every move he makes, but well worth it. :)

Everyone here will be there for you!!!

[apollo6]

catch 22-today went okay. Don't want to expect miracles.
Noticed more skin sores , one on his neck just pop up from no where. His little rump has a lot of infected ingrown hairs which I squeeze out to stop swelling. Still waiting for results on his tail.
Well one day at a time. Thanks for all the support.
xox Sonja and Apollo

[mypuppy]

We understand Sonja, but ohhhhh, thank goodness but those little miracles! We luv you bunches. XO Jeanette and Princess

[apollo6]

Today is day 2 on Trilostane. I am watching his stool, it seems very dark, but no blood , but concern. Did a walk with him, not trying to overdo anything. Monday I will get the results on his lump on his tail.

[Roxee's Dad]

Day 2 so far so good. :)

[apollo6]

Thanks. Don't want to get my hopes up yet, because I have read how so many others had upsets along the way.
will I am on day 3, will monitor, plan to go to drive to ocean and turn off Cushing for a day. Vet called back with the results on the lump not cancer, but some kind of inflammation of tissue and glands, on going, some dead tissue in the lump. Says let body handle it for know and doesn't send need to operate at this point.
When I get the actual report Monday will post.

[addy]

Hi Sonja,

Day Two! I hope you got some sleep :)

Pretty soon the unknown won't be so scary, you will have been there done that.

Thinking of you and Apollo. Sending good vibes for the test results,

Addy

[mypuppy]

Great news on Apollo's results Sonja. So happy for you. As for treatment, yes, we can say we have all hit a few bumps on the road during the course of treatment, but at the same time, that doesn't necessarily indicate you will too. At the same time, we have had our share of simple pleasures along the way. When my Princess was in remission of her cushings symptoms for 5 months straight without taking her trilo I was in awe, to say the least. Again, we cannot compare our pups, but I just feel compelled to re-emphasize these are the positive moments we look forward to with this "dratted" condition, and you should too. I know this has been so hard for you, but you have done a wonderful thing by your Apollo--you MUST really believe that. Keep up the great work! Tight hugs, xo Jeanette and Princess

[shevan]

My Shih Tzu was diagnosed with Cushings in May. We started him out on Trilostane - but after an initial good reponse, it stopped working after three weeks. My vet thinks it broke down. It was the liquid that is compounded at a pharmacy and you squirt it into their mouth (.33 cc's for Jett) every 12 hours. My vet says Anipryl doesn't work, he doesn't believe in it. Lysodren is popular, and cheaper, and you don't have to check it as often I think. We are going to go for compounded Vetoryl (the brand name) but it will be more expensive, and I don't think I can afford it, so I might go to something else. Trilo is good - they've have good results in UK and here, and it's the newest - less side effects I hear.

Good luck, and hugs!
Sheila:)

[mypuppy]

Hi Sheila,
About a month or so ago I was on the phone with Dechra (they are the makers of Vetoryl, which I am sure you are aware of) and I had asked about compounded trilostane and the tech. Informed me they do not recommend compounded trilostane for the very same reason you mentioned in your post. I do not know how much validity there is to what I was told and I never further researched since I get the brand name. BTW there are several online pharmacies which you can purchase the Vetoryl for a much lower price. Right now the less expensive one I use is valley vet.com. Maybe you can look into it for your pup. best regards Jeanette

[apollo6]

Still having the gurgling in his stomach. In reading some other input with other posts. Forgot I had pepto-children's , vet in past said to give to ease his stomach.

[littleone1]

Hi Sonja,

I know in the past, with other issues that Corky had, his vet said that I could give him Pepto, but only rarely. Corky's IMS has him on 1/2 a tablet of Pepcid AC once a day. He's doing good taking it with the Trilo. His stomach hasn't been upset with the Trilo.

There are adjusments that are done in the dosage amounts. Corky's dosage has now been increased twice, as his IMS started him on the lower dosage. At his present dosage, his cortisol level went down a little. Corky has been taking Trilo for almost 9 months.

Enjoy your break from Cushings. I know it can be very mind-boggling.

Terri

[Roxee's Dad]

Just checking in on you and Apollo. ;):)

[apollo6]

thanks, so far no big change today is day 4 of Trilostane. Too soon to see, maybe. Got to work. IMO said to call after 6 days, Wednesday.
Any one hear from Simon's Mom? Concerned hasn't posted since last Thursday. She was waiting for an ultra sound on Simon?

[addy]

I'm checking in too to say hi and let you know thinking of you and Apollo everyday :)

Addy

[jrepac]

Hi Sheila,
About a month or so ago I was on the phone with Dechra (they are the makers of Vetoryl, which I am sure you are aware of) and I had asked about compounded trilostane and the tech. Informed me they do not recommend compounded trilostane for the very same reason you mentioned in your post. I do not know how much validity there is to what I was told and I never further researched since I get the brand name. BTW there are several online pharmacies which you can purchase the Vetoryl for a much lower price. Right now the less expensive one I use is valley vet.com. Maybe you can look into it for your pup. best regards Jeanette

I'd be curious to hear what others have experienced re: compounded trilostane...naturally, the manufacturer of VETORYL is likely to tell you that their brand name version is the "best"...

really, it should not "break down"...that does not sound right, at all..

[mypuppy]

I thought the same thing. The more I live, the more I realize everything is a money making industry, but I would hate to think that the people I purchase these meds from are so unethical to actually make up stories like this, but at the same time would love to get something substantial to backup their story. Jeanette

[mytil]

I literally have just a few seconds, but wanted to give you a link we have on compounding in the Resources section for another FYI http://www.k9cushings.com/forum/showthread.php?t=185 - you will have to go to the bottom part to read more on this. I am sure others who use Trilostane will be on line and offer their experiences.

Terry

[labblab]

Here's the actual reply that Terry is referring to: http://www.k9cushings.com/forum/showthread.php?p=1254#post1254. At the bottom of that reply you'll find links to an article that discusses compounding issues in a fair amount of detail.

As an aside, I do think we've had at least one other member who experienced some instability problems with Vetoryl/trilostane in liquid suspension. But unfortunately, I can't remember any specifics.

Marianne

[labblab]

Sonja, I'm hoping that you and Apollo are still doing well this evening! Don't despair if you don't see a lot of improvement quickly. It may take some time, and his dose may even end up being increased. But you're starting out slow-and-steady which certainly seems to be the safest way to go. :)

Marianne

[apollo6]

thanks for the encouragement. It is hard to see the weakeness in his hind legs, and what comes with Cushing. It's like over night he has aged. Hoping to get a way in a month with the little guy once stable. His energy level is not what it used to be and he struggles to go for even a little walk. The results of his tail aspiration:
slides contin abundant crystalline debris, numerous melanin granules, and large amounts of cellular debris. Scatter foci of kerantinaceous debris are noted. There are foci of increased inflammatory cells consist of admixture of degenerate neutrophils, small lymphocytes, macrophages and rare eosinophils. Occasional reactive fibroblasts noted. etc, etc, identification of bacterial organisms difficult. NO evidence of neoplasia is observed. Findings: moderate pyogranumomatous inflammation and necrosis. suggest chronic inflammatory response or sterile tissue necrosis. Potential rule-outs include chronic irritation, cellulitis, or a foreign body reaction. Other likely rule-out adnexal dysplasia, or an inflamed tumor or cyst. suspect inflamed epithelial cyst or solid epidermal tumor. lesion should be closely monitored, or excised and submitted for histopathological examination. trying to hang in there.

[littleone1]

Hi Sonja,

I totally understand what you are seeing happening to Apollo with the Cushings. Corky was experiencing the same issues last year. Once he started taking the Trilo, and his cortisol level was under control, Corky really bounced back. I hope you will start to see improvement in Apollo soon.

[mypuppy]

Sonja,
As Terri's precious boy Corky and a lot of our other trilo pups here, it was so nice to have my old Princess back and watch her chase her ball all over the yard. And as Marianne pointed out, sometimes it takes a little longer to see improvement with some of our pups. I read Apollo's results, but most of the medical terminology is foreign to me. I am sure your vet must have elaborated. In turn, could you translate for the rest of us, unless some of our "geeks, (they know who they are--LOL) can assist? Do hang in there please and we are still here for you. Luv ya bunches...xo Jeanette and licks from Princess

[apollo6]

Will today is day 5 on Trilostane, at least so far so good. The IMO wants me to call tomorrow to check in with him on how Apollo is doing. Then get the ACH STIM TEST, I may also want a blood panel and urinalysis with it, in 10-15 days just to be on the safe side.
The results on his tail mean he either has an inflamed epithelial cyst or solid epidermal tumor on the under side of his tail , which I am still trying to figure out. I just may call the vet to explain. I don't know if maybe with the hair loose on his tail if one of the or a group of follicles got infected . But if I don't see some improvement the next step is to excised( take a sample?) and submit for histopathological examination. (don't know what that means either)
heart felt gratitude to all of you.
Sonja and Apollo.

[BestBuddy]

Day 5...yay.
It is a slow process but you are getting there.
Hopefully the tail problem will clear up and you don't have to take it the next step.

Jenny

[addy]

Hi Sonja,

Sorry to hear the news about the tail but hope it will turn out okay.
Day 5. It probably feels like forever to you but you have now made it through five whole days!

Isn't that amazing? :)

Keep up the good work.
Sending cyber hugs and positive vibes to you and Apollo. He's so cute

Addy

[apollo6]

Thanks, same goes for me .
I will call either today or tomorrow the IMO, dealing with a lot in my business to top things off. But Apollo is number one. So far think maybe the thirst is a little .
hugs and licks from Sonja and Apollo

[apollo6]

Day 6 still doing okay. Called the IMO specialist today, said Apollo does not have any bad reaction in taking the Trilostane. Next Wednesday through Friday, I am to go in and have Apollo's next ACHT STIM test. Will be nervous.
If Apollo's tail doesn't get better, I may need to a tissue sample to further investigate or possible remove the lump. Will see.

[Roxee's Dad]

And how is Apollo and mommy doing today? Looking forward to an update. :)

[apollo6]

It cheers me up when you all check in on me.
Apollo is doing well, good appetite, think the peeing is a little less.
White stuff is coming out of the lump in his tail when I put a needle tipped in hyd peroxide. About a few years ago he had a lump on the inside of his paw, I squeezed out this cheesy white stuff and it never came back. I wonder with the cushing it his immune system has weakened and can not fight this inflammation.
If it doesn't go down, I think I need to pursue with vet so it doesn't spread. Size of a quarter.

[addy]

Hi Sonja,

I had to take a Cushing break and put it in the box for a day. Feel much better now and glad to hear Apollo seems to be doing well except for his bump.

I used to get some blue antibiotic wash fron the vet. You mixed a squirt with water till it was the color of the sky.

I wonder if something like that might help his bump if white stuff is coming out of it. Just a thought. I can't remember the name of the solution. I would soak a cloth in the solution and hold it on the area for five minutes. It helped Zoe's paw, my office cat's infected anal glands and a variety of other ailments on various critters :)

Addy

[apollo6]

Dear Andy,
Like you said , I am taking a break from cushing tomorrow, Apollo will be wearing his American either blue or red cap and scarf for July 4th, will make a picture and post. Thanks for the input on a dressing, I have read to use Hydroperoxide also. More white and clear liquid came out today. Is this another cushing sign-inflammations that don't heal well? Tried to go for a mini walk, and I almost started crying he just sat down, his little hind legs are so weak, I picked him up and held and kissed him all the way home. I am a worrier, so I hover over him constantly.
Have a great 4th. Hope you Zoe and your gang have some fun.
I go Wednesday for Apollo's first ACHT STIM test after being on Trilostane for 10 + days. I want to do a blood panel , urinalysis, but the vet says don't need to at this time. Any input ? I worry with the lump on his tail that he may have an infection /inflammation.

[addy]

glad you are taking a break. We all need to. I had nice "me" time today too. It felt good though the pups were not happy I was in the pool and they had to watch through the window. It was too hot for Zoe to be outside.

I know it is hard to see Apollo totter and hesitate on walks but don't stop walking him even if you have to go slowly and take breaks, I fear the muscles will get weaker. maybe try shorter frequent walks. He is so lucky to have you baby him and kiss and hug and take such good care of him. I'm glad all of our pups have us.

It seems they get infections easier and have a harder time overcoming them. I think you should get whatever tests make you feel comfortable otherwise you will worry and second guess yourself. Why not talk it over with the vet and explain that you just want to be thorough and detailed because you fear an infection. Perhaps then the vet could narrow down testing to what would be applicable for infections.

Dear Sonja, I can't believe it is time for his stim test!!!!!! You made it girlfriend!!!!

Have a wonderful Fourth of July and I can't wait to see Apollo's picture :)

Love and hugs,
Addy

[mypuppy]

Hi Sonja,
Just wanted to wish you lots of positive thoughts for some good stim numbers. Keep your spirits up. Luv ya and little Apollo. Xo Jeanette and Princess

[frijole]

I'm watching too! Enjoy your day off! Kim

[apollo6]

you are all such angels. Will let you know how goes.
Love all of you. P.s. so does Apollo.

[apollo6]

Dear Andy will post picture, not great because pretty overcast. Did one today. Apollo was not interested in possing, but you can see the lump on his tail. Will be going for ACHT STIM test tomorrow and will bring up his tail. Need to further investigate and hopefully remove.
Scared may want a blood panel if feel he has an infection in tail. Noticed when I gave him a bath today, when rubbing area near pancreas, intestines moaned will have to bring that up also. I think I am getting a little paranoid , like I am just looking for things. My mom said Apollo looked great yesterday, did walk and just accept he tires out more easily.

[addy]

Hi Sonja,

Hoping the stim test is what it needs to be. I thought I read with Trilo they usually go for a higher number than the lysodren.

Thinking about Apollo and you and sure hope the bump gets resolved so you don't have to worry any more.

Zoe had mucus plugs this am from all that bread but at least she will walk today. Yesterday, forget it :) Which is why I asked the doc at the ER about how will that affect her colitis? I mean you have to know that was really tough on her insides. He said "it's just bread".
Doesn't give me much faith in our dog medics around here:mad:

Hopefully you have a better supply of vets in your neck of the woods.

Crossing fingers and toes for Appollo,
Addy

[apollo6]

Dear Andy,
I am there with you.
We did the ACHT STIM TEST THIS MORNING-NOON, ASKED ABOUT THE BUMP ON APOLLO'S TAIL, SAID TOOK OUT MORE TISSUE CAN RESEND IN AGAIN. FOUND FLUID IN BUMP. i COULD HAVE TOLD THEM THAT. Said I should wait until IMO specialist looks at test results on ACHT STIM , and ask him if I should get it excised( take a better sample) for another test. I said , can't you just cut the thing out of his tail, tech said because of location would have to amputate his tail. Well you can beat that didn't sit well with me. I totally understand what you mean about you poor little Zoe's inside. I will fight with IMO if he want me to go up to fast on the medication. My little Apollo's hind legs are getting weaker it seems. Sometimes I feel he has some spunk back then other times he just flops down. It is so hard to see. Because of his back problems, I do acupuncture which I hope will help with his insides and massage to help the weakness in his muscles. I know , I might be crazy, but I want the best for this little guy. One of these days I'll figure how to insert the little faces.

[addy]

Hi Girlfriend!

Glad to hear the stim test is over. How long of wait for the results?

Maybe the leg weakness is more related to his back problems. If not, that symptom takes a bit of time before you see improvements.

I made a miniature jump for Zoe last year, I can adjust the pole to different heights (not very high like anywhere from 2" to 5") and we do mini jumps for chicken treats. It seemed to strengthen her back legs. We would practice maybe 3-4 jumps 2 times a day. She can't go on many walks in winter, her paws freeze and we have to walk in the road, no sidewalks, so then the salt burns her feet. I wanted to keep her doing something.

But if Apollo has back problems, you couldn't do that.
Hopefully, the trilo will start taking care of his muscle weakness.

Hoping the stim test is perfect :)

Addy

[littleone1]

Hi Sonja,

You're not crazy. We all want what's best for our furbabies. I hope that the tail issue will be able to be resolved without surgery.

To insert the little faces, click on the smiles on the right side or the icons on the bottom.

[apollo6]

thank you all for your support.
My vet although on holiday called in with the results of the ACHT STIM TEST, (DONE 7/6/10) Apollo's cortisone is with in the normal range :DI will get a copy of the test faxed tomorrow and post the actual figures . I am to continue same dosage, 10mg. see the doctor in 4-6 weeks, get a physical to see how Apollo is doing, get a new ACHT STIM and blood workup to see how his liver , etc is.
The doctor said to just monitor the lump on Apollo's tail for now, doesn't see need to do biopsy at this time . Will update tomorrow.
Andy , I force Apollo to walk a little every day to strenghten the weakness in his hind legs, and you are right with his little long body and back he would not be able to jump over a stick. Well I did my first funny face. Ya!

[apollo6]

result of ACTH STIM TEST
PRE CORTISOL SAMP 1 1.6 RANGE 1.0-5.0
POST CORTISOL SAMP 2 2.1(LOW) :( RANGE 8.0-17.0
vet SAID OKAY BUT THE SECOND ONE SAYS LOW? SHOULD I BE CONSERNED?:confused:

[StarDeb55]

Sonja, the range you have posted on the post result is for a normal, healthy pup, not for one of our babies. Apollo's results are pretty, darn terrific. Congratulations, we knew you could do it!

Debbie

[Spiceysmum]

Hi,

Those numbers are low for a non-cushings dog but fine for a dog with Cushings so your vet is right. You wouldn't want to keep dropping alot lower than that but right now they are perfect!

Linda and Spicey

[Roxee's Dad]

Hi Sonja,
Congrats, you are there according to the numbers. I'm just a bit concerned at how fast the post number went down. Concerned not worried. ;)


June 2nd

Originally Posted by apollo6
ACTH STIM TEST:cORTISOL SAMPLE 1-6.9UG/DL CORTISOL SAMPLE 2-37.0

The post was 37.0

Today, approx 10 days after starting Apollo 's post is 2.1

Apollo is well within the safety range but watch him carefully as sometimes the cortisol will continue to drop.

Did the vet schedule his next stim test yet. Most probably in 30 days? Watch your boy for any symptoms of his cortisol going too low. JMO, I would schedule another stim within 2 weeks to make sure it doesn't go too much lower. I think 1.45 is the bottom range for post stim while on trilo.

How are his symptoms?

[littleone1]

Hi Sonja,

I had the same concern about Corky's first stim results after being on Trilo for 10 days. His was also 2.1. I did learn that it was in the normal range for cush pups.

You got good results. That's great. I agree with John. Corky's original level wasn't as high as Apollo's.

I hope everything continues to go well.

[apollo6]

Thanks for all the input. The vet said within 4 to 6 weeks for the next ACH STIM TEST and blood panel to see how liver is, etc is. Right now he is okay. Eating as usual, think the water intake down, still weakness in hind legs(told it could take months) What do I look for ?:confused: No appetite, lethargy?
I am still concerned about the second reading being so low also.:eek:
I can't imagine how bad it would have been had I listened to the vet, he wanted to put Apollo, who weighs usually a little under 10lbs, on 30mg. this is the results just being on 10mg. Maybe other members should be aware of not starting such high dosages.
I still am concerned about the lump on his tail, told to mointer.:(

[Roxee's Dad]

Hi Sonja,

I didn't mean to worry you but just want you to be aware that the cortisol may continue to drop. In the meantime you should be happy and have a little mini celebration with Apollo. :D


What do I look for ? No appetite, lethargy?

Yes, also runny poops could be a sign.


I am still concerned about the second reading being so low also

That 2nd number is where you want it to be and stay :D


I can't imagine how bad it would have been had I listened to the vet, he wanted to put Apollo, who weighs usually a little under 10lbs, on 30mg. this is the results just being on 10mg.

I think that you'll find that most of us prefer to start off on the conservative side. ;)

You did good, be proud of yourself and your little trooper. We are!:D

Lastly, and it's just my opinion, I wouldn't wait the 4 to 6 weeks for another stim. I would do it within about 14 days or if you suspect he has gone too low by way of his symptoms.

Keep up the good work and keep us updated:D

[apollo6]

thanks for the encouragement.

[addy]

Hi Sonja,

I came across a paper from a veterinary conference in Zurich (2010)

It had such positive insights into treating with Trilostane. It said that it really is all the Swiss use now. I was impressed and I wished I could have figured out how to send you the link, it would have made you feel good. But alas, I am not a computer literate:(

I'll keep working at that :):)

Addy

[marie adams]

Yeah Sonja,

You have great numbers. I just took Maddie in yesterday for her first real 30 day maintenance acth test so we will see if we stayed in good ranges. She still has shaking of her hind legs so if the numbers are the same as the last test I might decrease her dose a tiny bit, but with the input of the vet of course. Maddie is on Lyso so it a 4x a week dosing.

You are making good progress in understanding all of this stuff and making headway--haha!! Keep up the good work for Apollo!:)

[apollo6]

love you all , my vet told be to take a break from cushing , will be back Monday,
have a peaceful weekend

[addy]

Hi Girlfriend,

Wanted to wish you and Apollo a good night!

Addy

[apollo6]

Same to you-Andy
Over the weekend the family took a drive up the coast to Laguna Beach. Was a nice day. Then Sunday we drove over to Coronado Island, San Diego. But all I could see is how Apollo has slowed down compared to my Karma, she is only 1/2 year younger, but she has so much more energy and has all her hair. I know I shouldn't do it.
Everyone keeps telling me to not compare the two, they are two different dogs. I just love the little guy so much, he has slowed down so much. I know the vets say it could take months until there are major improvements. We need to try and stay positive for our little fur balls, they can sense our worry. On Friday the vet cheered me up and said look how bright eyed Apollo is and how alert. He also said he had come back from a conference that said cushing dogs can live a long life. Need to focus on the positive.

[addy]

I do the same thing. I compare Zoe's poops with Kokos and I know I should not. Koko is so much younger and such a different personality that it makes it alittle easier not to compare on some issues, but I think it is normal to start going that route.

Your vet is so right! I think you have alot to be positive about with Apollo, keep up the good work :) You have done so well!!! Look how far you have traveled.

I laughed the other day you posted on someone's thread about "a senior member" and girlfriend, did you not notice YOU are one?:D:D:D

Love to you and Apollo!

Addy

[apollo6]

Dear Andy,
Don't know how I became a senior member. Age wise I am, 57.5. Why lie about it. Okay now you all know. Will post on your thread.
Apollo's bop was mushy this morning. Don't know if I should be concerned. My vet said I could start Apollo on milk thistle to help his liver. Would like input from the rest of you. Said 50mg. 2 x a day?
Sometimes I feel like a pharmacist with all the supplements, and medication Apollo gets.

[addy]

Hi Sonja,

Not sure about the milk thistle but I will look to see what info I can find.

Now, you may not believe this, but I am one year older than you:) I thought you spoke my generation's language:D:D:D

Whenever you feel like Cushing's is coming out of the box too much, concentrate on those bright eyes of Apollo's!!!!! Dont you love looking into their eyes?

Have a good night and give your sweet baby a hug from me and Zoe.

Addy

[BestBuddy]

This is a really good site with info on Milk Thistle for dogs.

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

Jenny

[littleone1]

Hi Sonja,

There are several members that use Milk Thistle. It is suppose to help the liver. I give it to Corky. He gets 2 drops a day, as I have the liquid for him. The dosage in the capsules was too high for him, as he can have up to 64mg a day. He weighs a little over 18 pounds.

BTW - When you have a certain number of posts, this is when you become a senior member.

Terri

[addy]

http://www.canine-epilepsy-guardian-angels.com/milk_thistle.htm

Hi Sonja,

I found this site with an article from Whole Dog Journal about dosage and info from Dr. Jean Dodd about dosage.

Sounds like a really good supplement.

Addy

[apollo6]

thanks everyone.
Will be starting the milk thistle for Apollo after I buy, and for myself also. I have learned so much from all of you.
Love Sonja and Apollo

[marie adams]

Hi Sonja,

I give Maddie Milk Thistle. I bought it at Trader Joe's--I just dump it out of the capsule and mix in with her food at the evening feeding. She takes pills really nicely, but this one was funny to watch her try to chew it.:D

Take care!!

[apollo6]

Thanks, didn't know they have, milkthiste. I have used their flax-seed for Apollo in the past. Appreciate the input.

[addy]

Hi Sonja,

Just checking in to see how you and Apollo are doing. Hope everything is going well and the heat has eased up a bit.

I am still waiting to hear back from the IMS so we are not walking tonite. Too many mosquitos!!!

Love,
Addy

[jrepac]

milk thistle is pretty easy to find; I've heard a lot of different opinions on the dosage level...up to 300mg for a 20lb dog! I've been on 175/200mg for my 22lb Aussie for some time now. We also use Sam-E, which is the equivalent of Denosyl. It is a little expensive though.

I wrap the milk thistle in a bit of cold cuts, as I've found when I open it and mix w/food, she finds if very unappealing/unappetizing.

The LIGNANs are really hard to find! Vitamin Shoppe has been my most consistent source for these capsules.

[apollo6]

thanks on the milk thistle. Appreciate.
The latest thing is the weakness in Apollo's hind legs, the muscles have gotten smaller, and now he has cluster of little lumps on hind hip where he had a skin liaison, and side front. The lump on his tail is still there. When I stick a needle in it, pink fluid and small little white particles come out. The vet gave me a medicine to help clear up his skin and the skin infections. Said not to pick, I have been bad about not doing . I keep thinking if I can get the white puss out of the ingrown hairs , it will not come back. I see the vet on August 5th for the next test. Will bring up the new lumps( little bumps ). I am freaking out thinking he has cancer. I have got to stay positive for him. Like you said Andy , I see all these other dogs that are healthy and not as picky as I am about Apollo and I question myself if it is my fault he has cushions.

[marie adams]

Sonja please stop thinking you caused Apollo's cushings--you didn't!!:eek:

If feeding our dogs a more healthy diet and taking good care of them their whole lives is the cause then there would be a whole lot of sick cats and dogs. Even horses get this disease. With everyone on this forum always looking for answers I think we would have an answer as to WHY and there isn't an exact reason. So stop stop stop. You are doing everything you can possibly do to help Apollo and he knows it.:D:D

Relax and keep asking the vet questions....

Maddie still has the weakness in her hind legs, but is like the energizer bunny she still keeps going. In February when we just found out what she had she was having a hard time climbing the stairs, but since being on the meds she has no problem going up it might be a lot more noisy than it was in the past, but she does it multiple time during the day when we go up--so the longer you are on the meds the better it gets. I think Casey's mom said it might take up to 6 months for the muscle to get somewhat better-so I am giving it more time and praying it gets there.

Please take care of yourself for Apollo's sake.

[addy]

Oh Girlfriend,

Time to get that box out and lock Cushings up in it for awhile. With all the things going on in your life, it is making it harder for you to stay positive with Apollo. I know it will all get better and easier, it may just take some time, that's all.

Know this, Apollo has the best mom in the world and she did not make him sick BUT she is trying to make him well and is doing the best she can.

The Cush pups can get skin infections, doesn't mean it is cancer. Have you gone to a dermatologist? I can't remember. I did read with Trilostane, the hair and skin issues can get worse before they get better so perhaps that is what you are now seeing.

Look into those beautiful, bright eyes of Apollo's and just concentrate on them for a moment. You will find your strength.

Love and kisses and HUGS!!!!!
Addy and Zoe

[littleone1]

Hi Sonja,

Please don't blame yourself for Apollo's Cushings. There is nothing that you have done that could have caused the Cushings, and there is nothing you could have done to prevent it.

I know the lumps can be a worry. Corky's had at least a dozen lumps that have been surgically removed. They were only cysts. I know that we worry more, if that's possible, when we're not sure what they have. I hope that Apollo's are something very minor.

Relax a little and take some time for yourself.

[apollo6]

Thanks Terry, Andy, and Maria.
I go to the IMS on August 5th, will point out the lumps. Like you said, I do have a lot on my plate, the business going down, overseeing my 78 year old mother, wondering about the future.
Now I get to go to my HOA meeting and fight about issues I have about my house that have not been addressed. Always something.
Well on the brighter side, Apollo's cushing helped me find all of you.


Life is too short to wake up with regrets.
Love the people and pets who treat you right.
Forget about the ones who don't.
Believe everything happens for a reason.
It you get a second chance, grab it with both hands.
If it changes your life, let it.
Nobody said life would be easy.
They just promised it would be worth it.

Friend are like balloons.
Once you let them go, you can't get them back.
So I'm gonna tie you all to my heart so I never lose you.

[frijole]

Sonja - Just writing to say I'm reading along and sending warm thoughts your way. Hang in there. Loved the poem. You are a sweetheart. Keep the faith. Kim

[Casey's Mom]

Love the poem - thank you!!

Love and many hugs,

[apollo6]

Love YOU ALL.
Well, the ramp arrived yesterday. Apollo hates it , I have tried to cox
him with treats to go up and down, so far no success. He has free range of the house. His manly stroller, fire engine red, will be coming in a few days. I still want him to come with us on outings and when he gets tired I can put him in the carriage. The weakness in the hind legs is about the same. Read Rozze's dad is getting wheels for Roxie. If I have to I will do so also.
Wish I could do some form of water therapy with Apollo. But when he knows its bath time he hides underneath the bed and I have to pull him out. What a picture that is. Is this a cushing thing? Apollo is obsessively linking his front leg-it is pink, little if no hair and has tiny brown spots. His under skin is dark grey with spots know. It is so hard to see the changes in my little guy. But he still is beautiful to me.

[littleone1]

The poem is very special Sonja. Thanks for posting it.

I hope Apollo's legs will get stronger and that things will improve for you and your family.

[addy]

Hi Sonja,

What a beautiful poem, thank you for sharing it.

It might just take Apollo some time with the ramp. I always use the highest value reward I can for the hard stuff so maybe try using some really, really good treats with the ramp and only give that treat when you want him to go up the ramp. I know you have to be careful with his diet, but try going for the gold reward for sure, try a few repetions and then stop and try again later. He just may change his mind about it if he thinks it is a game for which he gets the tastiest morsel ever. Will your other dog go up the ramp? You could make it a game for both of them. Just a thought.

I am so glad I found everyone here and found you too:) :)

My cousin has a stroller for her dog, he loves it and she takes him everywhere in it because he can't walk far. I think Apollo will look awfully good in a red stroller:):):)

Tons of hugs,

Addy

[SachiMom]

Sonja,

I've been following along in the background.

You might try covering the ramp with a towel or throw rug. Something that he is not afraid of. We had built a several ramps for Sachi, but she wouldn't use them until they were covered in a fabric of some sort.

~Mary Ann

[mypuppy]

Sonja,
You are worthy without proof. I am so saddened for all your personal issues and can relate, as each of us here on the forum can surely also. One day at a time with everything is what I have learned in life. Sometimes matters are in someone else's hands, so do not fret about what you could have done or not. You are doing everything possible for that little precious boy, and should feel proud of yourself for such.
Remember when life throws you lemons, make lemonade! God loves you and little Apollo, and so do we. Tight hugs. Xo Jeanette and Princess

[apollo6]

Love all of you-Kim, Ellen, Terry, Andy, Mary Ann, Jeanette,
Gave Apollo a bath today , felt lumps near front area, back thigh(still same one). He has redness around front paws, hind areas are black. But he is still my beautiful boy. Might try the towel on the ramp, it is rough. I have tried treats will have to try some more.
Took a break from cushing's today. Went down to the ocean and took Mom and Apollo for a walk. Held him most of the time and just let him breath in the ocean breeze. He does tire out more then before. I tell him we are going to keep fighting and not give up.
Our other dog Karma still has more energy.
Have a nice evening.

[addy]

Hi Sonja,

I am so glad you went to the ocean. You need moments like that.

I am here with you, waiting for your next appointment, which I think is August 5th.:) Maybe they will get to the bottom of the bumps.

I looked up skin conditions in the Merrick vet book, but gosh, there sure were alot of conditions:confused:

I hope you have a good night and give Apollo a kiss for me and Zoe. Thanks for the input about the rabies shot. Sometimes all these decisions seem so hard, don't they?

Love and hugs,
Addy

[apollo6]

You are right. We all want what is best for these little guys. Got the fire engine stroller yesterday. Apollo was very content when I put him in it. Took me forever to close the contraption.:eek: Apollo started going up the ramp yesterday. Progress not perfection.:D

[addy]

aw, heck, we don't need perfection!!!!!!

I bet he looks mighty fine in that red stroller:D

I watched a "diving dogs' competition over the weekend. It took place in San Diego! Thought of you the whole time.

Sending you positive vibes and cyber hugs,
Addy

[marie adams]

Hi Sonja,

Oh how I should be working right now!!!:eek:

It is a good thing Apollo will use the ramp. It just won't work in my bedroom with a ramp or steps so Maddie can climb up on the bed. :( There just isn't room along side the bed and we have a foot board.

The poor thing looks at the bed and then flops down along side it. She climbs the stairs to the second floor so I am happy with that--it is the little things!:D

All the dogs will be jealous of Apollo's Fire engine!!1:D:D

Finally a beautiful day here on the coast!!!! I hope it is down there!:):)

[addy]

Sonja!!!!

check this out

http://www.dodgerslist.com/literature/watertherapy.htm

it tells about water therapy at home for Apollo!!!!

http://www.abledogs.net/poppy.html
this one too for dachsunds!!!!

last one
http://reboundhounds.blogspot.com/2009/04/healing-power-of-hydrotherapy.html

Addy

[apollo6]

You guys are the greatest. I will try to make a picture of Apollo in his stroller, excuse me his car. Today when he was excited and ran to me, he fell, I just hugged him and kissed him, I had to hold back the tears. He still has a hard time with the weakness in his hind legs. What makes my day when I go for mini walks and people look down and smile when they see him and tell me what a cute dog. And being a proud mom I grin. I am trying so hard to take each day as it comes. I look into my little guys eyes and say we are not giving up . We are going to fight this together.
Dear Andy thanks for the websites, love them. And thanks for the input Maria Adams. I am nervous about the check up on the 5th of August to see how Apollo is doing. Apollo still has the lump on his tail, every day I stick an needle and pink liquid comes out. I hope the vet will do something about it, maybe antibiotics. It takes so much out of us and the little angels, this disease. Couldn't do it without all your love and support.
Didn't know we had a diving contest, I know they have a dog surfing contest each year here.

[littleone1]

Dear Sonja,

I know it's a rough road. We do manage to get through it somehow. There always seems to be little quirks that keep popping up.

Sending positive thoughts and healing prayers that Apollo gets his strength back and that the vet will have a positive resolution about the lump on his tail.

Hugs,

Terri

[Squirt's Mom]

Hi Sonja,

Yeah, this disease can get to us at times. We find our selves worrying about every little thing, seeing monsters everywhere, jumping through hoops to do the improbable, and showing more and more gray hair by the day - unless you're like me and just pull it out! LOL :p

But after more than 2 years I have come to the conclusion that this disease is also a blessing in disguise. Squirt and I's relationship is stronger and more fulfilling than ever. We are so much more in tune and I learn more about her every day. I see others with their pups and they lack something that Squirt and I share intimately - a oneness, a completeness, a unity of spirit. I look at their baby and see so much more than they do and think how much they are missing out on, then I feel sorry for them.

Then there are the many friends we have made through this disease. Irreplaceable.

Hang in there, sweetie! You're a great mom and Zoe is in the best of hands with you by her side.

Hugs,
Leslie and the girls - always

[addy]

Hi Sonja,

I just love the thought of Apollo being able to get hydrotherapy in the bathtub!

You should be a proud Mom, you have a beautiful dog and every day is a precious gift. You are truly blessed to have such a wonderful relationship with Apollo. It is hard now, I know that it is, but you have come so far and are so strong in your love for your dog and your commitment to him. That, my friend, is truly a beautiful thing.:)

Addy

[mypuppy]

Dearest Leslie,
Wow! You have such a way with words, and I couldn't have said it better myself. I know what you mean when you say others do not seem to appreciate a deep bond with their babies. I too feel sorry for so many who view an animal as just that. As you and all of us here, our lives are enriched because of our babies, and we wouldn't trade it for the world--it's priceless! Take care and luv ya. Xo Jeanette

Sonja, I am thinking of you and Apollo, and wishing you will both get through this together. You are both blessed to have each other. Warmest regards. Xo Jeanette and Princess


Hi Sonja,

Yeah, this disease can get to us at times. We find our selves worrying about every little thing, seeing monsters everywhere, jumping through hoops to do the improbable, and showing more and more gray hair by the day - unless you're like me and just pull it out! LOL :p

But after more than 2 years I have come to the conclusion that this disease is also a blessing in disguise. Squirt and I's relationship is stronger and more fulfilling than ever. We are so much more in tune and I learn more about her every day. I see others with their pups and they lack something that Squirt and I share intimately - a oneness, a completeness, a unity of spirit. I look at their baby and see so much more than they do and think how much they are missing out on, then I feel sorry for them.

Then there are the many friends we have made through this disease. Irreplaceable.

Hang in there, sweetie! You're a great mom and Zoe is in the best of hands with you by her side.

Hugs,
Leslie and the girls - always