Todd going through Cushings testing! [Archive] - Canine Cushing's Information and Support Forums

Todds Mom

08-09-2010, 02:43 PM

Hi my name is Lisa and my beagle boy Todd is currently going through being tested for Cushings Disease. It started back in June, Todd just did not seem himself and I took him to the Vets because his allergies were really acting up (sneezing, reverse sneezing, runny eyes). She took a blood test to make sure that nothing else was going on with him beside allergies. So we went home just taking Benedryl. She called me the next day blood test is good all normal readings. Well around the beginning of July he got caught chasing a skunk and was sprayed. About 2weeks after that his sinus really started acting up, he could hardly move his head or open his eyes. Took him to the vet again. She said his stomach really seemed extended so she suggested taking an xray. Xray came back and she said that his liver was a little enlarge but not worried because blood test in June was normal. Sent him home with eye drops and doxyclene. After my call back to her because just seemed his head hurt, she put him on Rimdyl. He got better, we went to the beach came back and he had been peeing on the carpet for my son and drinking quit a bit. I noticed that his appetite was extremely big. Called the vet and they set me up with an appointment and had me bring in urine. She tested his urine and took more blood. She said that he had some protein in his urine. So I went home with the words maybe Cushings, she called me that night and his blood test was all within the normal range. Then she suggested that with the remaining urine she had send it out for a Cortiso/Creatinine test. Got that back a little out of range so wants to do an 8 hr blood test. Took him for that this morning and he would not let them take the blood. They couldn't even get the muzzle on him. The vet did not want to stress him so I made an appointment where I could be with him the next time. I am so sorry this is long but I just wanted to give you some background on our situation. The only symptoms I see are the drinking, peeing and appetite. I did take him off his wet food and started cooking vegetables and adding them to his kibble, he does need to lose some weight. Thanks to Judy from the Beagle website that I found you to help me out with this.

Test results from Urnine Cortisol/Creatinine is 10.2

addy

08-09-2010, 03:08 PM

Hi Todd and Welcome!

I know how anxious I was when I first joined this group, waiting to hear anything from anyone so thought I woould just say hello and tell you that the moderators and more experienced members will be along soon.

The Ur:CC Creatinine test cannot diagnosis Cushings, but it can rule it out so it looks like your vet decided the results indicated further testing.

I am sure the others can comment on Rimdyl. I know my Zoe had a very bad reaction to it and I immediately had to cut the dose in half and then discontinue it after a few days. There had been some talk on line about class action lawsuits and toxic reactions to the drug. I did not research it at the time so not sure how credible that info was.

I bring that up only in hopes others more knowledgable than I may discuss or have opinions on if the distended belly and other symptoms you saw could be attributed to the drug.

You are not alone in this journey and you have found a very caring group of people with a wealth of experience so take a deep breath and the others will be along soon.

Addy

Todds Mom

08-09-2010, 03:26 PM

Thank you Addy! He was on Rimadyl from Friday until Thursday of the next week for his sinus infection. She noticed his belly before he was on that. But then Todd has always had a belly, he has always stayed around 45lbs. He is a beagle/bassett mix.

judymaggie

08-09-2010, 03:57 PM

Hi, Lisa! Glad you decided to join -- you are now part of a new family with very caring and knowledgeable members. They will all help you along the diagnostic journey. As I mentioned on myBeagleWorld, there are lots of folks here who are so much more learned in Cushings than I am -- I feel a lot more comfortable with you in their hands than just in mine!

Take a deep breath and give Todd a hug from Abbie and me!

Squirt's Mom

08-09-2010, 04:39 PM

Hi Lisa,

Welcome to you and Todd! :)

If I am interpreting the UC:CR you posted correctly, then Todd's values are barely elevated. The higher the value, the more likely Cushing's is.

http://www.vin.com/proceedings/Proceedings.plx?CID=WSAVA2002&PID=2552

"Reference ratio for normal dogs is less than 10 x10 -6"

Is there a normal range listed after the 10.2? That would help make sure of what that means. ;)

Your vet has told you Todd's lab work was "normal" but we would like to see the actual results for any values that were high or low on those tests. If you don't have copies of the actual results, your vet should be happy to provide them to you. Most of us keep a file at home just in case we have to see a different vet for any reason. When you get the results for what sounds like the LDDS, be sure to ask for copies of that as well and post those results. One of our members is a lab tech and she helps us interpret the lab results and many members here can help with the cush specific test results.

We don't ask for test results, or the many questions that will be coming your way soon :eek::p, just to be nosy. The more info we have the more meaningful feedback we can offer. It has been our misfortune to have seen many folks who trusted their vet only to learn that vet wasn't really cushing's savvy at all and their baby suffered for it. For this reason, terms like "normal", "within range", "perfect" are not satisfactory nor often accurate. For example, if an Xray showed the liver is enlarged, I find it odd the liver values don't indicate the liver is working harder than normal for some reason. :confused: So, if we could see the lab values that would help alot! We won't get really nosy until we know you a bit better! :p

Now, for some of those questions. ;) Is Todd on any other meds, supplements or herbs other than those you have already mentioned?

Has your vet ruled out diabetes and hypothyriodism? These two conditions, as well as others, have signs that mimic Cushing's so it is important to rule them out in the beginning.

Is Todd intact?

How much does he weigh and how old is he?

It sounds as if your vet is following a similar path for diagnosing that our vet did. If so, the test Todd is having is the LDDS and requires 3 blood draws. You might ask your vet to let you take Todd with you between draws as they are several hours apart. That way his stress level may not be as high. Understand, this test cannot diagnose Cushing's on it's own but can give a very good indication of whether or not it is a real possibility. It is highly recommended that this test be followed by either the HDDS, ACTH, or UTK panel along with an abdominal ultrasound. If it were me, I would go for the UTK panel and ultrasound.

The UTK panel will include an ACTH plus test for five other hormones that can come into play with Cushing's. The ultrasound will allow them to see not only the adrenal, one of the glands involved in Cushing's, but many other organs as well. (The ultrasound saved my Squirt's life as a spleenic tumor was found and removed.) IMHO, these two tests will tell you the most about the possibility of Cushing's in Todd and the form he may have, plus the extra bonus of checking his other organs. These are things to discuss with your vet, of course. Squirt had a full gambit of testing and then some, but I would do it all again just to make sure of what we were dealing with. ;)

Cushing's can be a real roller coaster ride emotionally! You will many of us standing in line for that ride right along with you! :p We do understand. But you and Todd are not alone on this journey. We will be with you every step of the way.

The best thing you can do for Todd is to educate yourself. Read the links in our Helpful Resource section, read the threads here, read online....then ask questions, lots of questions, any question you may have, and we will do our best to help you understand. You are Todd's first and last defense, his voice, his advocate, and the more you know, the stronger you will be in these roles. Knowledge truly is power when dealing with Cushing's.

I am glad you found us and look forward to learning more about you both in the future.

Hugs,
Leslie and the girls - always

lulusmom

08-09-2010, 04:39 PM

Hi Lisa and welcome to you and Todd....thank you, Judy, for sending Lisa our way.

We've had a number of members with Beagle babies over the years and as I recall, they are a breed that is listed as a breed over represented in cushing's. As I recall, they are also a breed that are naturally a voracious eater so sometimes the pet owner may not notice that the appetite has increased. :D

We do ask a whole bunch of questions and if you are new the disease, you'll probably feel like your head is going to explode with info overload. Don't worry because that is perfectly natural. We've all walked in your shoes and are intimately familiar with the frustration, confusion, emotional rollercoaster and fear that comes with the diagnosis. Believe me, the more you learn, the more relaxed you will be. It's not an easy concept to wrap your head around so don't expect to be able to get there over night. Most, if not all, of us are experts in some field but we were all feeling pretty ignorant and inadequate in the beginning. Now for the questions.

Before I get down to the nitty gritty, can you please tell us the name of the eyedrops you are using for Todd? Some eyedrops contain a steroid and these alone can cause what is called iatrogenic cushing's. This is the easiest form to treat as the condition is reversed by withholding the meds that are causing the problem.

We always recommend that members start a folder for their dogs and keep all test results, vaccine records, certificates, etc. in that folder. This comes in really handy if you ever have to make a trip to the er vet. Believe me, after hour vets appreciate having a dog's up to date medical history at their fingertips. It makes it easier for you too when you get tongue tied or have a brain fart due to worry about the reasons that took you to the er. I seem to have lots of those, even if I'm not addled from worry. :D We also ask that you post the results of all testing that was done to diagnose Todd so that folder comes in even handier. To start things off, it would be great if you could post just the high and low values on any bloodwork or urinalysis and please include the normal ranges and the reporting units, i.e. ug, nmol, ng, etc. You mentioned that the UC:CR was abnormal and as Addy has already mentioned, this is an indication that cushing's is possible but as your vet probably told you, more testing has to be done. Can you post the results of the UC:CR for us.

The Low Dose Dexamethasone Suppression Tess (LDDS), the eight hour test you mentioned, can yield a false positive result due to stress and it sure sounds like Todd is extremely stressed at the vet's office. A lot of members choose to accompany their dog to the vets office. There are three draws done during the eight hours, the initial blood draw, one at four hours and one at eight hours. You can take Todd home or keep him with you and return for the four and eight hour draws. I'm lucky to have two cushdogs that are relatively comfortable at the vet's office. When you have the LDDS test done, can you post the results for us?

If it turns out that the eyedrops are not the problem and the LDDS test does come back consistent with cushing's, your vet should do additional testing to validate the LDDS. Most times, the LDDS can indicate what form of cushing's a dog has but if it doesn't an abdominal ultrasound is usually done to 1) make that differentiation and 2) to give the vets a good look at the surrounding organs to make sure nothing else going on. Your vet has already established by x-ray that the liver is enlarged. This is common with cushing's.

I could probably go on and on but I'll let you digest all of this first. I am sure that others will be by to welcome you and ask questions of their own. You can never give us too much information so don't apologize for the length of your post. Of course, I am going to tell you that not matter what because as you can see, I have a big problem with brevity myself....always have and always will. :D

Well Lisa, I'm sure sorry for the reasons Judy had to send you our way but I'm glad she did. You can relax a little because we're here to hold your hand, answer your questions, share our experience and help both you and Todd through this in any way we can. Just know that if Todd is ultimately diagnosed with cushing's, he can live out his expected lifespan with a good quality of life. We'll help you make that happen.

Glynda

P.S. I see that my girlfriend, Leslie, posted while I was typing so please excuse any duplication. Duplication is not such a bad thing when it comes cushing's. You will notice that Leslie and I have a lot in common too. Brevity is not her strong suit either. There's actually more than a few of us like that. It's a good thing we do it by posts, otherwise, we'd all be talking over each other. :D

jrepac

08-09-2010, 05:01 PM

Rimdadyl is a no-no for any dog with Cushings or even suspected Cushings. Frankly, any dog with any liver trouble whatsoever should not get Rimadyl. Not sure why more vets are not aware of this. If Todd seems woozy or is staggering around, please stop the rimadyl immediately.

NSAIDs are not recommended for Cushings pups, rimadyl in particular. I use doggie aspirin once in awhile for arthritis, but only if needed (as that is an NSAID also).

Been relying on daily supplements of glucosimine/msm in the form of doggie treats.

Jeff

labblab

08-09-2010, 05:02 PM

Hi Lisa,

A quick administrative note... I just wanted to let you know that your membership has now been manually approved, so from this point onward all of your replies should be visible as soon as you post them. Our automatic approval process is triggered by members responding to an email confirmation notice. But since you have posted a couple of replies now without having responded to the email confirmation, I'm guessing that perhaps it was misrouted to your spam folder. So the point is, you are now an approved member :). And if you do end up retrieving a request for email confirmation, you can just disregard it.

Marianne

Todds Mom

08-09-2010, 05:12 PM

Thank you for getting back to me so soon! I did call on Friday and tell them to make me copies of all of his test results and file. So I picked that up today when I took Todd. Okay! Todd is Neutered and he is a beagle/bassett hound and he weight is about 45lbs and has been that give a lb or 2 for a number of years now. Here are some of the readings.

The eye drops from what I can make out are NPD drops? Along with Benedryl

Bloodwork- Only Highs and lows
HCT- 56.6% REF 37.0 - 55.0
HGB- 18.4 g/dl REF 12.0 - 18.0
MCV- 79.2 fl REF 60.0 - 77.0
ALKP - 211 U/L REF 23 - 212
AMYL- 565 U/L REF 500 - 1500
T4 0.9pg/dl 0.8 - 1.5pg/dl Borderline low

Urine Cortiso/Creatinine Ratio
10.2 Ref 5-55

Thank you all again for your caring so much. It helps to know that I have someone to talk to. My kids just think he has a behavior problem. But Mom's know when there is something that just not quit right.

Todds Mom

08-09-2010, 05:17 PM

Todds Mom

08-09-2010, 05:21 PM

I am sorry here are the results of his first urnine test when I took him in I thought it was a bladder infection. That's what started the ball rolling on all of this.

Uro: 0.2
Pro: 4+
pH: 7.0
Bld:neg
Kel: neg
Bili: neg
Glu: neg
S.G:1.023

Thanks!

zoesmom

08-09-2010, 05:54 PM

Hi and welcome - Seems like there are some conflicting clues in Todd's recent work. I could be wrong but I think that the normal range for the UC:Cr is below something like 13.2. So if I dog is above that, then cushings is still possible and requires further testing. Below that, should normally rule it out. But as far as I recall, below 13 is usually a sign that it is probably not cushings. (I think the range given on your lab results must be the total possible range, for all dogs, including cush dogs.) You might want to redo that one, and I think they recommend taking 3 morning urine samples at home and combining them for testing accuracy.

Also, Todd's liver enzymes are not elevated, as we'd expect, altho' his ALK PH is at the very top of normal. The other thing is his USG (at 1.023) is not low, as is typical in cush dogs. Their urine is often so dilute that their USG can fall below 1.010 or lower.

On the other hand, it seems like he does several of the classic symptoms - thirst, pee accidents, appetite. And also his thyroid level is borderline low, another thing which can happen in cush pups.

Sounds like a urinary infection has been ruled out. Also, maybe our diabetes people can comment on that being a possibility. No glucose in urine - but isn't a blood test more accurate? Did you say you're going ahead with the LDDS (8 hour test)? Also, rimadyl could be a concern if it is cushings so probably best to withhold for the time being. Sue

Todds Mom

08-09-2010, 08:25 PM

Thank you Sue, you are right. I looked over his Cortisol/Creatinine and they have it broke down.

10.2 - Cortisol
119.1 - Creatinine

Ratio is 27 (High)

Sorry for the confusion! These things are to desifer.

Thanks again!
Lisa

lulusmom

08-09-2010, 08:40 PM

Hi Lisa,

The "D" in NPD stands for Dexamethasone. This is a steroid and with long term use causes iatrogenic cushing's. Since allergies are not only not a symptom of cushing's, allergies are usually masked by cushing's until the treatment kicks in, it didn't add up for me so I immediately suspected the eye drops. It doesn't matter whether it's a pill, nose drops or eye drops, the steroid enters the bloodstream and will cause the symptoms you are seeing. Please discuss this with your vet and try to find alternative eye drops without steroids.

Glynda

Squirt's Mom

08-09-2010, 09:44 PM

Hi Lisa,

Yes, please do address the eye drops with your vet before doing any testing. Dexamethasone is also what the second D stands for in the LDDS test. The Dex in the eye drops could be the sole cause of Todd's Cushing's signs and could skew any cush specific testing.

Oh, that would be so nice for you and Todd if this is just the eye drops, huh?

Hugs,
Leslie and the girls - always

apollo6

08-09-2010, 09:56 PM

Welcome to you both.
Until you get the right tests, don't assume cushing. Read up about it.
the test I did to confirm cushing were as follows.
ultrasound(to check for enlarged adrenal glands, and enlarged liver and other organs) FULL blood panel( to check for elevated readings) urinalysis, and a ACHT STIM TEST(test for extreme high levels of cortisone). You should go to an internal medicine SPECALIST, with knowledge in coshing. I had my little guy on a lot medications containing steriods which may have started the cushing. We are hear to help, ask questions, get information.
Sonja and Apollo

Todds Mom

08-10-2010, 12:26 PM

Thank you all for posting! Todd was only on the eye drops for one week. Could that have still caused it? My poor little pup is just not himself. I miss my Todd!!!! He just seems so unhappy! Did your babies act like that also?

Todds Mom

08-23-2010, 05:11 PM

Just received the results from Todd's LDDST blood work from last week. The vet called this morning a left a message on our answering machine. She said that his blood work came back normal. So we are back at the beginning. She wants me to call her tomorrow for an update on Todd. So I will ask her to send me the results of the test. Could it still be cushings with a normal LDDST blood test?
His drinking I think has slowed down (1 bowl a day). I still have to watch him for going to the bathroom in the house. His appetite is still really huge. I can tell by the way he acts that something is going on but what? He use to love to sit outside, now I have to drag him out, not all the time but most of the time. So I will keep you updated on whats next.

lulusmom

08-24-2010, 05:32 AM

Bumping up.

frijole

08-24-2010, 08:12 AM

Hi! To answer your question - it could be atypical cushing's http://www.k9cushings.com/forum/showthread.php?t=198

It would be very helpful to get the exact nos from that test... because we have seen vets and labs make mistakes... There are 3 nos. you need. You can easily call and get them. But get a photocopy for your files next time you visit the vet.

With the water drinking - did they rule out diabetes?

Did they do a UC:CR urine test?

The more you tell us about Todd the better so don't be shy. Glad you found us. We'll help best we can. Kim

apollo6

08-24-2010, 02:43 PM

Welcome
I am Apollo's mom. My little guy had allergies for years and was taking allergy medication that may have had steroids and also was on Rimadyl which also has steroids. So before you start with even thinking about Cushing, get the tests. It could be the medications he is on, because the blood panels look pretty normal. I had an ultrasound on the abdomen done showing enlarged adrenal glands and enlarged liver and kidney, pancreas scarring from buts of pancreatitis.
Also my Apollo had hair loss on both sides, ears, tail, increased water consumption, peeing, pot belly. Another test is the ACHT Stim test to check for cortisone levels. If it is the medications getting Todd off them might help. But we are not vets, so always check with your vet before making changes. If you think it is cushing read up about the signs, note 3 kinds, testing to check before you do anything. Get a specialists familiar with cushing's.

Todds Mom

11-15-2010, 01:40 PM

Just an update on Todd and his Cushing test. WE had his 8hr blood (I can never remember the name) test done last Wednesday and she called and gave us the results on Saturday. As you know the one in August came out normal. The one Wednesday came back still within the normal range but a little higher than the last. The thyroid test came back low this time. ( I will post results whenever I talk to her and ask her to fax me the results from Aug and Wednesday). Now she is thinking hypothyroidism. She said we could get an ultrasound done or we could start him on the thyroid medicne as it is rather safe to give. I don't know what to do.

frijole

11-15-2010, 02:38 PM

I read back a couple pages and the bloodpanel first done and the uc:cr test did not seem to indicate cushings and now you have the ldds test (8 hr) that is not indicating cushings. It could be hypothyroidism.

Refresh my memory - your issues are appetite, frequent urination, anything else?

I know the appetite can be a sign of thyroid issues but the urination? not so sure... Tell us more about the symptoms. Hang in there.. sometimes these dx's are long and frustrating... I had one easy one and one I'm still working on... I know its tough. Hugs, Kim

apollo6

11-15-2010, 03:38 PM

Dear Todd's Mom
An ultrasound would show if his adrenal glands are enlarged or other organs are enlarged. This would help determine what the problem may be. Also in Cushing an acht stim test is given to see if cortisone is being over produced in the body. It isn't an easy disease to diagnose and often time it may be another issue.
I have attached a simple explanation of cushing also showing picture of what cushing looks like in a dog.
http://www.kateconnick.com/library/cushingsdisease.html
Don't rush into any thing , just right now. We will help you get through this.
Hugs Sonja

Todds Mom

11-15-2010, 03:40 PM

I just spoke to to vet on the phone and she sent me the tests results from the 8hr blood test from August and from last week. I am not sure how to post these correctly but here it goes

08/19/2010-
Vet Dexamethasone
Suppression, 3 Samples
Vet Cortisol 4.3 1-6 (resting)uG/Dl
Time 1: 0
Vet Cortisol <0.3
Canine:
Post Dex: <1.0
Post ACTH: 5.0-18.0
Time 2: 4
Vet Cortisol 0.5
Time 3: 8

11/11/2010-
Vet Dexamethasone
Suppression, 3 Samples
Time 1: T:0
Vet Cortisol 3.5 1-6 (resting) uG/DL
Time 2: T:4
Vet Cortisol <0.3
Canine:
Post Dex: <1.0
Post ACTH: 5.0-18.0
Time 3: T:8
Vet Cortisol 1.5

His T4 in August was 0.9
November is 0.5

This is just confusing to me. We agreed to try him on a low dose of thyroid medicne and see if he improves at all and test his thyroid again in 3 weeks. IF he is not any better we are going to get a ultrasound done. So I don't know if it is hypothroidism or Cushing's .

Todds Mom

11-15-2010, 03:45 PM

Thank you Kim! His symptoms that I really say are his appetite is really bad, he will grab food and fingers both. He is hungry all the time. Also, he just looks sad all the time, like he is depressed. I know beagle's and bassett's kind of look like that anyway, but I just know there is something wrong. He is just not the same. He won't play with balls anymore or even go through his toy box. All he worries about is food.

Thank you Sonja! I will try to hang in there. I check this site out everyday and how all the other cushings pups are doing.

frijole

11-15-2010, 03:51 PM

So you don't have any issues with frequent urination? If so - I say treat the hypothyroidism. It is very easy. You give them a pill (or part of one) in the a.m. and one at night. It is best to give it two hours before or after food. Do this for one month and then go back in for retesting as you might have to readjust the dosage.

If you are still seeing symptoms or additional ones arise (urinary infection, hair loss, licking, skin issues, frequent urination) you might want to look into what is called atypical cushings. But for now.. I would just focus on the thyroid.

Oh and the pills are cheap too! Yeah. Kim

Todds Mom

11-15-2010, 03:57 PM

Kim, we did have an issue with urination, but as of late no. He will go out in the morning and holds it until we come home at 4:30pm. His drinking has really slowed down since it cooled off. The only time he drinks alot depends on what he eats. If i give him a bull pixel then he does. Other than that he is good. So we are going to treat the thyroid first and if that does not work we will go have the ultrasound. I hope this works! I want my baby back to normal!

Squirt's Mom

11-15-2010, 03:59 PM

Hi,

Good to hear from you again and good to hear that Todd remains in the "normal" range on his recent tests. Numbers are great, but knowing the pup is best and you know your baby. Something you said rang a distant bell in this old head...it seems I have read somewhere that babies who are hypothyroid can have a sad look on their face. I know in humans when the thyroid hormones drop depression is often one of the symptoms/effects.

If Todd were mine, I think I would try the thyroid meds for a bit then if things didn't improve, go for the ultrasound. Just my 2 cents worth, tho. ;)

Hang in there and do keep in touch while you are popping in!

Hugs,
Leslie and the girls :D always

Todds Mom

12-20-2010, 12:18 PM

Just popping back in to get your thoughts on Todd's condition. We just had blood work done last Friday to check his thyroid and the numbers came back good. So the medicne is working for his Thyroid. I just have this sinking feeling that he still has cushings. He just acts like he is starving all the time. His water intake varies, sometimes alot and other times not. He is just not himself, a little better, but not my Todd of a year ago. He doesn't tolerate play to much and other dogs. Other dogs never bothered him before now if they try to play he warns them with a big aroooo to leave him alone. I just feel there is someting going on more than hypothyroidism. For those of you that seen his numbers what do you think? He is just so food driven i am afraid he is going to hurt someone. He grabs hands and everythin if he thinks there is food in there.

littleone1

12-20-2010, 12:51 PM

Hi,

I just want to make a quick comment on Todd's behavior with other dogs. When Corky was diagnosed with hypothyroidism over 10 years ago, his vet told me that once he started taking his Soloxine there might be a change in his personality, and that he could become more aggressive toward other dogs. Luckily, this wasn't the case with Corky.

Terri

labblab

12-20-2010, 01:11 PM

Hi!

I am sorry that Todd is still having ongoing issues. I just went back to take a look at the results you posted for the two LDDS tests, and I must confess that I'm not certain as to Todd's most recent result. The LDDS test consists of a resting cortisol measurement, and then the administration of a testing agent with subsequent retests at the 4-hour and 8-hour marks. I think the normal range that your lab has posted for their LDDS results is <1.0 (although I'm more used to seeing norms closer to < 1.4...). [Note: The test results you posted show normal ranges for both the ACTH test and also the LDDS test, but my understanding is that only the LDDS was performed on Todd, so the normal ACTH range of 5.0-18.0 can be disregarded].

If I am tracking Todd's test results correctly, here were his three cortisol readings in August. It is the 8-hour result that you are looking at in terms of making a Cushing's diagnosis.

Resting: 4.3
4 hour: <0.3
8 hour: 0.5

If I'm correct that the normal range for this lab is <1.0, then it is true that Todd's August 8-hour result of 0.5 fell within the range for a dog without Cushing's. However, here are his more recent results (I think):

Resting: 3.5
4 hour: <0.3
8 hour: 1.5

If I'm reading the results correctly, then this most recent test WOULD be consistent with Cushing's (actually, pituitary Cushing's), because the 8-hour result is greater than 1.0 (and his 4-hour result was less than 50% of his baseline value). However, my interpretation is hinging on whether or not I'm picking the correct numbers out of the ones you have posted above. Can you take another look at your original page of lab results and try to double-check as to whether or not what I've written seems correct?

Thanks!
Marianne

Todds Mom

12-20-2010, 03:50 PM

I looked back on the test results that I have.

08/19/10
4.3 1-6 (resting)uG/DL
<0.3
0.5

11/11/10
3.5
<0.3
1.5

The numbers that I have down, she had them all circled on the lab test. She said his levels went up but still not a diagnoisis of Cushings. I think the hunger issue and his behavior is just not him. Something is wrong. I talked to her friday and she said they are not ruling out Cushing's, maybe in 4 months to test him again or we can go have a Ultra sound done. How expensive is the ultra sound? Thank you all for your quick replys.
Mariannne, on the second page this is what it says: A normal dog will show suppression of cortisol below 1.5 ug/dk at 8hr post administration of low dose of dexamethasone. Dogw with hyperadrenocorticism will not suppress below 1.5 ug/dl at 8 hrs. So what I am seeing is that he is right there borderline at 1.5 ?

labblab

12-20-2010, 05:40 PM

Mariannne, on the second page this is what it says: A normal dog will show suppression of cortisol below 1.5 ug/dk at 8hr post administration of low dose of dexamethasone. Dogw with hyperadrenocorticism will not suppress below 1.5 ug/dl at 8 hrs. So what I am seeing is that he is right there borderline at 1.5 ?
Yes, that is exactly right. And that clarifies things for me, too. For most labs, the cut-off point is indeed approx. 1.4 or 1.5 ug/dl. But it originally looked to me as though your lab had a lower cut-off point of 1.0. But this additional info now corresponds with what your vet has told you -- that these LDDS results are right at the borderline, but not yet consistent with a Cushing's diagnosis.

Marianne

Todds Mom

05-09-2011, 10:09 AM

Hi Everybody! It has been a while since I posted on here, but I have check in with you and your babies often. In my older post I had stated that Todd had went through testing and came up that the numbers were just not there to treat him for cushings. He has the potbelly, appetite and does drink a good bit. So we had him tested again ( last time was December) well the news came back that he does have cushings. The vet started him on Vetoryl 30mg once a day in the morning. THis is only his 2nd day on it an I am scared how he is going to do on it. I have read lots of different reactions on here. Here is the results of his 8hr blood test (can never remember the name).

0 HR 4.4
4 HR 0.3
8 HR 2.9

I also had them run other blood work and the only thing that was high was ALKP 549 U/L (23-212 High). The rest of his readings were within the normal range.
For the some of you who have your babies on Vetoryl how have they done? My Todd has not been himself since last July when we firs suspected it. But like I said we knew he had it but the numbers were not supporting that. He is also on medication for a low thyroid. Should I be nervous?

labblab

05-09-2011, 10:25 AM

Welcome back to you and Todd!

Yup, this time around, Todd's LDDS is definitely consistent with pituitary Cushing's. Does Todd still weigh around 45 pounds? If so, your vet is starting with a conservative trilostane dose of 30 mg. daily which should minimize risks of unwanted side effects. It may turn out that Todd will require a dosing increase down the road in order to completely control his Cushing's symptoms, but from our experiences on this forum, most of us feel that it is safer and easier on a dog to start low and work upwards as your vet has chosen to do.

I was so relieved when my own Cushpup showed improvements in his thirst and urination within just a few days of starting trilostane treatment. But don't feel downhearted if it takes a longer time for Todd's symptoms to be relieved -- it really does depend upon arriving at an optimal dose of the medication. That is why monitoring ACTH testing is an important component of treatment. Has your vet already scheduled an ACTH test to see how Todd is responding? The manufacturers of brandname Vetoryl recommend that the first ACTH test be performed within 10-14 days of starting treatment.

Please be assured that we have witnessed many, many treatment success stories here. And I'll definitely be rooting for Todd with the expectation that he will be joining that happy club!

Marianne

Harley PoMMom

05-09-2011, 10:28 AM

Is Todd's weight still around 45 lbs? If so, then the 30mg of Vetoryl once a day seems like an appropriate dose to me.

Many members have had a discussion with Dr. Tim Allen, a vet tech at Dechra's Kansas office, and he has communicated that a dog should start dosing at 1mg per pound.

When is your ACTH stim test and Chemistry panel scheduled next?

Please keep us posted and wishing you and Todd the best of luck.

Love and hugs,
Lori

Todds Mom

05-09-2011, 10:32 AM

Thank you so much for the quick reply. Yes he is still around 45, he was 46 lbs. They did start him out on 30mg once daily.

Todds Mom

05-09-2011, 10:41 AM

I am getting ready schedual his ACTH test now. They said 2 weeks. AGain thank you for your quick input. I really do hope this help him. I miss my playful fun loving Todd. All he thinks about is food. I am so glad I have this site to come to. I was really nervous over the weekend when I had to start him on the Vetoryl.

addy

05-09-2011, 10:11 PM

We will be crossing our paws and toes that the ACTH test goes well for Todd.:)

If you get nervous, just post it;) Someone is always hanging around to listen.

Hugs,
Addy

leigh

05-11-2011, 10:09 PM

I hope he's still doing well on the meds:) fingers crossed for great results:)

Squirt's Mom

05-12-2011, 12:04 PM

Hi,

How is Todd doing? Any news on the ACTH yet? When you get a chance, we would love a update! ;)

Hugs,
Leslie and the gang

Todds Mom

05-13-2011, 12:17 PM

Todd seems to be doing okay on the Vetoryl so far. No signs of him getting better, but I know i might take a while. Hungry all the time. My son brought home Mexican last night and walk away for a minute and needless to say Todd had Mexican:D. His food issue is bad, if he thinks you have food in your hands he is grabbing your fingers or whatever. But I am hoping that gets better over time with the medication. I don't think his potbelly could get any bigger. I set up his ACTH test for next friday. Just shy of being on Vetoryl 2 weeks. I will keep you posted and thank you all for your love and concern.

Harley PoMMom

05-13-2011, 12:37 PM

The food aggressive behavior should subside once his cortisol gets closer to the therapeutic ranges. With Vetoryl the therapeutic ranges are between 1.45ug/dl - 5.4 ug/dl. Also one's pup cortisol can go up as high as 9.1ug/dl as long as the clinical signs are controlled.

Here is a link about Vetoryl: Dechra's U.S. Product Insert. (http://www.dechra-us.com/files/dechraUSA/downloads/Product%20inserts/Vetoryl.pdf)

Just wondering~will your vet be checking Todd's electrolytes along with the ACTH test that is scheduled in two weeks?

Your doing a great job! Please keep us posted!

Love and hugs,
Lori

Squirt's Mom

05-13-2011, 12:38 PM

OLE'! :p "Todd had Mexican" - that was funny! :D

Sounds like things are going ok but his dose may not be quite high enough if you are not seeing much improvement in his signs yet - the ACTH will tell the tale, tho. It's not uncommon with Trilo (Vetoryl) to go through some dose tweaking at first so don't get discouraged. ;)

You are doing a fine job so keep up the good work and let us know what the ACTH results are, 'k?

Hugs,
Leslie and the gang

Todds Mom

05-20-2011, 10:41 AM

Well it has been almost 2 weeks with Todd being on Vetroyl and he is going today for his ACTH testing. I gave him pill around 8:00 and I am taking him around 1:00pm. I really have not seen much of a difference in him, he is still ready to eat everything but the kitchen sink. I have noticed he is starting to bark a little more than he did. He use to bark like a beagle, and then since last July very little but know he seems to be doing more. I am hoping for the best today! Keep your fingers and paws crossed.

Harley PoMMom

05-20-2011, 10:55 AM

Just a gentle reminder, according to Dechra the ACTH stim test should be completed within 6 hours after the dose of Vetoryl has been given. So if Todd has had his Vetoryl at 8am then the post draw for the ACTH stim test should be no later than 2pm.

All fingers and paws crossed here!

Love and hugs,
Lori

Squirt's Mom

05-20-2011, 10:57 AM

Good luck with the testing today! I hope all goes just fine!

Do let us know how it goes and certainly what the results are when they come in, if you don't mind sharing them.

Maybe you can take Todd to Taco Bell after he's finished! ;):p

Hugs,
Leslie and the gang

Todds Mom

05-20-2011, 11:01 AM

Thanks! I will let all of you know how he makes out. And Leslie believe me he would love to go to Taco Bell or any other food joint. He loves to eat! He lives to eat! He is so funny when we go through a drive thru he gets so excited he is in the back looking out the window with a smile and tail going 100mph. Silly dog!

Todds Mom

05-24-2011, 03:34 PM

Todds Mom

05-25-2011, 10:02 AM

I am not sure if I posted it right yesterday, but here are the results of Todd's ACTH test after being on Vetroyl for 2weeks.

T:0
Vet Cortisol 4.5 1-6 (Resting) uG/DL

T:1
Vet Cortisol 7.3

Canine:
Post Dex: <1.0
Post ACTH: 5.0-18.0

Does this look good to all of you. I have know ideal what it means. :rolleyes:

labblab

05-25-2011, 10:28 AM

Well I have the results of Todd's ACTH test done on friday.
Time 1 Vet Cortisol 4.5 1-6 (resting) uG/DL
Time 2 Vet Cortisol 7.3 Ug/DL

Canine
Post Dex: <1.0
Post ACTH: 5.0-18.0

She left me a message that she thinks Todd is doing well on the dose that we currently have him on. She is happy with the results this time and hopes to see it even better the next ACTH run in about 2 to 3 weeks. I really don't know what this means, but I really havn't seen much change in him. He might be just a bit more spunky than he was but not much. He never did drink a alot, only at times. And his appetite is still very bad. He grabbed my granddaughter spoon right our of her mouth the other day. I am hoping that soon improves. Other than that he is good. He has not lost any weight. Do you think the food thing is a habit now or do you think he still feels hungry all the time? I really appreciate your thoughts. If I didn't have you guys I would be lost, so thank all of you so much for listening.
I'm sorry for the delay in posting a reply to your questions from yesterday! I'm gonna go ahead and repeat it here, once again.

Just to recap, Todd weighs about 45 pounds and has been started on 30 mg. of trilostane once daily. This first ACTH monitoring test was performed approx. two weeks into treatment. Is that all correct?

If so, these are my thoughts. Your vet is starting out conservatively as far as Todd's trilostane dose. I'm guessing this is to minimize any unwanted side effects. But it also means that his dose may end up needing an increase in order to resolve his Cushing's symptoms. Having said that, I don't think it is unreasonable to remain on this same dose for another couple of weeks. Our experience here (and that of the manufacturers of Vetoryl) is that cortisol levels can continue to drift downward during the first month or so of treatment. So I'm also guessing that your vet is wanting to wait to see what the maximal effect of this trilostane dose is going to be before making an increase.

According to Dechra, the "ideal" treatment range for a dog on trilostane is a post-ACTH result of approx. 1.5 - 5.5 ug/dl. However, results as high as approx. 9 are acceptable as long as symptoms are effectively controlled. So Todd's result of 7.3 will be considered OK if his symptoms resolve on that dose. But if he has not improved by the next testing and the results are still above 5.5 ug/dl, I'd imagine that your vet will go ahead and increase his dose.

Here is a link to Dechra's Treatment and Monitoring Flowchart which will help you to make more sense of all of this. One hint: the Flowchart will be easier to read if you go ahead and print it out.

http://www.dechra-us.com/files//dechraUSA/downloads/Client%20Literature/47902_VETORYL_10mg_Treatment_and_Monitoring_Brochu re_Update_3_2_ps.pdf

Marianne

Squirt's Mom

05-25-2011, 10:33 AM

Hi,

I wish I could give you a good idea what the results might mean for Todd, but that is better handled by someone with a bit more knowledge and experience with Trilo than I. But I am sure someone will be along to help you soon.

How are Todd's signs? Any noticeable reduction in them since starting the Trilo? It sounds as if the appetite is still quite strong, unless it is common for him to snatch food? If the pup's signs are controlled, the post can go up as high as 9.1 ug/dl for a pup on Trilo as long as the signs are controlled.

Good control is indicated by favorable clinical signs as well as post-ACTH serum cortisol of 1.45-9.1 μg/dL (40-250 nmol/L).

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

Can you tell us how long after Todd's Trilo dose he had the ACTH? The timing of the test is important in getting accurate results so we usually ask about that and I know the experts will want to know. Todd is on once a day dosing, right?

Hang in there! You are doing a good job with Todd! :)

Hugs,
Leslie and the gang

PS. Glad to see Marianne posting at the same time!

Todds Mom

05-25-2011, 10:50 AM

Thank you Marianne and Leslie. Todd had his ACTH test done almost 2 weeks after starting on Vetroyl. Marianne I think my vet is being conservative on the dosage because of the side effects. He is 45 lbs and is on 30mg. I have not seen much change in him at all. Still has a very strong appetite. He never did drink an accessive amount of water. I am hoping to soon see some changes in him. He use to love when I would bring him tennis balls home, now he could care less. All he cares about is food. Thank you both!

Todds Mom

06-23-2011, 11:03 AM

Todds Mom

06-24-2011, 10:00 AM

The vet is putting him on 15mg of Vetoryl in addition to his 30 right now until the 30's are gone. I did not see 45mg on the online pharmacies. These pills are expensive. Wow1

addy

06-26-2011, 02:24 PM

T:0
6.2 1-6(resting) uG/DL

T:1
10.0

I was just wandering why his numbers went up, is that normal? I soon hope I see a difference in him, he just not the same Todd as a year ago.

I know exactly how you feel. I wish the same thing for my Zoe. I am not an expert on this, having just started Zoe on Vetoryl but looking back at Todd's first stim his post was about 7ug/l, wasn't it? So I am thinking Todd was started on a conservative dose and it may need a bump up. His resting is at 6ug/dl, which was the high end of the normal range. The pups can continue to drift lower during those first 30 days but, it would also seem that on a conservative dose, the opposite could also be likely and they would drift up. I think I will see that with my Zoe as well.

I will let others comment and also comment on the new dose.

Hang in there,

Hugs,
Addy

Todds Mom

07-06-2011, 10:46 AM

I started Todd on his higher dose of 45mg of Trilostane today. I am hoping to see some improvements on his symptoms. His main symptom is his appetite. He always had a very, very good big appetite but now he is hungry all the time. He is a beagle/bassett with short legs and if his belly gets any bigger it will be dragging on the ground:eek:. Wish us luck with the 45mg dosage!

Squirt's Mom

07-06-2011, 12:54 PM

Luck??? Pooh! Todd has as wonderful mom who works very hard for him; it is her love and devotion that will carry him through! ;) Who needs luck with such a great mom?

Hugs,
Leslie and the gang

addy

07-06-2011, 02:09 PM

I'll wish you luck:D:D:D:D:D:D:D:D:D:D:D:D

But Leslie is right, Todd will be fine with you watching.

Hugs,
Addy

Todds Mom

09-12-2011, 02:23 PM

Sorry I havn't been on in a while but we had a new grandbaby at the end of July and the other ones are 2 & 8 so we have been helping out with the little ones. But here what is going on with Todd, back in July as I posted his ACTH test came back with number where the vet wanted to see them. So she said we won't have to do another one for 6 months unless I see a problem. Todd has taken the Trilostan really well. I never seen any difference in his appetite and as of lately his belly looks really big. He just acts really sad! Now he is a Beagle/Bassett so that might be hard to judge, but he just does not seem right to me. So I called the vet and she is going to look at him and maybe schedule an ACTH test and then talk about going from Trilostan to Lysodren. What do you all think? I am just really worried about switching him. Thank you all in advance for your inputs!!!!

addy

09-12-2011, 02:40 PM

Hi,

Sorry to hear Todd is feeling under the weather. Usually you want a stim at 3 months for awhile and check electrolytes. I know it gets expensive. I wonder if Todd is not in therapeutic range. I see his dose increases but I think I missed if you are on once a day dosing or twice day dosing. I see the June test results and he was post 10ug/dl. What were the July results?

IMO, it is too early to discuss switching to Lysodren until you run some tests for additional information. Have you had an ultra sound done? Are there any other health issues? When does he seem sad and lethargic, right after dosing? Later in the day?

There is a wash out period when switching of 4-6 weeks.

Hang in there, others will be along soon.

Hugs,
Addy

Todds Mom

09-12-2011, 03:34 PM

He is on 45mg once a day. I did not get his results for July but I will when I see her tomorrow. He is on a thyroid pill 2x a day (I can not think of the name of it). We did not have any sonagram done yet. I wouldn't say he is lathargic because if he see's food or know when someone is eating he is happy as can be. I don't know what to think.

lulusmom

09-12-2011, 04:31 PM

Well Todd has had his second ACTH test since starting on 30mg of Vetoryl since the beginning of May. The test came back with readings a little higher than the first test done on May 20th. I see no improvement in him at all. She is going to bump his dose up to 45mg a day. He weighs 46lbs, so that dose should be okay. I am just a little nervous, he has done well so far on the 30mg, I hope all goes well with the 45mg. He is getting so tired of going and getting all these blood tests done, he got angry the last time. I am going to push this one to 4weeks. Do you all think that will be okay.
Here is his latest ACTH test results.
T:0
6.2 1-6(resting) uG/DL

T:1
10.0

I was just wandering why his numbers went up, is that normal? I soon hope I see a difference in him, he just not the same Todd as a year ago.

Food and timing could make the difference in 2+ points on the acth stim test. On the day of the acth stim test, are you giving him his dose with a meal and are you getting him to the vet within 3 or 4 hours of dosing?

Here what is going on with Todd, back in July as I posted his ACTH test came back with number where the vet wanted to see them. So she said we won't have to do another one for 6 months unless I see a problem. Todd has taken the Trilostan really well. I never seen any difference in his appetite and as of lately his belly looks really big. He just acts really sad! Now he is a Beagle/Bassett so that might be hard to judge, but he just does not seem right to me. So I called the vet and she is going to look at him and maybe schedule an ACTH test and then talk about going from Trilostan to Lysodren. What do you all think? I am just really worried about switching him. Thank you all in advance for your inputs!!!!

When your vet told you that Todd didn’t need another acth stimulation test for six months was she aware that Todd’s symptoms had not improved? If that was the case, one of two things should have been suspected. 1) The dose is still too low or 2) Todd may be a dog who needs twice daily dosing. It will be a lot easier to figure out which one is the more likely scenario after you post the results of the most recent acth stimulation test.

Based on the information you have provided so far, I would agree with Addy that it is too soon to be discussing switching to Lysodren.

Glynda

Todds Mom

09-14-2011, 09:58 AM

Okay so I took Todd to the vets last night and he gained 2lbs and she gave a check over. She said everything she can see looking at him seems okay. She is concerned about his big belly, don't know if it is just weight gain or his cushings acting up. His numbers at the end of July were good.

T:0
Vet Cortisol 3.2

T:1
Vet Cortisol 4.6

So what she wants to do is bring him back in for another ACTH and see if maybe the dosage needs adjusted. In the meantime I am really going to watch his intake of food. He is always, always hungry and stealing food. This is going to be a challange. He goes Sept 30th for another ACHT test.

I guess we just have to wait and see. 2lbs in 2 months is alot for a dog, that is probably why he hasn't had very much energy.

She said that if his blood work comes out okay about maybe getting an Ultrasound and seeing an Internist.
That is all I know for now I guess it is just a waiting game.

Todds Mom

01-17-2012, 12:09 PM

Hello everybody! I know it has been awhile since i have been on here but let me assure you that I do keep up on all of your babies even though I don't reply. Here is where I stand with Mr. Todd the hound, took him for a ACTH test last Friday, feed him at 8:30 and his first draw was at 1:00pm. The vet called me yesterday with his result and wanted to let me know that Todd's test results came back too low.

Resting Cortisol is 0.5 L Normal 1-6 (Resting)
2nd Blood Draw 1hr later is 0.9 Normal5.0 -18.0

She wants me to stop his trilastane for 1 week and come in for a Resting blood draw and see if his numbers come back up. Then she will probably lower his dosage. She said sometimes the compounded doses are higher than if you were to get the regular pills ( I have no clue).

I have not seen a difference in him at all. In fact I thought for sure she was going to tell me his numbers were high. He still has a huge appetite, pants from time to time. I have never seen a big difference in his appetite (unless that is the hound in him). Due you think the compounding drugs are okay? I just don't know what to think. Please help!!

frijole

01-17-2012, 09:08 PM

I have never used trilo but I know many have used the compounded version without problems. Who is doing the compounding?

I also think it is strange that you still have cushings symptoms yet the reading is so low. What dosage are you on? Your dogs' weight is?

I'm wondering if the lab screwed up the test or switched results. Kim

Todds Mom

01-18-2012, 01:17 PM

Thank you Kim for responding! I was thinking the same thing about it being a mistake. I order his Meds through Diamondback. He takes 45mg and he weighs around 48 lbs. I just know from what I have read on here that low results I should see different symtoms, but I have not. Like I said I thought she was going to tell the results were high. We go next Tuesday for just one resting blood draw in the morning. Any feed back would be appreciated!

Todds Mom

01-25-2012, 03:25 PM

labblab

01-25-2012, 03:43 PM

I am glad that Todd's cortisol level has rebounded. But I am guessing that if his resting cortisol is now back up to 4.2, his post-ACTH result will probably soon be above the desired therapeutic range for a dog being treated with trilostane (if it is not already). The laboratory "norms" that are given on your test report are for dogs who do not have Cushing's. For Cushpups being treated with trilostane or Lysodren, the desired cortisol levels are lower. For instance, the manufacturer of Vetoryl (brandname trilostane) recommends a post-ACTH treatment range of 1.45 - 5.4 ug/dl (with levels up to approx. 9 allowed as long as symptoms are under control).

I think your vet's suggestion to resume dosing at a lowered amount of 30 mg. seems reasonable. However, if you feel more comfortable waiting a while longer until a full ACTH is performed, that is entirely your choice. If Todd starts becoming even more symptomatic, though, I think you can safely guess that his cortisol has risen to a point where it would be OK to resume treatment at that lower dose, with or without the full ACTH beforehand. I would then retest with an ACTH, however, approx. two weeks after starting back in again.

Marianne

Harley PoMMom

01-25-2012, 04:01 PM

If it were me, I would not rely solely on starting the Trilostane based on a resting cortisol test because stress, among other things, can cause a base line cortisol reading to elevate.

If Todd were my furbaby, I would have a post ACTH stim test done and based on that reading plus Todd's symptoms, would indicate to me whether the Trilostane should be restarted.

Todds Mom

01-25-2012, 04:53 PM

Here is where we stand right now. Todd had is Resting Cortisol tested on Tuesday because she wanted to check it after being off the pills for 1 week. She called me today and told me that his Resting Cortisol is nice and normal at 4.2 1-6(resting). She said she would like to start him back on 30 mg of Trilostan. I asked her if it is normal won't that take the levels back down and she said not necessarily. So she said that we can wait (and not give him any pills) if I am scared and have another ACTH test done in 1 month and then go from there.

What do you think, should I have put him back on the Trilostane or waited like I told her I wanted to. Todd has symptoms if his levels are high or low (it has to be the hound in him) so looking for them are hard to do. This dog is driving me crazy, but he is my baby and we do what we have to, to make sure they are healthy.

Thank you Marianne for making me feel better about putting him back on. I have decided to start him back on the Trilostan because he is so symtamatic. He got in the kitchen cabinet on monday and pop-tarts and cereal all over the floor. My problem is that he still had symptoms when his readings were low. Wow! It is a guessing game with this dog.

Also, do you think the compounding is just as good as the real Trilostan?

lulusmom

01-25-2012, 07:19 PM

My two cushdogs were on trilostane compounded by Diamondback Drugs for two years and once stabilized, their acth stim tests were perfect every quarter.

As I recall, Todd's symptoms never really resolved, even when his cortisol was too low. If he was on once daily dosing, you may want to talk to your vet about switching to twice daily dosing. If your vet wants to start with 30mg once a day, perhaps you may consider restarting with 15 or 20mg twice a day.

Cyn719

01-25-2012, 11:41 PM

Just wanted to say hello and I am just catching up on your thread -I agree with Marianne - its ok to wait and then if symptoms get worse start meds or start now at the low dose and recheck - will be checking back to see what you decide..........Todd is just adorable!!!!:)

labblab

01-26-2012, 09:55 AM

In response to your question about compounded trilo, just as was the case for Glynda, we have had a number of other members through the years who have been very happy with their results and relationship with Diamondback Drugs. However, I am guessing that your vet's comments about compounded trilo may stem from this recent study:

In a blinded, controlled study sponsored by Dechra Veterinary Products of Overland Park, Kan., Audrey K. Cook, BVM&S, MRCVS, Dipl. ACVIM, Dipl. ECVIM-CA, at Texas A& M University, College of Veterinary Medicine, placed 12 separate orders for compounded trilostane with eight pharmacies over the course of six weeks and then sent them to be analyzed with two controls.

The control capsules contained no trilostane or branded trilostane (Vetoryl by Dechra). The laboratory found the correct amount or no trilostane in the control capsules but the trilostane in the compounded drugs varied from 39 percent to 152.6 percent of the amount claimed on the label.

In all, 20.5 percent of the compounded drugs contained less than 85 percent or more than 115 percent of the amount she prescribed in the order.

“If I want to give a dog 100 mg of trilostane and I use the Dechra medication Vetoryl, I know that I am giving 100 mg,” said Mark E. Peterson, DVM, Dipl. ACVIM, of the Animal Endocrine Clinics in New York.

The study did not release the names of the compounding pharmacies involved, so there is no way to know which ones had a problem with the dosage of their trilostane. So I think that leaves owners with a bit of a question mark, especially in any situation when symptoms and/or monitoring test results are suddenly surprising after a dog has seemingly been stable on a specific dose of compounded meds.

I know there are times when a compounded product is necessary, like when a dosage is needed that is not available in brandname form, or the drug is needed in an alternative form such as liquid, or when the cost of the brandname version is simply unaffordable to the owner. But if it were me and I was just starting out on treatment, if possible, I would opt to begin with the brandname med until my dog was stabilized. Then, if I felt as though I couldn't afford to continue and needed to switch to a compounded med, I would at least have a baseline for comparing its performance. As I say, this is just my own opinion, and we have a number of members who have been very satisfied with compounded meds from the get-go.

Marianne