Sophia - Boxer on Vetoryl - Cortisol now too low?

[jasonhbaum]

Hello. My Boxer Sophia may have Cushings. She is almost 8 years old. In April, we took Sophia for her yearly exam and the vet noticed an irregular heart rate. After testing, she was placed on a daily dose of sotalol. Since the heart issues we noticed Sophia was drinking alot of water and just wasnt herself - not as cuddly and a bit lazy. We thought maybe this was due to the Sotalol. This past Monday night, when Sophia was sleeping, we noticed she had very shallow and rapid breathing - so much so that it kept us up all night. We took her to the vet the next day and they ran a blood test. The results came back and after some proding the doctor mentioned it could be Cushings. Looking at the symptoms of Cushings Sophia fits - excessive drinking, diluted urine, urinary accidents, small bloated belly, reluctance to jump on furniture or people, excess panting, seeking cool surfaces to rest on. She was a crazy, typical boxer that loved to chase things and run around the yard and now she prefers to lay on the porch. She does have energy for walks and occassionally fighting with her sister.
. The results of the blood test are below. We have a dexamethasone test scheduled for next week. I found this site and it seems like it might be my home for a good while.

Test results: Tot Protein:6.5 Albumin:3.5 Globulin:3.0 AST:14 ALT:78 Alkaline Phosphatase:1373!!! (in April it was 294) Bilirubin:0.2 Urea Nitrogen:11 Creatinine:0.7 Phosphorus:5.7 Glucose:111 Calcium:9.7 Sodium:149 Potassium:5.5 Chloride:110 Cholestoral: 504 (338 in April) CPK:39

I think it is pointing towards Cushings. Should I let my vet perform the treatment (he mentioned the lysodren) or should I ask him to refer me to an internal medicine specialist? Thanks for reading this. Any replies would be greatly appreciated.

[StarDeb55]

Welcome to you & Sophia! I must warn you that we tend to play 20 questions with new members. You have given us a great start by telling us about Sophia symptoms & the results of her routine bloodwork. Has any Cushing's diagnostic testing been done such as an ACTH or low dose dex test? These specific tests are an absolute must to make the diagnosis. General labwork can hint at Cushing's but general labwork can't make the diagnosis since it does not take a look at cortisol levels & how the adrenals respond. If specific diagnostics have not been done, you absolutely can't start treatment just yet. Has your vet ruled out diabetes & thyroid? I ask about these 2 as their symptoms can overlap Cushing's.

When it comes to the Cushing's diagnostics, the low dose dex is considered to be the gold standard for diagnosis, but it has one huge drawback. The test can yield a false positive in the presence of non-adrenal illness such as diabetes. It is absolutely crucial that you confirm either a positive low dose or ACTH with a second test such as an abdominal ultrasound or the high dose dex test. The abdominal US will give you more bang for the buck as it will take a look at the adrenal glands along with Sophia's other internal organs which will give you a better idea of her overall health. There is a screening test you can do which is inexpensive called a urine cortisol creatinine ratio, which is a rule out test. You would collect urine from Sophia at home, preferably the first morning pee, & take it into the vet. A positive result indicates that Cushing's is possible but further diagnostics are required. A negative means you aren't dealing with Cushing's & you're done. Cushing's is probably the most difficult endocrine disorder to diagnose in our pups, so you want to make very sure you have a confirmed diagnosis before you start either medication, lysodren or vetoryl.

Just to let you know, I'm a medical lab technologist with 30+ years experience, so I can help you sort out some of these numbers. Can you do one favor for me? Please post the normal ranges, along with reporting units as this can vary from lab to lab. I will tell you that the alk phos is very high, I don't need the range for that. This is not unusual in our pups as a badly elevated alk phos is frequently what tips off a vet to take a look at Cushing's.

When it comes to going to an IMS, it may not be necessary as long as your general practice vet is very experienced in treating Cushing's. I'm a little concerned about the experience level, if your vet is proposing to start lysodren based on the general labwork alone. If that's the case, I do think it would be in Sophia's best interest to get a referral to an IMS.

Hope all of this helps, & please keep us posted.

Debbie

[frijole]

Hi! Just welcoming you and reinforcing what Deb said. Don't worry about cushing's just yet... focus on making sure the diagnostics are all done first.

And if it is cushing's, just know Sophia can lead a normal and a happy life. My girl Haley was treated with lysodren for over 4 yrs. She passed a few mos ago at the age of 16 1/2 and it wasn't cushing's that took her.

Glad you found us... read up.. ask questions and we'll get you ready to deal with the vets on behalf of your girl. Kim

[ChristyA]

Hi and Welcome,
We went to 3 different GP's before we went to an IMS. The GP's had us all over the spectrum with tests, dosage amounts,,etc. The IMS got us on track in one visit, and did all the proper tests.

In my opinion the GP's were a waste of time and money.

This is a complex disease that needs a Dr. who knows what they are testing for, which tests need to be done and when, and about the medication.

I don't know where you are located but here is a link to the ACVIM to help you find an IMS.
http://www.acvim.org/websites/acvim/index.php?p=2

Let us know what you decide and how it goes. The folks on this site have helped me immensely. They knew more about Cushing's than all 3 of the GP's I went to. They held my hand through the testing, induction phase,,everything. And they will do the same for you.
Christy

Just remember, Sophia is depending on you to be her advocate in this process and make decisions for her. Never be hesitant to question your vet or any vet on the treatment of your girl.

[jasonhbaum]

Thank you for the replies. We have a low dose dex test next Wednesday. I will post the bloodwork results and normal ranges. I am really debating on whether to go to the IMS or not. If not for my wife asking the vet to compare Sophia's April bloodwork to the bloodwork we just had done he may never had mentioned Cushings. We were thinking something was going on with her heart and possibly the sotalol was causing her to retain water etc... There are two vets at the office so I will check if they have experience with treating Cushings.

[Squirt's Mom]

Hi Jason and welcome to you and Sophia! :)

I am really glad you found us before you let the vet start Sophia on any treatments. The LDDS is a good starting point tho the UC:CR could rule out Cushing's via this simple urine test. This is the urine cortisol creatinine ratio previously mentioned (UC:CR).

Cushing's a very difficult condition to diagnose because so many variables can affect the cortisol levels and there are several other conditions that mimic Cushing's. This is why it is essential that thorough testing be done BEFORE starting any treatments. ;) The good part is that Cushing's is a very slowly progressing condition so you have plenty of time to be sure of what is going on with your sweet girl.

You and Sophia are part of our little family now and we will be here for you any time. Ya'll are not alone on this journey. Read all you can, ask lots of questions, then read some more. Knowledge truly is power when dealing with Cushing's. You are Sophia's first and last defense, her only voice, her advocate; the more you know the stronger you will be in these roles on her behalf.

Hang in there!
Hugs,
Leslie and the girls :D - always

[addy]

Hi and Welcome from me and my pup Zoe,

Zoe and I started on her Cushing's journey because her hair was thinning and not growing back after a gromming as it had been and her tail looked awful. Other than that she had no other strong symptoms. My first vet was picking out a drug to give her based on the UC:CR test and told me all her hair would fall out in 2 months if I did not treat her.:eek: That did NOT happen.

We found a specialist and we have gone through alot of testing and we had to indeed fix her chronic diarrhea before considering treatment. Right now she is on wait and watch for 3 months while taking melatonin and lignans. We started out journey in April of this year so you can see you do not have to rush into anything and don't let anyone push you into treatment based on one test or some bloodwork. Non adrenal illness can affect Cushings tests. Heart problems can cause water retention, etc so my advice would be proceed with caution and try to be as thorough as you can afford to be.

This group is a wealth of information from very special people who hold hands and offer support as well as sharing their knowledge and experiences so I am glad you found your way here.:) The more you learn the more confident you will become with Cushings. I won't minimize it, it is hard sometimes.

Hugs,
Addy

[apollo6]

Welcome.
A blood panel only does not mean cushing. AN ULTRASOUND of the abdominal, and a ACHT STIM test can help in determining cushing.
Please do not start treatment until you are sure it is cushing and what type it is.
Below is a short run down on cushing.


http://www.kateconnick.com/library/cushingsdisease.html
Hugs Sonja and Apollo

[jasonhbaum]

Thank you to everyone who has responded. I am going to keep on top of this testing. I am posting her test results again with the normal levels for Debbie. Sophia and her sister are the only kids we have. It is very nerve racking when they have to go thru this kind of stuff.

Test results (normal range in parentheses)
Total Protein 6.5 (5.0 - 7.4)
Albumin 3.5 (2.7 - 4.4)
Globulin 3.0 (1.6 - 3.6)
AST 14 (15 - 66)
ALT 78 (12 - 118)
Alk Phosp 1373 (5 - 131)
Tot Billirubin 0.2 (0.1 - 0.3)
Urea Nitro 11 (6 - 31)
Creatinine 16 (4 - 27)
Phosphorus 5.7 (2.5 - 6.0)
Glucose 111 (70 - 138)
Calcium 9.7 (8.9 - 11.4)
Sodium 149 (139 - 154)
Potassium 5.5 (3.6 - 5.5)
Chloride 110 (102 - 120)
Cholesterol 504 (92 - 324)
CPK 39 (59 - 895)

Lipase 970 (77-695)
Hemoglobin 19.4 (12.1 - 20.3)
Hematocrit 52 (36 - 60)
WBC 7.1 (4.0 - 15.5)
RBC 7.74 (4.8 - 9.3)
MCV 67 (58 - 79)
MCH 25.1 (19 - 28)
Neutrophils 5751 (2060 - 10600)

Again, thank you for your comments and words of encouragement.

[gpgscott]

Welcome Jason and Sophia,

Sophia's alkp is grossly elevated, this is common with Cushing's.

I agree with Leslie, too much money and time is wasted in my view with a helter-skelter diagnostic process. I also advocate first the UC:CR and we have been adivsed by a noted Dr. that a three day pooled sample of urine is necessary to rule out vagaries. This test is non invaisive and relatively cheap and if it is negative for Cushing's you are done with Cushing's specific testing and on to looking for another medical issue. If it is positive for Cushing's you must do more testing to confirm. My next choice the the full adrenal panel ACTH from UTK (university of Tennessee@Knoxville). This panel gives you cortisol and five other hormones all of which can cause Cushing's. If you have a positive ACTH then I would suggest an abdominal U/S to image the adrenals and the rest of the internal goings on. If negative you focus more on disease processes other than Cushing's. Even though the LDDS is considered the 'gold standard' it is widely acknowledged that it can produce false postive results and I really don't see any need for it as the previously mentioned labs will nail down a Cushing's diagnosis and the only thing the LDDS can possible add to the mix is an impression of ADH vs PDH (adrenal dependant/pituitary dependant).

Just my opinion but I think following this path gives you more answers quicker with the least stress on the pup and least overall expense to you.

Good luck. Scott

[labblab]

You already may have found plenty of reference material on your own, but here's a link to a diagnostic flowchart that offers a quick summary of some of the strengths and weaknesses of the various Cushing's tests. It is part of an information brochure published by the company that manufactures Vetoryl (trilostane), but it is applicable to diagnosing Cushpups regardless of which medication is selected for treatment.

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

As you'll see (and as everybody has already pointed out), each test has it's own strengths and weaknesses. From your description of Sophia's classic symptoms and from her lab results, it definitely sounds as though Cushing's is a likely possibility. And it's probably a toss-up as far as which test any given vet would prefer to administer first in her situation -- different vets have different preferences. Here's a set of recommendations given by Dr. Rhett Nichols (http://www.k9cushings.com/forum/showthread.php?t=210)that has always seemed pretty reasonable to me:


Final screening recommendations

What if the patient has only biochemical changes and no or mild clinical signs suggestive of Cushing’s syndrome?
The ACTH response test may be the preferred test. In these patients, it may be better to miss a diagnosis of HAC [Cushing's] in early stages by using a test with lower sensitivity than falsely diagnose HAC by using a test with lower specificity.

Is nonadrenal illness present?
The LDDS and ACTH response tests can give false positive results in the face of nonadrenal illness, but the LDDST is more likely to do so. Thus, the ACTH response test is recommended when nonadrenal illness is present.

What if the patient has moderate to severe clinical signs of HAC and has no known nonadrenal illness?
The LDDST is preferred as the initial screening test. This test has a higher sensitivity as compared to the ACTH response test.

Is an AT [adrenal tumor] suspected?
The LDDST is recommended because the sensitivity of the ACTH response test for HAC caused by an AT is only 62%.

Has the Cushing’s syndrome suspect been treated with a cortisone
preparation?
The ACTH response test is the preferred test if an animal has a definitive or questionable history of receiving exogenouscorticosteroids and has signs compatible with HAC...

Given Sophia's classic symptom profile, I do think the argument could be made for your vet opting to start off with the LDDS. One question mark I might have is that Sophia had an elevated lipase reading. I believe this would be associated with inflammation or irritation of the pancreas, and whether or not this would present an issue for the accuracy of the LDDS in her case, I do not know.

If you do have doubts about your vet's familiarity with Cushing's treatment, in general -- then I agree that you may be better served by deferring any testing until you get set up with an IMS. The IMS may still want to start with the LDDS, but that way all the testing and treatment decisions will be made under the guidance and direction of the same professional. As the others have said, this may save you money and aggravation in the long run...

Marianne

[StarDeb55]

Jason, thanks for posting those normal ranges. As several of us have already mentioned, the alk phos is grossly elevated which is quite typical for our pups. Believe it or not, we have seen pups with even higher alk phos values than this. Sophia, also, has the typical elevation is cholesterol. Alk phos, cholesterol, and ALT are usually always elevated in our pups as the liver is in overdrive to process the excess cortisol that the adrenals are producing. The good news is that the ALT value is normal. I see Marianne has mentioned the elevated lipase reading. if Sophia's amylase was normal, I'm not sure how concerning this is. Elevations in both test may be pointing at pancreatitis which can be very serious. Our pups, also, seem to be prone to pancreatitis. I think to be on the safe side I might ask the vet about this, & perhaps see if running a cPL test is warranted. The cPL is specific to diagnose pancreatitis. All of the other labs look real good, so there's nothing to worry about there.

Debbie

[ChristyA]

Hi,
Just wondering how Sophia is doing?
Christy

[jasonhbaum]

We had the LDDS test done and had her thyroid levels checked. Just got the results on Friday - I will post the numbers but the doctor believes she is positive for Cushings and her thyroid levels are low. He is referring us to a specialist - Internal Med and Cardiologist. Sophia is on sotalol for her heart so the doctor wanted us to see the cardiologist first to make sure the heart meds wouldnt interfere with any type of Cushings disease. Should get a call from the specialist today or tomorrow for scheduling the appt. I am very worried as I am reading horror stories about thyroid issues

[labblab]

Jason, thanks for this update, and I am really glad that you will be moving on to consultation with the specialists! As far as the thyroid, I am not sure what you are reading that has you feeling so worried. Low thyroid is actually a very simple condition to treat with medication if Sophia truly does have a deficiency. But it is also not uncommon for untreated Cushpups to exhibit low thyroid readings that end up resolving on their own once Cushing's treatment is underway. Your specialist should know how to request additional thyroid testing that will give you a better picture of Sophia's situation in that regard.

Marianne

[lulusmom]

Hi Jason,

I am glad that your vet has referred you to a specialist. Hopefully, the specialist will also confirm the cushing's diagnosis. A majority of dogs with cushing's will have low T4 but this usually normalizes once a dog is stabilized on treatment. This is merely a transient condition. A small percentage of dogs with cushing's will have concurrent hypothyroidism requiring thyroid supplementation; however, your vet should want to rule out any adrenal and nonadrenal illnesses that may be lowering T4 levels before pursuing a diagnosis of hypothyroidism. I am not sure where you heard horror stories about hypothyroidism because it is problably the most common canine endocrine disease out there and most dogs diagnosed with it do not have cushing's. It is extremely easy and inexpensive to treat. My tiny Pom was only 1 year old when diagnosed.

Looking forward to hearing about your consult with the specialist.

Glynda

P.S. I see that Marianne posted before my feeble fingers could finish. As usual, she has stated my thoughts with clarity and in fewer words. Sorry for the duplication.

[labblab]

Glynda, thank you so much for the compliment, girl :p -- but every single reply that you post on this forum adds additional info, insight, support and/or much needed levity!!! ;) :)

Marianne

[jasonhbaum]

Thank you all for your replies. It just seems like everything is piling on and I am wandering if one illness is the root of the others - cardiomyopathy, cushing's and hypothyroidism. We have our appointment set for next Monday to see both the IM and Cardiologist.

[littleone1]

Hi Jason,

I just wanted to add my two cents about hypothyroidism. Corky was diagnosed with it about 10 years ago, which was many, many years before he was diagnosed with Cushings. He is taking medication for it, and he has been doing very well.

Terri

[jasonhbaum]

Hello all. Here are the results of the LDDS testing
Tube 1 - 9AM - 3.8ug/dl
Tube 2 - 1PM - 0.9ug/dl
Tube 3 - 5PM - 2.2ug/dl

Test states normal results would be 1.4ug/dl 8hrs post dex

Thyroid
T4 0.2 (Ref Range 1.0 - 4.0ug/dl)
Free T4 5 (Ref Range 8 - 40ug/d)

Can anyone tell me what the approximate costs are? The tech said for Cushings diagnosis it could be $600-1100 and for the cardiologist visit it will be approx $500. Seems steep to me but the cardiologist is the only one in the Pittsburgh area.

[frijole]

I think your vet was just guessing at those numbers... because you have already done quite a bit of testing. Other than an acth which is probably around $200 and an examination - the specialist has enough to go on to give you a cushing's opinion without doing much. So I think the number for the cushing's part is high.

Be sure to bring copies if you can of all tests that have been done with you for them to look at.

I agree - hypothyroidism is very frequently seen with cushing's. Easy to treat and cheap too.

Deb mentioned earlier that you might want to do a spec Cpl test for pancreatitus. Have you noticed any stomach issues or eating issues? Be sure to mention the elevate lipsase to the specialists. Some heart meds effect the stomach and appetite.

Sounds like you are in good hands. Do keep us updated!! Kim

[labblab]

I just wanted to add that I believe the LDDS results you posted would be consistent with the pituitary form of Cushing's. Given those results, I don't know whether the IMS will recommend an abdominal ultrasound or not. An ultrasound is often recommended as part of the general Cushing's diagnostic process, and especially to help distinguish between pituitary and adrenal Cushing's when the LDDS results are not definitive as to type. If your IMS does request an ultrasound, that could cost approx. $400 (although it could be more or less). So an ultrasound added to an ACTH could get you up to that $600+ range :o.

Marianne

[brandysmom]

Jason,

I just wanted to say hello and welcome to you and Sophia. I found this forum last year and has been a great support system with lots and lots of knowledge. I also have a boxer with cardiomyopathy and she is on Sotalol too. Her cushing's is atypical and she was also diagnosed as hypothyroid several months ago. She is on a low maintenance dose of Lysodren for her cushing's and Soloxine for the low thyroid. My IMS put her on a conservative dose of the Soloxine because thyroid medications can sometimes cause more arrythmias as it speeds up the metabolism. She has been great so far so please don't be worried. I'm glad you are going to see a specialist. I didn't get anywhere with diagnosing and treating Brandy until we went to an IMS last December. Best of luck with your appointment and I will be looking forward to hearing more about Sophia.

[jasonhbaum]

Kim - Sophia hasnt had any changes in her appetite or problems with stomach. She has been showing some incontinence when sleeping - she pees the bed (our bed).
Reading these comments really puts me at ease. It is overwhelming at times and the anticipation of having to wait until Monday for the appts can drive me nuts at times.
Did Brandy show signs such as not as affectionate, rather lay on the floor when she used to always be on our lap.. etc? If so, did that change once you started the meds? I have two boxers and they would run circles in the yard.

[brandysmom]

Yes, Brandy was exactly like that. She was always a lap dog as you know boxers can be :) I actually had to purchase a dog bed for her for the first time ever because I felt so bad she was just laying on the floor. She is now back to being a cuddler and wanting to sleep in my bed with me, except I have to lift her due to her arthritis in her back legs. She puts her front paws up on the bed and I left her back end. Every once in a while she will run around the back yard too, but not like she used to. She has slowed down a lot in her old age. She is exactly 11½ today.

[jasonhbaum]

We took Sophia to the specialist today. She first saw the cardiologist who did an echo on her heart. Everything looked normal and the 10min EKG looked fine. We have her on a 24-hour halter.
Saw the IM next. She did an echo on her as well. Andrenal glands were enlarged. Liver and everything else looked OK. She did the ACTH and urine tests. We should hear back in the next day or so.
Speaking with the specialists we decided to make sure the heart issues are OK then treat the Cushings if that is what she has. I will post the results of the tests as soon as I get them.
For today Sophia is wrapped in pink med-wrap.

[jasonhbaum]

Still no results. Will try calling again today.
Brenna - did you ever consider Anipryl? Sophia seems to have mild symptoms and from reading some articles the Anipryl may be a good first attack. There is so much information I cannot grasp what treatment would be best - trilostane, lysodren or anipryl? Our IM says they like to use trilostane. I guess I can ask her why they choose that treatment over the others.

[jrepac]

Still no results. Will try calling again today.
Brenna - did you ever consider Anipryl? Sophia seems to have mild symptoms and from reading some articles the Anipryl may be a good first attack. There is so much information I cannot grasp what treatment would be best - trilostane, lysodren or anipryl? Our IM says they like to use trilostane. I guess I can ask her why they choose that treatment over the others.

Hi Jason,
from what I've read here, it does sound like Cushings; the UCCR test and ACTH will likely confirm that. And, you did the ultrasound (which can sometimes be inconclusive as well). But, you may be in the early stages of it, so the symptoms may be few and mild, at that.
I've been in that spot as well. But, behavioral changes such as those you describe are also indicative of cushings: laying on floor instead of bed/furniture, seeking out cool places, less jumping/running, etc. Even if the consumption of food/water is unchanged, these other changes can be indicative.

Re: Anipryl, some vets may use it as a "first try", when symptoms are mild/few or when other health conditions are involved. Anipryl has fewer side effects (relative to other treatments), but is also seen as less effective. Only about 20-25% of dogs respond well to it, and then another 40% or so have "some response"--and, for some dogs, it just does not work. From what I've been seeing/hearing, many vets are leaning towards trilostane (Vetoryl) right now.

On a positive note, I've been using generic Anipryl (selegiline) for 2 yrs now and it has kept the Cushing symptoms in check; I too was dealing with a mild case, but it was troublesome and causing some obvious problems (skin dark, belly extended, urinary infections,etc). My Aussie responded to the Anipryl in 2-3 weeks and we've been on that plus several over the counter supplements (melatonin, lignans) for quite some time now (crossing fingers as I write this). Her general condition and quality of life is quite good at 13.5 yrs old! If you do try Anirpyl, and see no response in the first 30 days, the vet will double the dose and go for another 30 days to see if your pup responds. If no response, then another drug will have to be tried....but, if you are a bit lucky, it may work for you.

Good luck!

Jeff

[brandysmom]

Hi Jason,

Unfortunately with Brandy being diagnosed with Atypical Cushing's I did not have the option of Anipril or Trilostane. I could either treat her with Lysodren or Ketoconazole. I chose Lysodren and she also gets melatonin and flax lignans. Atypical is different that traditional Cushing's. Her cortisol is not what is elevated. It is her sex hormones but the symptoms are identical. So far it has helped. I plan to have her retested in December providing there are no issues in the meantime.

I am anxiously awaiting Sophia's test results. I hope you get all the answers you are looking for so that you can treat her appropriately. Take care.

[jrepac]

Hi Jason,

Unfortunately with Brandy being diagnosed with Atypical Cushing's I did not have the option of Anipril or Trilostane. I could either treat her with Lysodren or Ketoconazole. I chose Lysodren and she also gets melatonin and flax lignans. Atypical is different that traditional Cushing's. Her cortisol is not what is elevated. It is her sex hormones but the symptoms are identical. So far it has helped. I plan to have her retested in December providing there are no issues in the meantime.

I am anxiously awaiting Sophia's test results. I hope you get all the answers you are looking for so that you can treat her appropriately. Take care.

right, if the cortisol is not elevated, then you are looking at a different treatment protocol....which could simply be melatonin + lignans for some; in my case, we have elevated cortisol plus 4/5 of the other hormones elevated, so I elected to go w/anipryl + melatonin + lignans. Trilostane would not be the first choice in my case either (though some will use it nonetheless)

[jasonhbaum]

Thanks again. I am still waiting for the results. Call every day if not twice but havent gotten the callback.

[jasonhbaum]

I got my test results back and they say Sophia has Cushings. They want to start with 30mg trilostane/2x per day. Here ar ethe test results:

ACTH Response
Pre Cortisol 4.9ug/dl
Post 20.6ug/dl
Normal response to ACTH is 5.5 - 20.0ug/dl

Urine Sample
no infection
Specific Gravity 1.006 (Range 1.015 - 1.050)
pH 7.5 (Range 5.5 - 7.0)
Protein 2+ (Negative)

Vet findings: Urinalysis shows abnormal increased protein levels and low concentations. ACTH stim test are just above the normal range. These results, combined with previous LDDS results, ultrasound and other tests are enough to make the diagnosis of Pituatary dependent Cushings.
Recommend beginning Vetoryl 30mg capsules 2x per day and rechecking ACTH test in 2 weeks.

What is the prednisone for? Anyone know where to order to Vetoryl? I will check the other forums for the more information but at least we have a diagnosis.

Now to the research on trilostane. I know alot of people have used it on here. Want to find out what I am in for - or better yet, what Sophia is in for.

Thanks in advance for any words of advice and support

Jason and Sophia

[Harley PoMMom]

How much does Sophia weigh?

[jasonhbaum]

Sophia weighs 57lbs. I have been trying to find out why the UC-Davis recommends only 30mg/1x per day rather than 2x per day. So far none of the articles really state why

[Harley PoMMom]

Both good questions. With regards to once vs twice a day dosing if we look at all the studies throughout the world you will see that about 80% of dogs do well with once daily dosing. One huge advantage of once daily dosing is owner compliance which goes up substantially when owners only have to dose once a day. While twice a day dosing may result in a lower amount of trilostane being used pre day it will require closer monitoring as the ACTH stimulation tests tend to be lower so we have to look for both hypocortisolemia and electrolyte abnormalities.

Urine cortisols can be a problem. Many studies have shown that the only way to accurately gauge urine cortisol levels is to obtain the first morning voided urine sample on 3 consecutive days and then pooling the urine to run a UCCR. When done in this fashion it is likely an accurate test. Otherwise there is likely too much day to day variation to make a single random cortisol very helpful.

Dave Bruyette DVM DACVIM

Hope this helps!

[Harley PoMMom]

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

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

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

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

Marianne

You can find information about pharmacies that compound Trilostane here: http://www.k9cushings.com/forum/showthread.php?t=2600

The prednisone is used if Sophia shows signs that her cortisol has gone too low. These signs could be diarrhea, vomiting, lethargy, not wanting to eat.

Love and hugs,
Lori

[jrepac]

seems like she has just crossed the border into the Cushings zone so to speak; I am surprised the vet did not want to start w/a low dosage of trilo....a lot of people have had success starting w/50% of the recommended dose, adjusting upwards only if needed

[labblab]

Since Sophia weighs approx. 60 pounds, a beginning total daily dose of 60 mg. actually does fall at the low (and recommended) end of Dechra's initial prescribing range (1-3 mg. per pound). It is true that UC Davis would likely start at even a lower dose -- probably 30 mg. total daily. However, at this point I think it's a toss-up as to which of these two treatment protocols any given U.S. specialist favors.

Marianne

[jasonhbaum]

OK my head is spinning now. Looking over some of the comments by Dr Bruyette it seems like he recommends 5mg/pound and giving it once a day. Is there a time issue with this Vetoryl - ie the sotalol I give Sophia has a life of 12 hours so I give it to her twice a day? Is this the same with Vetoryl? I would rather start with a low dose and work up than start with a large dose and work down. Thank you for the information. I will continue to reseach the forums.

[labblab]

As you are discovering from your reading, there is a fair amount of variability among recommended trilostane dosing protocols. And different specialists have different preferences based upon their own experiences and their professional orientations. It has only been within the last five years or so that trilostane has become widely used here in the U.S. So as more data is collected, we can probably expect that dosing recommendations will continue to be modified.

However, Dr. Bruyette's comments undoubtedly referred to 5 mg. per kilogram rather than 5 mg. per pound. Pound vs. kilogram recommendations can be very confusing :o :confused:.

Here's a quote from a reply that we received from Dr. Bruyette back in 5/09:


We start at 3-5 mg/kg once a day in the AM...

Since one kg. equals 2.2 pounds, his typical starting dose at that time would have ranged from 1.4 - 2.3 mg. per pound. Since Dechra themselves are now verbally recommending a starting dose of 1 mg. per pound, it is possible that Dr. Bruyette has also scaled back his starting dose as well. We just don't know.

In some sense, however, the inital dose for any dog is a bit of a craps shoot since there is individual variation in the way that every dog metabolizes the drug. That's why the monitoring ACTH tests are so important to decisions regarding subsequent dosage changes after the dog starts treatment.

In answer to your question about "timing," here is a quote from Dechra's U.S. Product Insert:


Trilostane absorption is enhanced by administration with food. In healthy dogs, maximal plasma levels of trilostane occur within 1.5 hours, returning to baseline levels within twelve hours, although large inter-dog variation occurs. There is no accumulation of trilostane or its metabolites over time.

Because trilostane's effectiveness only lasts for about twelve hours, some researchers have concluded that twice daily dosing should be the preferred protocol. As a result, some specialists prefer to start dogs with twice daily dosing right from the start. However, others feel that most dogs whom they have treated have done fine with only once daily dosing. So for the reasons given in Lori's previous quote from Dr. Bruyette, they reserve twice daily dosing only for dogs who do not show satisfactory symptom resolution with only a morning dose of the medication.

If you haven't already found it, here's a link to Dechra's U.S. Product Insert. It may answer some additional questions that you may have.

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

Marianne

[jasonhbaum]

Thanks Marianne

[jasonhbaum]

seems like she has just crossed the border into the Cushings zone so to speak; I am surprised the vet did not want to start w/a low dosage of trilo....a lot of people have had success starting w/50% of the recommended dose, adjusting upwards only if needed

jrepac - I was thinking of starting at a lower dosage as well. May try to do the 30mg/day instead of 60mg/day. Struggling with that decision. I had some correspondance with Dr Bruyette and he stated the recommended dosage is 2-3mg/kg.

[jasonhbaum]

Sophia started her Vetoryl this AM. Starting at 30mg 2x a day but I am thinking of going to 60mg in the AM. Hoping for success with this.

[labblab]

Jason, good luck to you and Sophia :)!!! Please keep us updated, OK?

Marianne

[Squirt's Mom]

Hi Jason,

Just popping in to say we are with you! If you need help, just holler! Keep in touch!

Hugs,
Leslie and the girls :D - always

[Bichonluver3]

Welcome!
I guess I have to stand up for my GP here. He has been absolutely wonderful. He has treated some Cushing's before but not a whole lot. He reads, he studies, he asks other vets. Whenever he has a question he is on the phone to Dr Oliver at UT. Best of all, he talks to ME. He gives me hard copies of all tests and we go over them in detail. He knows I am a nurse and while I don't know animal medicine, I feel that he values my opinion and intuition. Many times we have gone the route I wanted to go. If he thinks it is not a good way, he will tell me and also explain his position.He has spent hours on the phone with me when we discuss various treatment options and not charged us.
He loves Chloe and Chloe loves him. I trust him and know that, if the time came where he believed we needed to see a specialist, he would not hesitate to tell me.
Chloe has done well on her melatonin and flax hulls (except for a UTI we are treating:o)
Sorry to spout off like this, and I am certainly not knocking IMs. I guess what I am trying to get across is that there are vets & IMs that are good and bad. It depends on the doctor and the simple question; Are you comfortable with him and do you trust him (or her!!!!)
Keep us posted,
Carrol & Chloe

[jasonhbaum]

It has been a little over a week since Sophia started on Vetoryl. She gets 30mg/2x per day. The excessive thirst has stopped and she hasnt had any accidents in our bed. She seems a little more energetic and is definitely back to her cuddling (could be because it is cold outside). We have an appointment on Monday for a follow up ACTH test.

[jasonhbaum]

Sophia has been on her Vetoryl for 2 weeks now. We just had the 14 day ACTH testing done and she was at 2.2 Pre and 5.6 Post. We currently give Sophia 30mg Vetoryl 2x/day. The IMS wants to increase to 80mg but she is willing to try giving 60mg once a day instead of splitting it (30 - 2x/day). I do not know if this makes sense unless by giving a larger dose all at once would lower her numbers. Any information would be greatly appreciated. We are going to call our regular vet to see if they can do the follow visits as the IMS charges $220 for the ACTH test.

[jasonhbaum]

Hello. One other question
Sophia had her 14 day ACTH test and it came back as 2.2Pre and 5.6Post. The IMS suggested increasing the Vetroyl dosage from 60mg to 80mg or she said we could try to give Sophia all 60mg in the AM - we currently give her 30mg 2x/day - and have her retested in 3 weeks. These numbers seem borderline as from what I read you want to be between 1-5 Pre and Post but preferably closer to 1 in Cushings Dogs. I know that 85% of dogs respond to a single dosage of Vetroyl but would giving her the 60mg instead of 30mg in the AM and then testing throw off the results of the ACTH test? I do not fully understand the ACTH test but does the larger dosage of 60mg outperform the 30mg twice a day or should we really be moving toward increasing the dosage for a better outcome?

[littleone1]

When Corky's cortisol level was higher than 5.4, his dosage was increased. He was on 31mg BID, and we stayed with the BID, with 40mg a day. This really helped to reduce his cortisol level.

The range of 1-5 is for dogs being treated with Lysodren. The range is slightly higher for dogs being treated with Vetoryl/Trilostane.

When the cortisol level gets to 5.4 or higher, a higher dosage is usually recommended.

Terri

[lulusmom]

Hi Jason,

The results of the acth stim you posted are pretty darn good. Vetoryl drops cortisol very quickly and it is known that it will continue to do so for up to 30 days. We've actually seen dogs here who's cortisol continued to drop after 30 days. For this reason, unless an acth stim test shows that the Vetoryl is having very little effect, it is not recommended to make adjustments to dosing until the 30 day stim test can be assessed. You mentioned that you have seen big improvements in Sophia so I am confounded as to why your IMS wants to increase the dose.

I have two cushdogs and both treated for two years on the compounded version of Vetoryl. They are tiny guys 4.5lbs and 6.5 lbs so I read everything I could get my hands on about the drug. Both dogs did great on 30mg but one took that dose once daily and the other got 15mg twice a day. Based on everything I've read, plus my own experience with the drug, I personally would not do any dosing adjustments until the 30 day stim. If I did make adjustments, I would not change to a once daily dose but rather make an incremental adjustment to the twice daily dose.

The therapeutic range as referenced in the Dechra (manufacturer of Vetoryl) brochure is 1.45 - 5.4 ug/dl. UC Davis has done their own studies and their treatment protocol lists 1.5 to 5.5 ug/dl as the desired therapeutic range. As you can see, Sophia's post number is a mere fraction over both but as long as Sophia's symptoms have completely resolved, 5.6 ug/dl is more than acceptable. I believe you're on the right path and should stay the course.

Glynda

[jasonhbaum]

Thanks for the replies. I decided to stay on the 30mg BID of Vetoryl until we have her tested again at 1 month. I am also going to go to my regular vet for the next ACTH test. After this test we will decide what to do. Sophia is back to her normal playful self and most symptoms have gone away after three weeks. Yesterday she didnt have a good day - her stomach was gurgling all night and when we got home there was a dark green diarrhea in a few rooms. She was still very energetic and playing with our other boxer. We mixed in some rice with her dinner and breakfast. Stool was very loose last night but this morning it seemed a little better - light brown in color and soft. Have a call into the vet to make sure this isnt pointing to anything.

[Squirt's Mom]

Let us know what the vet has to say about the diarrhea. This is one sign of an overdose, as you know, so I am a bit concerned. Big ole worry wart that I am! :rolleyes:

Hugs,
Leslie and the girls :D - always

[jasonhbaum]

Hello everyone. I wanted to post my update on Sophia. She went on the Vetoryl a little over a month ago (30mg 2x per day). Her 14 day ACTH test came back as 2.2ug/dl Pre and 5.6ug/dl Post. The IMS wanted to increase the dosage but I kept it the same since the documentation for the drug said it may take up to 30 days to take effect. We just did her 30 day ACTH test and it came back as
<.07ug/dl PRE and 4.0ug/dl POST
My vet was going to check with the IMS to make sure we should stay at the same dosage. Sophia is back to her normal playing self and back to laying on our lap. Have not seen any over-drinking of water or have not had any accidents in the house.
We did run into some diarrhea when she first started on the Vetoryl but the IMS perscribed Metronidozal and it went away in a few days.
We also had a urine test completed at the 30 day mark.

14 Day ACTH
2.2 ug/dl PRE
5.6 ug/dl POST

30 Day ACTH
<0.7 ug/dl PRE
4.0 ug/dl POST

Urinalysis 30 Day
Cortisol (Urine) 16.3ug/dl
Creatinine (Urine) 108.8 mg/dl

So far I am happy with everything. Her heart rate is good - she is on Sotalol. Her activity is great. Thanks for all of the assistance and well wishes.

Jason and Sophia

[Squirt's Mom]

Hi Jason,

You done so good when you told the vet you did not want an increase! :D:D Way to go! You have learned a lot and Sophia is benefiting from it!

Those numbers look good! The pre being low on the 30 test, could have been effected by simple nerves if Sophia was especially nervous that day. Since the post is within range and there is a good spread between the pre and post, it looks good to me! On top of that, your description of her behavior says even more strongly that she is doing good on this dose right now!

Keep up the good work and stay in touch!

Hugs,
Leslie and the girls - always

[jasonhbaum]

Hello. My boxer was diagnosed with Cushings a few years back - Cushings and a heart murmur. She has been on Trilostane and Sotalol. She has been urinating in the house for the last few weeks. (Note: we had to put my other boxer to sleep right before the time this started) Vet did an ACTH test this past week and the results came back that her cortisol was very low. We are waiting for his callback after he discusses with an internist. Has anyone experienced this before? Another note: I have been walking her more lately. Her heart and everything else on blood work were OK.

[Harley PoMMom]

Hi and welcome to you and your girl,

So glad you found us and we will help in any way we can.

If you could get copies of all tests that were done on your girl that would help us a great deal.

When a dog's cortisol has gotten too low (Addison's crisis) glucocorticoid supplementation, such as predisone, is vital . If the electrolytes are unbalanced then some sort mineralocorticoid supplementation will be needed.

An ACTH stimulation test will show if the cortisol is too low, and a Chemistry panel is needed for the electrolytes, if your vet performed these tests could you post those results, please.

Is your girl having any adverse reaction? Any vomiting, diarrhea, is she drinking normally?

Hugs, Lori

[labblab]

Hi Jason. Welcome back to you and Sophia, although I'm sorry she's having problems. And I'm surely sorry you lost your other boxer so recently. That has to be hard on the whole family!

You'll see that I've merged your new thread into your old thread so that our readers will have access to Sophia's complete history (and I've also revised your thread title). Can you fill us in on any other monitoring ACTH tests that have been performed during these past years? Has she remained on the same dose of trilostane all this time?

Also, if you can give us the exact results of this most recent test, that will help a lot as far as feedback we can offer you. Aside from the increased urination, is Sophia having any other problems?

Thanks in advance for your answers to all these questions!
Marianne

[goldengirl88]

Jason:
You need to have your dogs electrolytes checked if your dog is having an Addisons crisis. It is a serious situation. How low is the cortisol? Do you have prednisone to give him? Did you drop the dosage or stop it altogether? Is he vomiting, diarrhea, lethargic? Hope it works out. Blessings
Patti

[molly muffin]

Hi Jason, yes we see it happen sometimes, that when they have been on trilostane for a few years that their bodies react differently to it and the cortisol levels can drop too much. A supplement like prednisone is often given in that case and if they electrolytes are off, then usually IV fluids are administered.
You won't restart any trilostane until symptoms of cushings returns, if it does and an ACTH test to confirm has been done and then you'd go to a lower dose than she has been on for the last couple years, since she is now showing sensitivity to it.

Sharlene and Molly Muffin

[jasonhbaum]

Thanks for the replies. She has been excessively thirsty - especially at night. I will try to get the test results to post. For now we are cutting the trilostane in half until the vet gets back to us.

[labblab]

Jason, if Sophia's cortisol has dropped too low, you really need to discontinue the trilostane entirely for the time being in order to allow her adrenal function to rejuvenate. Does your vet know you are still dosing her?

Marianne

[Squirt's Mom]

From the Dechra brochure on Vetoryl (Trilostane) -


A post-ACTH
stimulation test resulting in a cortisol
of <1.45 μg/dL (<40 nmol/L), with or
without electrolyte abnormalities, may
precede the development of clinical
signs of hypoadrenocorticism. 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).

If the ACTH stimulation test is
<1.45 μg/dL (<40 nmol/L) and/or if
electrolyte imbalances characteristic
of hypoadrenocorticism (hyperkalemia
and hyponatremia) are found, VETORYL
Capsules should be temporarily
discontinued until recurrence
of clinical signs consistent with
hyperadrenocorticism and test results
return to normal (1.45-9.1 μg/dL or 40-
250 nmol/L). VETORYL Capsules may
then be re-introduced at a lower dose.
Owners should be instructed to stop
therapy and contact their veterinarian
immediately in the event of adverse
reactions or unusual developments.

[jasonhbaum]

Hello everyone. Sophia's ACTH cortisol levels were at <.7 pre test and after test was 1.5. Vet is still waiting to hear back from the internist. Should be by tomorrow. Should I discontinue the trilostane all together. The vet wanted to make sure you can stop cold turkey before advising me to do so. I cut her dosage in half for now.

She is drinking excessively at night and urinating alot. She doesnt seem lethargic at all. Still has an appetite.

[molly muffin]

Oh gosh, do not give trilostane at those levels. Dechra, does not want levels to go below 1.45 either pre or post.
I'll let some of the others pop in with their thoughts, but personally I would not give the trilstane. It doesn't hurt to stop and start trilostane. If ever there is a doubt, don't give, you can restart at any point it is needed.

Sharlene and Molly Muffin

[Harley PoMMom]

Sharlene is absolutely correct that the Vetoryl has to be stopped. Sophia's cortisol is way too low and prednisone should be started, since her drinking is increased I am worried that Sophia's electrolytes are unbalanced as well and it is vital that they be checked.

With Vetoryl one can stop it and with no tapering.

Please do keep us updated.

Hugs, Lori

[molly muffin]

Thank you Lori. That is exactly what I was wondering, if increased drinking was a possible sign of electrolyte imbalance. Was Sophies electrolytes checked?
sharlene and molly muffin

[goldengirl88]

Please immediately stop the Vetoryl and get your dogs electrolytes checked out. Your dog is at the same exact number my Tipper was at for the pre and really close on the post. I havd to keep Tipper off the Vetoryl for a week. She was then started on a dose 10mg lower than she had been taking. I was told by Dechra that once a dog is on a certain dose for a while, you need to decrease it as the decreased dosage will provide the same amount of control as the prior dosage. I am hoping Sophia is doing well. God Bless
Patti

[jasonhbaum]

I stopped the trilostane. Still waiting to hear back from the vet - who was waiting to hear from the internist. Will post updates when I hear from vet. Any advice on the excessive thirst? She is up almost every hour at night wanting a drink. I try to limit her and last night I had to resort to putting her in a kennel for 2 hours so we could sleep for at least that long without waking up.

[goldengirl88]

Jason:
I hate to give you this reply, but you are not supposed to withhold water from a cush dog , it can be dangerous. You will have to tuff it out until you get the results from the vet. Blessings
patti

[StarDeb55]

Jason, Patti is 100% correct. Please DON'T EVER withhold water from a cushpup. They are not peeing everywhere because of drinking so much. They have to drink tons because their kidneys are working overtime producing urine. Without ready access to water, they can dehydrate quickly becoming seriously ill. I know it's a huge pain, but have you tried doggie diapers, or perhaps trying to teach Sophia to use piddle pads?



Debbie

[jasonhbaum]

Thanks for the replies everyone. We are toughing it out and hopefully will hear from the vet today.

[goldengirl88]

Jason:
Hoping the vet contacts you soon. I know how hard waiting to hear results can be. Hang in there. Blessings
Patti

[labblab]

Jason, this is crazy that your vet is taking this long to get answers for you. You and/or your vet can go ahead and call Dechra directly (they manufacture brandname Vetoryl). They have vets on staff who serve as technical representatives and field clinical questions such as this for vets and owners. Here is contact info for their U.S. office in Kansas. You can call them yourself today!

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

Marianne

[molly muffin]

Oh my gosh, this is ridiculous to wait to hear this long when a pups cortisol is going too low. That is outrageous!! Low cortisol can be life threatening. arggghhh

Okay, trying to stay calm. Why don't you give that vet a call and Dechra yourself. This is beyond ridiculous at this point. It's been days and days.

Sharlene and Molly Muffin

[goldengirl88]

Jason:
What is going on? We are worried for the safety of Sophia. Have you talked to the Dr. and gotten her straightened out? I pray all is well. Please let us know. Blessings
Patti

[jasonhbaum]

Spoke with vet. All other tests look good. Her urine was very diluted so we are trying to get a good sample in the next day or two. Vets want us to start her back on the trilostane. Will keep you updated. Vet thinks this could be related to us losing our other dog recently but not sure.

[labblab]

Spoke with vet. All other tests look good. Her urine was very diluted so we are trying to get a good sample in the next day or two. Vets want us to start her back on the trilostane. Will keep you updated. Vet thinks this could be related to us losing our other dog recently but not sure.
I hope by this, you mean starting back at a lower dose? If not, please call the Dechra technical team per the contact information given above. I guarantee they will tell you that 0.7 is too low for a "pre" number -- they just reconfirmed the info for another member yesterday that the "pre" should be no lower than 1.45. You have nothing to lose by consulting them, and Sophia's safety to gain.

Marianne

[goldengirl88]

Jason
Please,if you love your dog,do not listen to this vet. The pre number is too low.I know as my Tipper was at a .7 and I had to stop the Vetoryl, and after a week went on a lower dose. This is dangerous, and nothing to play around with. Blessings
Patti

[jasonhbaum]

Following up with vet now. Asked they fax me the ACTH report.
Thanks for the concern

[goldengirl88]

Jason:
Please tell us the numbers as soon as you get them, and please hold off on the trilostane. Blessings
Patti

[Budsters Mom]

Hi Jason,

We are a bunch of worried mother hens here waiting on those ACTH numbers. Please withhold dosing any more Vetoryl until the ACTH results are in and the numbers are high enough to resume. I HOPE you will will restarting at a lower dose. When the cortisol levels drop too low, it can be life threatening. This does worry us! Hugs,

Kathy

[Jenny & Judi in MN]

I'll tell you what my IMS told me. We used Lysodren on my Jenny which is an entirely different drug but her levels got so low her post # on her ACTH was .5

She did prednisone for several months and has been off all Cushings meds for over a year.

The IMS told me not to consider starting cushings meds again till her post # got over 2. He said he didn't want Jenny to have the full blown cushings symptoms again but he didn't want her overmedicated again either.

I think trilostane is nicer to their system so hopefully your Sophia's cortisol will bounce back faster than my Jenny's has. But my regular vet had wanted to keep Jenny on Lysodren even at her very very low levels. With the folks here urging me on, we saw a specialist and I"m very glad we did.

Mentally, it's been nice having a break from the cushings meds and the ACTH. Jenny's coat got really pretty when her cortisol was almost nonexistent! LOL her levels are slowly creeping up now.

keep us posted!

[jasonhbaum]

Sorry for the delay in my response. My vet had spoken with some IMS specialist and was thinking it was more of an infection. I called Dechra and they thought the numbers were low but not alarming. After two weeks of antibiotics the excessive thirst and the incontinence went away. But - she stopped eating. We lowered the trilostane in half. She is now eating but the excessive thirst is back. Its like a big cycle with her. We were giving the trilostane 2x daily and cut it back to 1x. Have to call vet today but I am going to maybe try to get new RX so we can give lower does 2x daily. Will update again.

[goldengirl88]

Jason:
Do you have the numbers from the ACTH test to share with us? What dosage are you currently giving? What did Dechra advise you to do? Blessings
Patti

[jasonhbaum]

I am sorry I dont have any of the test results with the exception of the one I posted a few weeks ago. Sophia has been on the same dosage since she was diagnosed. We had tried the half dosage of trilostane (1x daily) but she immediately started with the excessive thirst, no appetite, up every hour symptoms. When we went back to 2x daily she seems to be fine. We are going to cut the dosage in half but give 2x daily. Another ACTH test is schedule. I will post results