Finnigan-14y/o German Shepherd/ Chow

[finni]

Hello-
I must admit I've been lurking and learning here since my (14 year old, 60lbs) puppy, Finnigan, was diagnosed with Cushing's.

My vet, and all of the other vets at the animal hospital, has only used Lysodren to treat cushing's. Taking that into consideration, I did lots of research, but decided that I thought Trilostane was the better treatment for us.

I'll try to keep this kind of short.

My vet suggested the Finni start at 60 mg/day.
Having read about the UC-Davis recommendations I suggested 30 mg/day. She was fine with starting at a conservative dose.
So 30mg/day it was.

Finni had the ACTH tests and we've lowered his doses because of that.
first my vet suggested 30 mg every other day (again, she's only experienced with Lysodren) I did more research and we agreed 20 mg/day.
I noticed he was a bit more lethargic lately and he had his last ACTH test and chem panel 2/4/11.

Results:
pre 1.1 ug/dL
post 1.3 ug/gL
potassium 5.7 normal range 3.6 - 5.5 mEq/L
ALT (SGPT) 214 normal range 12 - 118 U/L
Alkaline Phosphatase 979 normal range 5 - 131 U/L

All other results were normal.
We've started Finni on Denamarin for his elevated liver enzymes.

My vet thought 1.3 was good (it is according to Lysorden)
Vetoryl treatment monitoring flow chart says <1.45 is to low
UC-Davis says < 1.5 is to low.

I took Finni off trilostane for 3 days (Vetoryl treatment monitoring flow chart suggests 3 - 7 days)
We've lowered his dose to 10 mg/day we'll re-test in a month.

Here are my questions:
Do you think 3 days off was enough?

I always get his ACTH test 5 hrs after dosing, it looks like UC-Davis suggests doing the ACTH test within 2-3 hrs after dosing. What is your opinion of when to test?

Does anyone have experience with Denamarin? Did it lower the liver enzyme levels?

I really hope everything I'm doing for Finni is right, I love that wee guy.

Thank you in advance.
And thank you for being here for me and Finni through all of this. It means more than you know.
-Jeannie

edit:
Oh duh! that should be German Shepherd it the title.

[addy]

Hi Jeannie,

Well, it sounds like you have been reading alot and I am glad you are helping your vet. I do admit that worrys me a bit, your vet needing that much help but you've done a good job.;)

I have no experience with either drug but others will be along soon that do. I do know that Dr. Tim Allen at Dechra (manufacturer of Trilostane (Vetoryl) can be reached via phone or email and I am sure he would be happy to discuss proper dosing and interpretation of tests with your vet as he has told some of us he does that.

I am glad you came out of lurking;):). The experts will want to ask you lots of questions and that is a good thing because they really know what they are talking about.

It sounds like you already went through our wonderful links to treating with Lysodren and Trilostane so I won't point those out to you.

Glad you are here, sorry for the reason why.

Hugs,
Addy

[Harley PoMMom]

Hi Jeannie,

Welcome to you and Finnigan from me and my boy, Harley.

I believe the ACTH stim numbers do give a very good reference as to what one's dog should fall into but one cannot go by numbers only. How the dog is feeling and what symptom/s they are displaying or not displaying should also be considered.

Dechra states that a dogs cortisol may go up as high as 9.1 ug/dl if clinical signs are well controlled.

Also, Dechra recommends to conduct an ACTH stimulation test 10-14 days after every dose change.

How was Finnigan's Cushing's confirmed? Is he seeing a GP or an IMS?

Was diabetes and any thyroid problems ruled out? Was an ultrasound done?

Sorry to ask you more questions but the more information we know about your sweet boy the better our feedback can be, ok?

Love and hugs,
Lori

Dechra's U.S. Product Insert
http://www.dechra-us.com/files/dechraUSA/downloads/Product%20inserts/Vetoryl.pdf

[finni]

Thanks for the welcomes.
I'm feeling painfully ignorant right now. I'll try to intelligently answer all the questions.

Finni has been more lethargic and drinking less which is part of the reason we've now lowered the dose to 10 mg/day.

Every two weeks for every does change? Thanks for the info. I don't know how I missed that.

Finni had an ultra sound about a year ago, everything looked good. This was before the Cushing's diagnosis. My mind is a bit of a blank right now (I don't have his paper work with me) I believe the test was because of the elevated liver enzymes, but she did mention the adrenal glands when saying everything looked good.

Is there a specific test for diabetes? His glucose level on that last chem panel was 76, normal range 70 - 138
I'll ask for the thyroid test at his next visit. Can diabetes or thyroid problems mimic Cushing's, or is it that they are usually partner disorders?

He is seeing a GP. He was excessively panting. He's always had a big appetite and weight problems. He started needing to go out to urinate in the middle of the night. All of these are much better now.
Cushing's was confirmed through the Low Dose Dexamethasone Suppression Test.

Hug to you all from me and Finni,
-Jeannie

[Harley PoMMom]

Non-adrenal illnesses, like diabetes and thyroid problems, can create false positives on LDDS tests. And they both do have some of the same symptoms as Cushing's.

Has your vet given you any prednisone?

[finni]

No, I don't have prednisone. I'll ask for it.

Will the trilostane affect the results of a diabetes and thyroid tests? After I get the thyroid test should I have the LDDS redone? How can I know if it was a false positive?

When I ask for the diabetes and thyroid tests should I ask for anything specific?

Was the glucose level enough to clear him for diabetes?

Hug! you guys really are a wealth of information.

[Harley PoMMom]

Was an Urinalysis done on Finnigan? With my boy, Harley, this is included with the CBC/Chemistry blood panel. If an Urinalysis was done could you post the results, please.


His glucose level on that last chem panel was 76, normal range 70 - 138Although I am no vet, this looks pretty good, but the Urinalysis will also show if glucose or ketones are found in the urine.

If I were to have Harley's thyroid tested, the blood sample would be sent to Dr. Jean Dodds. Here is a link about her: http://www.itsfortheanimals.com/HEMOPET.HTM

The main concern with Cushing's tests is that not one test is 100% accurate at diagnosing this disease. That is why it is important to confirm a diagnosis of Cushing's with another test. If one has the LDDS test done and the results are positive than confirm this with either an ultrasound or an ACTH stim test.

Love and hugs,
Lori