Cloud (10 1/2 year old Sheltie)

[ferris]

Cloud is a 10 1/2 year old Sheltie, weighing approximately 34 lbs. Approximately 1 year ago, he started to lose some hair and developed dry, itchy and flaky skin. I did some research on my own and on the Central Illinois Sheltie Rescue page and also a blog about low thyroid in Shelties. It specified that even though the thyroid came back normal, most Shelties have an underactive or low thyroid. My vet prescribed soloxine, 0.3 mg and the condition cleared up.

Approximately one month ago, Cloud started to have some "accidents" in the house and I noticed the he was emptying his water bowl and always looking for any food he could find other than what was in his bowl (which he always finished). My vet went through the whole series of tests, starting with urine, low dose dexamethasone suppression test and high dose dexamethasone suppression test, which came back leaning towards Cushings. We then did an ultrasound and the adrenal gland and abdominal cavity were fine. No enlargment of the adrenal glad or surrounding tissue were found. My vet spoke to a specialist, or endocronologist and they agreed on pituitary cushings. They are both in agreement that the medication to use is Vetoryl (trilostane) with a 10 mg doseage once a day.

His stats are as follows: the cortisol urine result was 15.7, the low suppression test Cortisol Pre 2.9, Cortisol 2 was 2.3, Cortisol 3 was 2.1. The high suppression test was Cortisol Pre was 3.1, Cortisol 2 was 2.8, and Cortisol 3 was 2.0.

What are your thoughts and advice on the above information?

Thank you in advance for your response.

Ferris

[apollo6]

WElcome Ferris
I like that the vet wants to start Cloud low. But before you do you should get the ACHT STIM test to see if his cortisone is high.
Other's will be along to give input. We would like you to post your lab results and also what the ultrasound report said.
Hugs Sonja and Apollo

[labblab]

Hello Ferris, and welcome to you and Cloud!

I only have a moment to post right now, but I want to tell you how glad I am that you have found us. Also to comment briefly on the info that you've provided re: Cloud's history and diagnostics. And actually, it's easy for me to be brief because it sounds as though your vet has been very thorough and methodical in his care :).

The testing sequence makes perfect sense. Although you would have to check the lab's printed reference range for Cloud's UC:CR result, I am assuming that it was high enough so as not to be able to rule out Cushing's. The LDDS definitely is consistent with Cushing's, but the pattern is such that it does not help distinguish the type -- so that explains the HDDS and ultrasound. Off-hand, I cannot remember the testing norms for the HDDS, but the ultrasound does indeed indicate pituitary-based Cushing's since both adrenal glands were of equal size and no abnormalities were noted.

So that leads you right into the treatment decision. As Sonja has already indicated, many vets like to perform an ACTH stim test prior to beginning treatment in order to establish a baseline cortisol level prior to starting with the medication. But it is not an inexpensive test, so your vet may be deciding to hold off on an ACTH until Cloud's first monitoring "milestone" is reached -- approx. two weeks into treatment.

I will say that your vets are being quite conservative as far as a starting dose for Cloud. Dechra, the manufacturers of brandname Vetoryl, recommends a starting formula of 1 mg. per pound. UC Davis recommends a lower initial formula of 1 mg. per kilogram. Cloud's starting dose of 10 mg. for a 34 pound dog is even lower than that. This should help to insure that any negative side effects are minimal. But I also caution you to not become downhearted if you don't immediately see positive improvements in his symptoms. His dosage may end up needing to be increased significantly. But that's the value of the ongoing monitoring ACTH tests -- to provide guidance as to the appropriate dosing level for any individual dog.

So once again, welcome. Please keep us updated as to your progress. And please give Cloud a big pat for all of us here!

Marianne

[ferris]

Thanks for your concern and advice. I will be picking up the meds tomorrow morning and will start treatment as recommended by my vet. I will keep you advised.

Again, thank you.

Ferris

[ferris]

Hi: Cloud has been on the meds for 3 days now & only change has been loose stool.
Ferris

[labblab]

Ferris, do you already have Cloud's first ACTH monitoring test scheduled? According to Dechra (the manufacturers of brandname Vetoryl), this test should be performed within 10-14 days of beginning treatment.

Loose stools can be a sign that a dog's cortisol level has dropped too low. And if Cloud were to exhibit other signs of overdosing (lethargy, vomiting, loss of appetite or thirst), then I would definitely be concerned about this possibility. Given Cloud's very conservative dose, it would be surprising if this were the case. But you just never know. If I were you, I would call your vet to report the loose stools so that he/she is aware of this complication. If Cloud worsens in any way or develops any additional problems, your vet will likely discontinue the trilostane and advance the timing of the monitoring testing.

Here is a link to the U.S. Product Insert for Vetoryl. It will provide you with a great deal of information related to trilostane treatment and monitoring.

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

Marianne

[ferris]

Thanks I will call him today.
Ferris

[ferris]

I spoke to him & he states that I should not stop the meds & just watch him for now.
Ferris

[lulusmom]

Hi Ferris. How is Cloud doing today?

[ferris]

Hi : The stool problem has cleared up so I assume he is adjusting to the meds,otherwise,no change.

[ferris]

Cloud had his ACTH response test he is on 10mg of VETORYL once a day.The results were (cortisol Pre 1.7-cotisol two 2.6) The vet says all looks okay,what do you guys think?

[labblab]

Hi Ferris,

How is Cloud doing behaviorally? Are you seeing improvement in his Cushing's symptoms? If so, then I would say that those 30-day ACTH results are great -- right in the middle of the ideal therapeutic range. :)

Marianne

[ferris]

Just had his second ACTH response test & the readings were (PRE 3.4CORTISOL 2 = 4.2)He is on 10 mg of VETORYL, vet says all looks good. What do you guys think?

[Squirt's Mom]

Hi Ferris,

The big question is, how is Cloud acting? Have you seen an improvement in the signs? The signs are as important as the numbers when determining how a pup is doing with treatment. ;)

Thanks for the update and I look forward to hearing how Cloud is doing!
Hugs,
Leslie and the gang

[ferris]

I would say he is 100% of his old self.

[ferris]

Can someone tell me if the last test numbers are good or poor.

[lulusmom]

I think those numbers look fantastic!!! I'm sure I don't have to tell you how great it is to see our dogs return to their old sweet selves with treatment. Good job!!!

[Squirt's Mom]

Hi Ferris,

The numbers are good but most importantly, you have seen Cloud return to his old self. Some vets treat by the numbers only but it is vital to look at the pup and see how they are doing. Some pups do better with the numbers a little higher than recommended, some a little lower. So we ask about the signs as they are the visible indicators of how the treatment is working.

It sounds like you and Cloud are on the right path! :cool::) So keep up the good work and stay in touch to let us know how things are with ya'll. ;)

Hugs,
Leslie and the gang

[ferris]

Thanks all!