9 yr old doxie with diabetes n pit cushings

[Lucys' Mom]

Just started my 9 yr old on 30mg of
Trilo once a day in morning, has diabetes for a yr as well
Noticing her appetite not as good in
evening feeding. Any ideas why, she's
Getting stim Tuesday 14 days after starting

Before diabetes, not great eater but last year
Not a problem, on only venison cause
Of pancreatitis attack in feb

Thank u

[Harley PoMMom]

Hi and welcome to you and Lucy! I am so sorry for the circumstances that brought you here but glad you found this forum.

Could you tell us how much Lucy weighs? Is her diabetes controlled? What test/s were done to confirm Lucy's cushing's? What symptoms led you or your vet to test for cushing's in the first place?

Did your vet give you any prednisone?

Sorry to ask so many questions but the more information we know about your precious girl the more meaningful our feedback will be, ok?

Love and hugs,
Lori

[Lucys' Mom]

Hi Lori

Lucy weighs 15 lbs
She had ultrasound n stim test, sent
to University of Tenn, we r going to
A internist, all levels were up including
Coritsol which was triple normal reading

She is def pituitary cushings, 3 specialists
confirmed that

Thanks for ur input

[Lucys' Mom]

Diabetes was up n down
Always suspected cushings but now
definite diagnosis
Symptoms r similar to diabetes as u know
Do not have pred only Trilo
Not a fan of prednisone

[Harley PoMMom]

Some dogs can develop cortisol withdrawal when first starting Trilostane/Vetoryl. The clinical signs include weakness, lethargy, anorexia, and weight loss.

Also, I believe, once the cortisol has been lowered Lucy's blood sugar levels might be off. Have you checked her blood sugar recently?

[Lucys' Mom]

Hi Lori

I did a curve Tuesday was still a little high
250-300, still at 13 units Nph 2x a day
Ims said sometimes takes 2-4 months
for insulin requirements to drop
I know sometimes Trilo is given 2x a day
split in half, wondering if that could help
Just not sure why losing appetite 2nd feeding

I will ask on Tuesday when next stim is done
Will see how Trilo is working

[Harley PoMMom]

Does she have diarrhea or is she acting lethargic or vomiting? These are signs of low cortisol and this would be needed to be addressed.

[Lucys' Mom]

No diarrhea
Went on a nice walk even though
my babies back legs shake
Praying that gets better
She spit up a drop early today when I left her
With granny but she makes herself sick when I leave her
We r glued by the hip n she is withe 99%
of the time

[Harley PoMMom]

Although I am no vet, the 30 mg seems to me an appropriate dose for her 15lbs. Dechra, which markets Vetoryl, recommends 1.0-3.0 mg/lb for a starting dose. Here is a link to the Dechra Product Insert: Dechra's U.S. Product Insert. (http://www.dechra-us.com/files/dechraUSA/downloads/Product%20inserts/Vetoryl.pdf)

We have a sister site that deals with canine diabetes, I really suggest you join them there too, they are wonderful and knowledgeable about canine diabetes: http://www.k9diabetes.com

Do you have the copies of any of the tests that were done on Lucy and if so could you post those results here?

Love and hugs,
Lori

[Lucys' Mom]

I am getting copies Tuesday when I go
For stim test
I'm just wondering about twice a day Dosing n
Why people have to do that

[StarDeb55]

Welcome to you & Lucy! I can't help with the diabetes as I have no experience. Normally, twice daily dosing is instituted when a pup is showing a rebound of symptoms in the afternoon/evening after the AM dose. This can happen because trilostane is only in the body for about 12 hours.

Debbie

[Lucys' Mom]

So does that mean very hungry again?
Cause I'm getting opposite

Thank u so much

[apollo6]

Dear Lucy's Mom
Welcome. Don't know much about diabetes. But my Apollo, 12.5 year old mini dachie is on Trilostane. He weighs 10 lbs and is on 10mg. to start. The leg shaking hopefully will get better. It can be a number of things, muscle wasting, arthritis that was covered up by the high cortisone Lucy was producing. My Apollo also has the pituitary cushing. If Lucy is throwing up or loses appetite call the vet right away. This could be a side effect. Will be asking you lots of questions. You came to the right place.
Hugs Sonja and Apollo

[StarDeb55]

Rebound of symptoms means the initial symptoms such as excessive hunger, drinking tons of water, & inappropriate urination that a pup suffers from prior to treatment, may return in the afternoon.

Even though the Dechra insert does state a starting dose of 1-3 mg/lb, one of our administrators has had several phone conversations with the US Dechra technical reps concerning starting dosage. On the phone, Dechra is now suggesting that a starting dose be no more than 1 mg./lb. The Univ. of California at Davis vet school uses an even lower starting dose of 1 mg/kg. Based on the above 2 suggested starting doses, IMO, your doxie's dose appears to be quite high. Based on the above 2 dosages, your pup probably should be on no more than 15 mg. trilo daily. Your pup's cortisol level may have dropped a bit too low which is why you are seeing the poor appetite. Is your pup still drinking ok? If not, I would strongly suggest you give a dose of prednisone, if available. This will work quite rapidly, within about an hour. If your pup is still drinking ok, I would strongly suggest you get in touch with your vet, making them aware of your concerns about the noticeable decrease in appetite. Your vet may want you to withhold tomorrow mornings trilo dose to see if your pup gets to feeling better. If you can't get in touch with your regular vet, it might be a good idea to contact a emergency vet clinic, explaining your concerns.

Debbie

Debbie

[Squirt's Mom]

Hi and welcome to you and Lucy! :)

You mentioned you are not a fan of prednisone - I know EXACTLY what you mean; I don't care for the side effects myself. However, it can be, and often is, a life-saving drug. When dealing with Cushing's and the strong drugs used to treat it, having pred on hand for emergency situations is critical. It isn't given long term in these cases but rather as a rescue dose when the cortisol goes too low - which can be fatal. It is used to try to prevent permenant damage which causes a condition the opposite of Cushing's called Addison's. In Addison's, the body cannot produce enough cortisol so it has to be artificially supplied via drugs.

Loss of appetite can be a sign of the cortisol going too low, as others have already said. It could also be an effect of the blood sugars being too high. Please do sign up at our sister site, K9diabetes - they are the experts in this area and I know they can offer you some great help.

Trilostane has been known to cause the trembling in the hind legs but as the dose is dialed in and the pup adjusts, this can improve. With Trilo, it can take quite a bit of tweaking to get the dose correct for your baby so don't get discouraged. I have always felt that is it best to start with the lowest possible dose when dealing with Trilo and build up rather than start with a higher and have to face possible over-dose problems. ;)

I am glad you found us, tho I wish you didn't have the need. Please stay in touch and let us know how Lucy is doing.

Hugs,
Leslie and the gang

[Lucys' Mom]

Hi Lori

Im going for first Stim test since starting Trilo. I called Dechra today.
They suggested for Dogs with both Diabetes n Cush, 2x a day dosing.
They recommended 10mg morning and 10mg at night. I guess I need to see what cortisol levels are before I gang up on my IMS. But
truthfully, I wish that was what she was on. Will keep you posted.

Stephanie n Lucy

[Harley PoMMom]

Twice a day dosing in a diabetic dog, I believe, is usually the normal protocol.

I'm thinking your vet is trying the 30mg to get the cushing's under control. I believe getting the blood sugar regulated in a dog that has elevated cortisol is hard to do.

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

Love and hugs,
Lori

[Lucys' Mom]

Hi Girls, have not been on in awhile, but not out of my thoughts. :)
Started Lucy on Trilo compounded 15mg 2x a day instead of 30 1 x a day. Started last Monday. Gave her body a chance to heal from ketone episode, BG's went from 100's weeks ago after Ketone episode to now in the last 2 weeks, 300-low 400. She is on 16 units 2x a day of NPH.
Trying to get her down into the 200's so I can get her cataracts fixed.
Fingers crossed and lots of prayers for that as well. I read a lot of Trilo hopefully lowering insulin needs but I know it can take months, so might have to up the NPH. Dont want to switch insulins again as thats how the ketone nightmare happened. Right now things are not perfect
but not bad either. Hope everyone else is fine.

Stephanie and Lil Lu

Moderator's Note: Stephanie, I have merged your update on Lucy into Lucy's original thread. We normally like to keep all posts on a pup in a single thread as it makes it easier for other members to refer back to the pup's history, if needed.

[Squirt's Mom]

Hi Stephanie,

Good to hear from you again! :)

Starting low and slow is a good idea with Trilo - it is easy to adjust up and much less risk of the cortisol going too low. Good plan, Mom! :)

Do stay in touch and let us know how the treatment is going. If you need to ask any questions, we will be here.

Hugs,
Leslie and the gang

[Lucys' Mom]

Hi Girls

Started trilo 2 weeks ago, on 17 units NPH 2x a day

Still getting Bg's in the 440-550 range. Does anyone have any ideas?

[lulusmom]

Hi Stephanie,

If it's been two weeks since starting Trilostane, Lucy is due for an acth stimulation test. Cortisol still may be too high which is why you are having a hard time regulating the diabetes. Are you scheduled for an acth stim test? If you've already had one, can you please post the results?

Glynda

[Lucys' Mom]

Hi Glynda

Lucy orignally started Trilo in March, was on it for 6 weeks, and had 2 stim tests. Here are the numbers, At that time, she was on 30mg once a day. After the ketone episode we took her off for 2 weeks, and is now back on BUT 2x a day 15 mg.

4/6 Pre 2.3 then it says 5.2 post
4/21 just says 4.7 post

Thank you.

[Lucys' Mom]

one more thing, all of Lucy's hormones were elevated per Univ of Tenn
they recommended Lysodren, my IMS wanted to use Trilo.
Would her cortisol be normal if the Trilo was not working and elevating the other hormones more?

[lulusmom]

Stephanie, any time you change the dosing, whether up or down or from once to twice daily, you should have a stim test done 14 days after the change. The is particularly important for a dog with diabetes. The last stim in April was perfect but that doesn't mean it has stayed that way so there is a very real possiblity that you may have to increase the dose a bit. In your position, I would make an appointment for a stim test asap.

Glynda

[Squirt's Mom]

Hi Stephanie,

If her cortisol is lower then the Trilo is working as it should in that area. However, it is possible that while the cortisol is going down some or all of the intermediates may be rising as a result of the Trilo.

UTK recommends Lysodren for pups with elevated intermediates because Trilo has been shown to cause elevation in these hormones while Lyso will lower cortisol and all intermediates with the possible exception of estradiol; it can be produced outside the adrenal glands and Lyso works only on the adrenals.

Hope this helps!
Hugs,
Leslie and the gang

[lulusmom]

Hi again,

I just remembered seeing an abstract of a 2010 study that Lori, one of our moderators posted recently. The results of this study showed that Trilostane doesn't always reduce the insulin requirements in dogs. Here is an exerpt from McLauchlan, G. , Knottenbelt, C. , Augusto, M. , Helm, J. , McGrotty, Y. , & Ramsey, I. . (2010). Retrospective evaluation of the effect of trilostane on insulin requirement and fructosamine concentration in eight diabetic dogs with hyperadrenocorticism. The Journal of small animal practice, 51(12), 642-8. Retrieved from http://dx.doi.org/10.1111/j.1748-5827.2010.01005.x


Clinical Significance: Insulin requirements and fructosamine concentrations do not consistently reduce during trilostane treatment for HAC. Prospective studies are required to provide recommendations regarding reductions in insulin doses with trilostane treatment.

I still think you should have an acth stimulation test to make sure that cortisol is within the desired range of 1 - 5.5 ug/dl but you also should discuss this study with your IMS.

[Lucys' Mom]

Will schedule stim test this week
what is the opinion put there will once or twice a day dosing?
she started on once a day at 30mg and BG's were on 300's
now 2x a day at 15mg BG's are in 400-500's
but she also was in hospital for a week beginning of May with ketones
when they changed insulin

thanks girls

[Lucys' Mom]

Hello

Has anyone heard negative feedback
using compounding pharmacies?
My endocrinologist said he prefers the real
thing

[frijole]

Yes. Not all compounding is equal. Here is a thread with links that might be helpful. I am sure some of our members will chime in on where they get their trilostane compounded. Kim

http://www.k9cushings.com/forum/showthread.php?t=202

[Lucys' Mom]

Hi Kim

Vetoryl

[addy]

Hi,

We have quite a few members using Diamondback in Az for compounding. Very reliable. Zoe is on 10 mgs of Vetoryl. If I have to change her dose to 12 or 15 mgs, we will have to compound Trilostane.

Hugs,
Addy

[frijole]

Hi Kim

Vetoryl

:D:o Sorry... I edited my answer but you saw it before I noticed you had typed trilostane in the subject line... sorry. :D

[LacubriousDogs]

Roadrunnerpharmacy.com

[lulusmom]

I buy all of my dogs' meds from Diamondback Drugs, a compounding pharmacy in Scottsdale, AZ. They have compounded my two cushdogs' meds for several years. Our internal medicine specialist, as well as a two of our old gp vets use Diamondback routinely in their practice so having them call in refills was never an issue.

[Todds Mom]

I just had to up my Todd's meds to 45mg, I had 30mg that I had just gotten and had to get the 15. But I went on Diamond Back and got a quote for 45mg of Trilostan and it was only $27.00. I couldn't believe it. Considering I spent almost $100.00 for both the 30mg of Vetoryl and 15mg of Trilostan. What a difference in price.

[Lucys' Mom]

Hello out there

My doxie has been on Trilo and I need to know if this is normal.
Her urine was very diluted before we started and now that she has been on it for a few weeks, urine is getting darker. Is this a good sign?

Thank you.

[Squirt's Mom]

Hi,

I moved your latest post concerning the urine to your original thread. This way we can keep all the info about your baby in one place.

Uncontrolled cortisol makes the kidneys unable to concentrate the urine so it is very dilute, sometimes even clear prior to treatment. As the cortisol is lowered and the organs start to recoup and function more normally, you can expect to see the yellow tint return to the urine.

However, there are grades of color and if the urine is a dark yellow or orangey or brownish looking, then that could mean an infection. If a pup has a UTI, the urine will often have a very strong smell as well as a darker color.

Hope this helps!

How is your baby doing on the Trilo? Have there been any ACTHs since starting it? If so, would you mind posting the results?
Hugs,
Leslie

[Lucys' Mom]

Hi Leslie

Been a bit of a roller coaster, thanks for the quick reply, will find u in up to now, Lucy was restarted on compounded Trilo 15mg 2 x a day
Originally she was on 30mg once a day and levels were perfect with 14 and 30 day stim tests. Ok, fast forward, went to see Endo in NYC, and he does not like any compounded trilo, Lucys levels were 10.2 after 14 days of compounded version. So switched to Vetroyl 30mg, had pharmacist open them (a friend) and make me up 15 mg, so gave her them for 2 weeks, still showing signs, so we up'd dose to 20mg 2 days a day and going for stim test next Friday, 12 days after starting 20mg.
Her urine is getting to look like mine now, she drinks more in morning than at night. Her sugar is still high 300-400 at 18 units of NPH 2x a day. Hopefully her stim tests will be better and I can work on the diabetes levels. I think she needs some reg with the NPH, endo
suggested maybe 70/30 or some reg and NPH, so one step at a time. uggggggg, want my little Lu better and her eyes fixed......... :(

Thank you

[Squirt's Mom]

I'm so glad you have a friend who can split those caps for you! That is so nice and prevents you from handling the drug. :)

Some vets are very anti-compounding and some have no issue with it. We have had a pup recently who did much better on the brand than on the compounded version so it can make a difference in some pups. Of course, who is doing the compounding and where they are getting their supplies is a factor, too. ;) 10.2 is not an optimal post number for a Trilo pup but it is very close - 9.1 is the top range recommended for the post number. I hope you see the improvements needed on the new meds and dose very soon.

As her cortisol is more controlled, you may find the diabetes is easier to get under control and maintain. Are you a member of our sister site, k9diabetes? If not, go on over and register - they are the experts on diabetes! http://k9diabetes.com/forum

Hugs,
Leslie and the gang

[Lucys' Mom]

Hi Leslie

Got Lu's stim tests back today
Cortisol Sample 1 3.3
Cortisol Sample 2 8.8

3o days ago

Sample 1 3.3
Sample 2 10.7

[Squirt's Mom]

Hi,

Those numbers look better and are within the range for a Trilo pup. :) The post number can go up to 9.1 and as long as signs are controlled, that is acceptable. At 8.8 if Lucy's signs are going away and she is acting more like her old self, that is more important than the numbers. ;) Does she seem to be more like her old self these days? Are you still seeing any signs?

You are doing a great job for Lucy! I know she appreciates you so very much.

Keep up the good work!
Hugs,
Leslie and the gang

[Lucys' Mom]

Hi Leslie

She is def acting and playing more. Her diabetes still is not perfect.
Waiting to speak to the endo doc in NYC today. The only time she drinks a little more is about 3 hrs after she eats each meal which is 2x a day, which makes me think more and more she needs some fast acting insuling with the NPH

Her urine is darker now, more like mine not diluted.
Funny thing her numbers were better on once a day dosing
She originally started on 30mg once a day numbers were
5.2 and 4.7 (14 and 30 day) then after the whole keto episode switched to twice a day 20mg 2x a day and numbers got higher??

[Squirt's Mom]

That is odd. Are you using the same med as last time? Was one brand name and one compounded maybe? If both were compounded, was it the same pharmacy and did they use exactly the same thing as the first time? I think I would look into these possibilities just in case. We have a member who's baby did better on the brand (Vetoryl) than on a compounded Trilo so it is worth looking into for sure.

It may also be possible that her diabetes is causing the higher ACTH numbers and once it is controlled, they will come down but I will let our diabetes experts address this as I know very little about diabetes. :o

If Lucy is eating kibble, dry dog food, that may explain some of the drinking after eating. Kibble causes our babies to drink more than canned, home cooked, or raw fed babies do. I have two on kibble and it amazes me how much water they drink compared to Squirt, who is on home cooked!

I'm so glad to hear that you are seeing more of the old Lucy! That means you are on the right track!

Hugs,
Leslie and the gang

[Lucys' Mom]

Hi Leslie

Spoke to the endo doc, kinda going back n forth what to increase
trilo or insulin. Her sugar was 467, 520 and high today. He feels she
might do better on Lysodren. uugggggg, does not have a lot of experience with Trilo from what I gather nor does my reg vet.
Anyway, he wants to increase Trilo to 30mg from 20mg 2 x a day,
I said naaaaa so he said ur call. I feel 25 mg 2 x a day is enough of a increase. Truthfully I would like the 8.8 post lower as well, might help bring the BG's down as well. This is def a battle of what to increase
so im trying the 25mg 2 x a day and taking Bgs a lot this week to see if they come down. I will speak to him in a week

Thanks for listening

[Harley PoMMom]

According to this study: "Retrospective evaluation of the effect of trilostane on insulin requirement and fructosamine concentration in eight diabetic dogs with hyperadrenocorticism."

Increasing the dosage of Trilostane may not have any effect on the insulin requirement.

Here is an excerpt from this study:
Insulin requirements and fructosamine concentrations do not consistently reduce during trilostane treatment for HAC. Prospective studies are required to provide recommendations regarding reductions in insulin doses with trilostane treatment.

http://www.ncbi.nlm.nih.gov/pubmed/21121919

Love and hugs,
Lori

[Lucys' Mom]

so Lori, Leslie

what im thinking is increase trilo a little to 25mg 2x a day from 20mg
do stim test in 2 weeks, if levels r good, then i think i need to change insulin to 70/30 which he will want to do next

i really do not want to switch to lydrosen, lu is shedding a lot, forgot to mention that, dont know if tis the season for that

ideas, thoughts, help :)

[Harley PoMMom]

If Lucy's clinical symptoms are still troublesome to her then increasing the dosage from 20mg twice a day to 25mg twice a day, I believe, is a good idea. But if your vet is considering upping the dosage to gain better control the diabetes then IMO, I don't believe this would be a good plan because we have seen many dogs have their cortisol go lower while being treated on the same dosage over a period of time.

This is JMO and hopefully others will chime in too.

Love and hugs,
Lori

[BestBuddy]

I'm with Lori on this.

If you have a post stim under 9 and are starting to see some improvement in symptoms it is possible that you will see lower numbers in another month at the same dose. With the cortisol lower you really should be seeing some better BG numbers so it might be time to look at the insulin. How much does Lucy weigh again?

Is Lucy on any other medications apart from vetoryl and insulin?

Are all the BG numbers high or are there some lower as well?

Jenny

[Lucys' Mom]

She's still shedding quite a bit n bgs high
Anywhere high 300's to a high yesterday
She still drinks a little more water morning hours

Spoke to another Reg vet I use on vacation
He agrees to up Trilo too
I'm still only comfortable upping to 25 MG
2x a day, not 30
He said 30 as well as endo doctor
My insulin was running low so I change bottle
Too yesterday to see if a difference
The endo likes lysodren cause he has more exp with it,
Reg vet n internal med dr likes Trilo
Better, ok shoot me now

[Lucys' Mom]

J
Jenny

Lucys weighs 15.5 n no other meds
Except 1/4 tab of pepcic

[BestBuddy]

Lucy is on a fairly high dose of insulin so I am surprised you are not getting some better BG numbers. Is it possible you have overshot the dose of insulin and are seeing rebound BG which would be high and stay high?

All dogs are different and those of us that have had our dogs crash because of too high a dose are what you would call gun-shy. It may be right for Lucy to end up on 30mg X2 of vetoryl but I would much prefer to go up slower. It does mean maybe an extra ACTH test but it stops an emergency visit if you overdose so is probable cheaper in the long run.

I gather you are using NPH at the moment, what did you start on?

Jenny

[Lucys' Mom]

She was regulated on 13 units 2x a day until Pancreatitis then Ketoadosis (new IMS changed insulin to 3 units 3 x a day of 70/30)
was in emergency hospital for a week with ketones
now on 18 units NPH
All doctors agree once cushings is better insulin will decrease even though there is a article out there saying differently, it is not their experience with their cush/diabetes dogs
i up'd dosage to 25 mg last night, had 2 doses so far took BGs
325, wowowowowow, thought i was seeing double, hoping it keeps getting lower, im watching and praying, maybe a coincidence, i did change insulin bottle as well. who knows........def not rebound, everyone thinks that

[Jenny & Judi in MN]

that is great that her levels are going down!

My Jenny has Cushings and diabetes and at 11 pounds needed 7 units twice a day of NPH before she got where we wanted her. She was in the 500's - 600's for a long time.

When I asked my vet which we wanted to focus on the Cushings or the Diabetes, he said "both" so I understand the balancing act.

Hopefully this new bottle did the trick!

Judi

[Lucys' Mom]

Hi Judi

Is ur pup on Trilo or Lysodren?

[Jenny & Judi in MN]

Hi: Jenny is on Lysodren. We are just upping her maintenance dose this week because once a week wasn't cutting it.

eta: I'm currently hanging with my vet who is not a specialist and he says he has had a lot of success using lysodren and wants to continue trying it with Jenny. If it doesn't work we may switch. I can understand your concerns, these are powerful drugs.

[Lucys' Mom]

Lucys hair color has changed a lot especially around the next area.
Any ideas what this means?

[addy]

Hi,

My Zoe used to be white with honey color spots and part honey color on ears and tail and face. Most of the honey color is gone now except on her face and ears and that has faded. Sometimes with treatment, the color comes back and sometimes with treatment the color changes. I am not sure why.

Hugs,
Addy

[Squirt's Mom]

Hi,

Is there any chance that a collar or some such has caused the color change? Sounds elementary but ~~sigh~~ I ask from experience. :o:rolleyes:

Hugs,
Leslie and the gang

[Lucys' Mom]

never wears a collar :(

[frijole]

We have an administrator named Alison who gave the most spectacular explanation of the change in hair color and I will not do it justice.... I just know that after a dog has been treated we sometimes see additional hair loss and then the hair that comes back is a different color or texture. It actually is a good thing because the body is healing and the hair is growing back. Kim

[littleone1]

Corky's white fur changed color around his neck due to a yeast infection. When I used KetoChlor shampoo, which was recommended by a dermatologist, his white area got worse. Dr. Allen told me that the Ketoconzonale in the shampoo is what made his other white fur discolor, and that his fur would return to its normal color, which it did, after I stopped using the shampoo. I'm very thankful that Corky's vet put him on an antibiotic for the yeast infection.

Terri

[Lucys' Mom]

Can anyone tell me if stool and urine color changes with Trilo?
Stool not brown anymore, more orange color. Urine def darker

Thank you

[Harley PoMMom]

If Lucy is concentrating her urine it could have a darker color. Does her urine have any odor, any blood in it?

Orange stools could come from a number of things...foods that are orange in color like carrots, sweet potatoes can make the stool an orange color. Dog's that have IBD or IBS can have orangish stools. Is Lucy's stool formed? Does she have diarrhea?

[Lucys' Mom]

No odor or blood just darker now
Stool is formed yesterday after passing
Formed twice piece was loose n very small
Amt was runny, def not hard anymore
Softer for sure

Gave her tylan powder which I always have
In case
She had pancreatitis in Feb so I'm always concerned
She's been on the new dose of Trilo for
16 days will take her for another stim
Test next week

No carrots or sweet potatoes given
Looked at it again in bag , color is brownish
Orange, I'm a little neurotic been a tough year for her

Thank you for always helping

[addy]

Hi,

I have been following along. My Zoe has colitis. When we started the name brand Vetoryl it flared her colitis. When we upped her dose from 10 mgs to 15 mgs, 10 being Vetroyl and 5 being compounded, her stools were fine. When we upped her dose again to 20 mgs name brand Vetoryl no compounded, it flared her colitis again. I had to increase her metronidazole again and am hoping it settles down. Her poo color has been all over the place thought I don't think I have seen green;)

Her urine was also darker first pee in the am last week when we upped the dose and switched to the name brand completely. Not quite as dark now.

Hope the stools get better.

Hugs,
Addy

[Lucys' Mom]

Can anyone tell me the difference between the urine cortisol test and the ACTH besides the method, is one more accurate than the other?

Urine one seems so much easier on the pup

Thank you

[frijole]

Can anyone tell me the difference between the urine cortisol test and the ACTH besides the method, is one more accurate than the other?

Urine one seems so much easier on the pup

Thank you

The UCCR test is cheap and quick. It can rule out cushings. If it comes back positive it means it MIGHT be cushings and you move on to other tests. You can't diagnose cushings with any one test.

The acth test will measure cortisol and it is an hour to two hours long... never affected my dog at all. It is expensive because the product they use for the test is very expensive. Even if it comes back positive you need to do additional testing as you can have false positives on the acth test.

If I had to do one initial test I would do the 8 hr low dose dex suppression test. It is more accurate and can potentially also tell you which type of cushing's it is.

If you go to our Resource Section there are articles that describe each test and the pros and cons. Kim

[Lucys' Mom]

Hi Kim

Should have been more clearer, Lucy was already confirmed and has been on Trilo, I wanted to know if ACTH tests are necessary for 3 month check ups or can we do urine testing? My other vet just measures pre cortisol numbers, doesnt inject with cortisol and does not do post cortisol for follow ups

Thank you

[frijole]

My bad. I didn't go back and read. :o Sorry! I can't comment on the urine test for tracking results because I now remember the discussion about it and yours is the first case I remember when a vet mentioned it... I always had the acth test. I can only say my Haley never suffered from them and she was treated for 4 1/2 yrs. Kim

[Lucys' Mom]

Lucy now has high blood pressure, they want to put her on meds for this
Is this common, will meds help

THank you

[labblab]

I will let others with more experience re: high blood pressure answer your most recent question. I do know that we have other Cushpups here who suffer from high blood pressure, but I do not have personal experience in that regard. However, I do want to comment on your earlier question:



Should have been more clearer, Lucy was already confirmed and has been on Trilo, I wanted to know if ACTH tests are necessary for 3 month check ups or can we do urine testing? My other vet just measures pre cortisol numbers, doesnt inject with cortisol and does not do post cortisol for follow ups

At this point in time, ACTH testing remains the "gold standard" for monitoring trilostane or Lysodren treatment. We do have one other member here whose vet is choosing to rely on urine testing for trilostane monitoring. However, to date, we have not seen any research studies here that support the validity of using urine testing (UCCR) to determine optimal trilostane dosing. We are aware of protocols that utilize UCCRs in conjunction with ACTH testing in order to determine whether a dog might be better served by switching to twice-daily from once-daily dosing. But that is different from making dosing decisions based solely upon the results of a UCCR.

There is some recent research that is exploring the use of baseline cortisols under certain circumstances for trilostane monitoring purposes. But there are also situations in which these same researchers still advocate for the necessity of performing full ACTH testing. So based on research that I have personally seen, I am aware that some vets may be basing some dosing decisions upon baseline cortisol alone. However, I am not aware of any research that endorses using urine testing alone.

Marianne

[Harley PoMMom]

When a dog has high blood pressure, getting it under control is very important. Elevated blood pressure is especially hard on the kidneys and can do damage to the retina.

How high is Lucy's blood pressure? In dogs, hypertension is most often a consequence of another primary disease. Cushing's is one of those diseases that can cause high blood pressure.

It is very important that a dog is not overly stressed or anxious when the blood pressure readings are taken, so the vet may need to do several readings over a period of time before confirming that high blood pressure does indeed exist.

Love and hugs,
Lori

[Lucys' Mom]

Hi Lori

They said it was very high, will get numbers tomorrow.
Lucy had blood work last week and ACTH

her pre is 2.2 post is 3.4, she is 15 lbs on 30mg of vetroyl 2 x a day
her ALK and I think AST were still high ALK was 1100, her BUN was 61
other kidney levels normal

Her cholesterol little high but Trigyl 800, yikes, was normal for last few months, not sure if going back to chicken instead of venison changed that, that was her only change and I also added a multi

Now high blood pressure, so I think her cataract surgery is going to be postponed again, oh, im so sad. thank you

[Harley PoMMom]

Those are great stim numbers!! Congrats on that! Just wondering, how is the diabetes going, is it well controlled now that the cortisol is within the therapeutic ranges? Has Lucy had any reoccuring pancreatitis episodes?

My boy, Harley, had high blood pressure which he took amlodipine to control it.

Sending huge and loving hugs, Lori

[Lucys' Mom]

Hi Lori

thanks for the encouraging words, her bg's have been good too, finally low 200's but now I have the high blood pressure issue. Could this cause the elevated BUN and liver values, they started her on the same meds as ur pup, do I need to worry about side effects, they told me 1/2 pill at night. i have to talk to endo doctor tomorrow and eye doctor too see if we know have to postpone eye surgery, does this get better?
do i need to worry about insulin too? not sure if u know what answer

thank you
Lori

[Lucys' Mom]

forgot to answer ur ?

so far no recurring pancreatitis issues, i give her pepci ac with each meal 1/4 tablet and every other day, I have her some tylan powder,
cause her stools can be a little on the soft side

[Harley PoMMom]

I believe that all her health issues are contributing to her elevated BUN and liver enzymes.

Amlodipine may cause elevated levels in the BUN, liver enzymes, creatinine, and potassium but after a period of time these elevations should level out.

I don't know of any interaction between amlodipine and insulin but that does not mean it doesn't exist.

Sending huge and loving hugs, Lori

[Lucys' Mom]

I just gave her first pill for bp tonight
Bun n liver were already high

Fingers n toes crossed
Thank you

[Lucys' Mom]

Does anyone use milk thistle for ur pups?

[Harley PoMMom]

Many members use milk thistle to help with liver function, I also used it with my boy, Harley.

How is Lucy doing with her Amlodipine and when does her BP get checked again?

Love and hugs,
Lori

[Lucys' Mom]

Hi Lori

Day 2, im getting BP checked Friday, hopefully it will kick in by then
her BP was 280 and they did it several times with a doppler at eye doctor yesterday. What kind of milk thistle did u use and do u think it works, how much do you give?

Thank you..

[Harley PoMMom]

I purchased the milk thistle that I used from the "The Vitamin Shoppe." Here's a link: http://www.vitaminshoppe.com/store/en/browse/sku_detail.jsp;jsessionid=RF5RBQ1PAZ5TCCTLKKEFAFYK NNJISUNE?id=VS-1915 I gave Harley 2 drops twice a day and I do believe that it helped.

Hoping that on your vet visit on Friday that Lucy's BP is normal. Keep us posted, ok? ;):)

Love and hugs,
Lori

[Lucys' Mom]

Hi Lori

Thanks for the info, Lil Lu is 15.5 lbs, do you know how many drops per day? COuld it cause diarrhea?

[Harley PoMMom]

Milk thistle's side effects may involve stomach upset and diarrhea. With Harley I started him on one drop once a day for one week then increased this to one drop twice a day for another week. By the fourth week he was getting the two drops twice a day. When possible, I always tried to start any new medication on him very gradually. Harley weighed about 23lbs so with Lucy weighing 15.5lbs I believe gradually getting her to two drops twice a day would be adequate.

Here's a link to an informative article about Milk Thistle: http://wendyblount.com/etvma2/milk-thistle.pdf An excerpt from this article about dosage:
Dosage: Milk thistle is usually supplied as a solid extract, standardized to 70-80% silymarin. Milk thistle should be used for at least 8 weeks before expecting results such as improvement in biochemistries.
· Dried herb: 15-20mg/lb SID
· Concentrated extract: 2-5 mg/lb BID-TID
· Alcohol extract: 2 -5 mg/lb BID-TID Although I don't recommend the alcohol extract.

Love and hugs,
Lori

[Lucys' Mom]

Thank you Lori

Went to vet yesterday to get bp checked, they checked with a doppler, more accurate, the problem was it took the tech a good 15-20 min to get the reading, I was holding her, but it took to long and poor little Lu's reading probably was higher, anyway she went from 280 to 170 in 4 days, so im thrilled, eye doc said he wont do surgery till 150 which is fine, no we are waiting another week to see if it drops more, i dont want to increase dose just yet, shes on 1/2 a pill of 2.5 norvasc right now. I hope next week they get the reading quicker.

[Harley PoMMom]

280 to 170 in 4 days is a significant drop!! Great job!! I agree with you that if it took a while for the tech to take her BP that this could result in a higher BP reading.

With Harley, I always tried to have his BP reading done during the morning, he was usually their first appt. We found that when we did the BP reading in the evening it was almost always higher. Also, Harley preferred to have his BP readings done on his rear leg. He just seemed calmer when it was done on the rear leg instead of the front.

You're doing a wonderful job!!

Love and hugs,
Lori

[Lucys' Mom]

Hi girls

Need some help again
Lucy had cataract surgery one one eye, been in steroid eye drops since then Nov 2 down to only 2 different ones 1 x a day
She now came down with demotopic mange in her right ear
Right eye had the surgery.
She never had a ear infection her entire life
Last stim test was done right before surgery, had awesome numbers
Won't do one again till she is off the drops , I'm hoping next week he will stop them
Eye doc thinks there is no link there between drops and mange
My vet said her immune system is low cause of the surgery and that's why she got it . We r using goodwinoil ointment, ear is improving but
A few more spots showed up one on elbow 2 on check, vet says if it keeps spreading he will need to put her on heartworm meds for 3 months, was never on that. a
Do Cush dogs take heartworm meds

Any help u can offer

Thank you.

Stephanie n Lu

[lulusmom]

Hi Stephanie,

Can you please get a copy of the acth stim test and post the results here? It sounds like you are dealing with demodectic mange. This can happen if a dog's immune system is compromised or the dog is super stressed. The heartworm medication your vet is referring to is probably Revolution. This is a spot on treatment that is effective on heartworm, fleas, tick and mites. My cushdogs have gotten one treatment already for sarcoptic mange and are about to get their second treatment. I did check with my cushdogs' specialist to make sure it was okay first.

As promised previously, I am providing a link to the information on how to store the cortrosyn below:

http://endocrinevet.blogspot.com/2011/03/how-to-extend-your-supply-of-cortrosyn.html

[Lucys' Mom]

U r genius

Dr Peterson is Lucy' doc lol, small world
I waiting for him to call back about heartworm med
Last stim test was done in oct right before cataract surgery
She has diabetes too
It was 2.2 and 3.4 or other way around got to check with vet
Doc Peterson has Lu on 2 x 30 mg of trilo a day.
No sense doing stim test till she's off of pred drops for her eye which is very soon
My reg vet said all u said that she has been stressed over all that she's been thru, he just doesn't want it spreading,ear is healing but it's now on side of face under ear.

Thank you..

[lulusmom]

Seriously, Dr. Mark Peterson is Lulu's specialist? :eek: Well, make sure he knows that he's supposed to save you money by following his own instructions. :D

[Lucys' Mom]

Hahaha

He doesn't do The stims, my reg vet does, he gets the reports and then tells me what to do

Any side effects from revolution

[lulusmom]

None of my four dogs or my friend's four dogs, who exposed my dogs have had any adverse effects from the Revolution.

[Lucys' Mom]

Hi again

Lucy has demodectic mange not sarcopic
I read revolution does not work on that one?

[lulusmom]

Revolution is a heartworm med and while the manufacturer doesn't list it's efficacy for demodex, some vets do prescribe it off label. I'm not familiar with any other heartworm treatment that addresses demodectic mites but would like to find out more. Can you please ask your vet which treatment s/he uses? There used to be another spot on topical called Promeris which was extremely effective in treating demodex but they no longer manufacture it because of the number of adverse reaction reports received. I used it routinely for shelter puppies with severe demodex at a slightly reduced dose and it worked great with no side effects.

[labblab]

Per Bayer's website, their "Advantage Multi" can be used for treatment of both sarcoptic mange and Demodex mites:

http://www.animalhealth.bayerhealthcare.com/4882.0.html

Marianne

[Lucys' Mom]

Hello

Do all Pituitary tumors grow to the point of causing more and more problems? If so, does the meds have no effect on the actual tumors, just on the symptoms?

Thank you..

Moderator's Note: I have merged your latest post into Lucy's original thread. We, normally, like to keep all posts on a pup in a single thread as it makes it easier for other members to refer back to the pup's history, if needed.

[StarDeb55]

In the great majority of our babies, the pit tumor does not enlarge. There are, however, certain breeds that seem to be more likely to develop what is termed a macroadenoma. Neither trilo or lysodren actually have any effect on the pit tumor. What the medication does is stop the overproduction of cortisol by the adrenals. The pit tumor constantly sends out a hormone, ACTH, which tells the adrenals to pump out cortisol in excess. Lysodren actually causes necrosis of the adrenal cortex tissue where cortisol is produced. Trilo blocks the biochemical pathway responsible for the production of cortisol.

Debbie

[Lucys' Mom]

Hello

I might have to lower my doxies dosage from 30 to 20mg of Trilo
My endocrinologist and the vets at Dechra dont like compounding.
I know Vetroyl comes in 10mg but buying 4 boxes of those is costly.

Can people please share their thoughts and is is as good as the Vetoryl capsules?

Thank you..

[Lucys' Mom]

My little hot dog has these hard whiteheads on her chest coupled with excess skin that is red and keeps enlarging and also bleeds sometimes
Vets just tell me to leave it alone, I tried covering up with bandaids so it would not rub and get more irritated.
Anyone have any suggestions.

Thank you..

[Lucys' Mom]

Hello, Can anyone tell me if they know of acupuncture affecting dosage of Vetoryl. Since Lucy started acupuncture, her energy has decreased and is sleeping a lot. No more spunk, last Stim tests were pre 2.1 post 3.1 in. She is also diabetic and her insulin has decreased by a few units
since starting acupuncture. Her back legs are also extremely weak.

Any advice?

Thank you..

[frijole]

Hi there! My Annie had acupuncture for years and it helped her tremendously... course keep in mind that it is only as effective as the person doing it so it will vary.

They place the needles in different points depending on what they are working on. Each time I went in I told them what that week's issues were (lethargy, hyper, lack of appetite, leg weakness etc) and that is what they focused on. It could be that your dog is lethargic because they were concentrating on calming Lucy down.

I would have a sit down with the vet doing the acupuncture and tell them what you are seeing and that you need them to focus on strengthening the back legs, increasing energy, etc. If it doesn't work then maybe it's the person doing the acupuncture.

As my brother always told me, "Remember 50% of all doctors graduated in the bottom half of their class " :D

Kim

[Lucys' Mom]

Thanks Kim, I do have complete faith is this doctor, she wont BEST VET on Long Island for the past 2 years, going tomorrow and will let her know whats going on.