Eskimo

[Eskimo'sMom]

Hello, My name is Teresa and I have an Aussie named Eskimo. I resuced her or as the saying goes she rescued me 7 years ago. I did not know then how much love I could have for an animal. She allowed me to try new things... Go to beaches, hiking, parks and meet new people. None of which I would have done if not for her. In addition, she showed me the true meaning of Love and Loyalty. Because she is truly part of my family, I make sure she eats well and goes to her yearly dr. visits. Last August a dog attacked her while on her night walk. She ended up with stitches.While she was getting her stitches removed , I mentioned to the dr that she is beginning to drink a lot of water. They did a urinalysis test and blood test. Both came back good. Then a few months later, the did an ACTH test, this came back with borderline numbers. Finally in March of 2011, we did a low drex test. Dr left me a message last Thurs stating that Eskimo has a mild case of Cushings. I cried and then went into research mode the following day. Eskimo will be 11 years old in June and she looks VERY healthy. I am reluctant to give her any meds (trilostat) bc I am afraid she will deteriote in health. I have yet to meet with her vet since she is out of town . But in her message she stated that she wanted to get her started on Trilostate. Can anyone tell me what in each of the tests did they find that confirms she has Cushings. Also, is Cushings life threatening, and what happens to Eskimo if I choose not to give her her meds?

[zoesmom]

Hi and welcome -

First off, could you please post the results of all those recent tests (this year and last). Vet should be willing to provide copies.

Trilostane (and lysodren) are both good drugs, if given and monitored properly. Dogs can live out their lives, in relative normalcy, on either drug. But the key is an educated owner and a knowledgable and cooperative vet - who is willing to learn if needed and listen to your concerns. Not treating is much scarier, IMHO.

Here is a link to what an untreated cush dog will experience. And it's not pleasant.
http://www.k9cushings.com/forum/showthread.php?t=195

So take a deep breath, start reading in our resource section, and get ahold of those test results to post here. It will be ok. We've all been down this same road and we are good at hand-holding here, too. Sue

[littleone1]

Corky and I also want to welcome you and Eskimo.

I know that cushings can be frightening at first, but it really helps to learn as much as you can about it. Posting information on the tests Eskimo had, along with the test results, would be very helpful to our members.

Cushings is a slow progressing disease, but if it is left untreated, it can seriously damage the internal organs.

Corky was diagnosed with cushings over two years ago, but his symptoms went into remission for seven months. When they returned, Corky started taking Trilostane. He's been taking it for 1 1/2 years now and has done very well on it. The dosage has had to be adjusted, but that is to be expected. As long as the treatment is monitored carefully, there shouldn't be any problems with it. Corky has many other medical issues that are not related to cushings, so he's also taking different meds, but the Trilo is really working for him.

Take a deep breath. You will find, as I did, that there are so many caring and knowledgeable people here who have a great deal of experience with cushings. I would have been lost without them.

Terri

[Harley PoMMom]

Hi Teresa,

Welcome to you and Eskimo! I am so glad you found this forum but so sorry for the circumstances that brought you here. We will help you and Eskimo in any way we can.

Strong symptoms are a huge part of making the diagnosis, and a Cushing's savvy vet will not initiate any treatment without strong symptoms and a proper diagnosis. Some of these clinical signs are: Drinking and Urinating excessively, Ravenous Appetite, Pot-bellied Appearance, Hair loss on the main body sparing the head and legs. There are other symptoms and since all dogs are different, not all dogs get the same symptoms but these are usually the norm. Is Eskimo displaying any of these symptoms?

Like Sue has mentioned, please do get copies of all tests that were done on Eskimo and post the results here. You see, the more we know about your girl the better our feedback will be.

When deciding to treat with Lysodren/Mitotane or Trilostane/Vetoryl, IMO, either medication is safe when monitored appropriately and with owner observation and each med can have similar adverse effects. So "owner observation" is always a crucial component of treatment.

Each has it's pros and cons, they work differently, they are both safe when monitored appropriately, yet they both can have the same and serious risks and adverse effects.

One or the other may work better for an individual dog.

Another important consideration is the degree of experience your vet has with whatever treatment he/she chooses. Cushing's requires a good partnership with one's vet.

Please do not hesitate to ask any questions, ok? Here is a link that I hope you will find helpful: Links to Cushings Websites (especially helpful for new members!). ( http://www.k9cushings.com/forum/showthread.php?t=180)

Love and hugs,
Lori

[Eskimo'sMom]

Eskimo has been diagnosed one week ago. I am to meet with her vet on the 16 of April to discuss treatment. Eskimo looks good and acts well. I do not want to make her worse if not needed. Her vet has already stated that she would like to place her on Trilostane. Very weary about doing this. So , what happens to her if I choose not to treat her and how accurate are the ACTH and LOW DEX tests. She has taken both. I will get the numbers and post tomorrow.

[Squirt's Mom]

Hi Teresa,

One of our mods will be moving this post to put it with your original thread on Eskimo. That way all your info is in one place and easy to reference.

When you get a chance to catch up on your original thread, you will see that we have asked for more info on Eskimo. The more you can tell us, the better insight we can offer. ;)

I'm sure you will get more replied and input soon but here is a link that explains what happens in untreated Cushing's:

http://www.compliancehome.com/news/FDA/14174.html

It may be that Eskimo can wait on treatment for a bit yet...once all the info is together it will be easier to see what is going on with her.

Hugs,
Leslie and the gang

[Squirt's Mom]

Hi again, Teresa, ;)

Can you tell us what signs you are seeing in Eskimo other than the drinking? Has her appetite increased? getting into trash, eating non-food items, food aggression? Has she lost any hair, especially on her torso and/or tail? Does she have a pot-belly? Dose she pant for no reason? Is she peeing more often? had any accidents inside? Does her face look like it has lost weight? Has she shown any reluctance to jump on furniture ect.? Does she tire more easily on walks and in play? Do her back legs tremble or seem weaker?

These are all signs common in Cushing's. If Eskimo is not displaying these signs or if she has only mild signs, then waiting to treat is the best option, IMHO. Cushing's signs are a very important part of diagnosing and monitoring treatment once it has begun. So if she doesn't have any signs or her signs are few and mild, then it won't hurt to wait. As her cortisol rises, these signs will more than likely become much more obvious.

Cushing's is a slowly progressing condition which means you have time to 1) make absolutely sure you are indeed dealing with Cushing's via thorough testing, 2) look into the treatment options available and decide which would be best for Eskimo, and 3) educate yourself on the condition so you can be the best advocate possible for her.

For now, just take a deep breath and try to relax a bit. :rolleyes:;):) Hard to do, huh? I so understand but you have found the very best place to learn about Cushing's plus have all the support you can imagine. We are here to help you in any way we can. I think we all came here in a state of shock and fear, heart-broken that our precious babies were sick but most of us have found that it isn't nearly as bad as we first thought once we started to understand what we were dealing with. Cushing's is not necessarily a death sentence - it can be and is treated successfully by 1000's of people every day, and their babies live out their normal life spans with minimal problems. We have many such stories here. So ask all the questions you can think of and we will do our best to help you understand.

The most important thing I have to tell you today is this - you and Eskimo are not alone on this journey. We will be with you every step of the way.

Keep your chin up!
Hugs,
Leslie and the gang

[marie adams]

Hi Teresa,

Welcome!! You are in the right place to get all the info to help support you on this journey.

I just recently lost my best buddy--Maddie. She was an Aussie. We were lucky enough to have her in our lives for 12 wonderful years. I can tell you that if I had been able to catch Cushings early she would not have lost so much muscle mass in her hind legs. Maybe it would have happen anyway, but I am not sure, she had full blown Cushings by the time I discovered a link as to why she panted, was losing her fur, etc. She had 85%++ of the symptoms--the vet kept telling me she was getting older.:(:(

I am not sure what will happen if you don't treat or hold off, but make sure your vet understands Cushings Disease really well and then they can tell you what to expect. Everyone here is GREAT and they know their stuff; I just got here late in the game for Maddie--we had started treatment with Lysodren. Maddie did great on it no side effects--you can always read our thread.:)

Ask all the questions you want because everyone has info to share with you!!:):)

[apollo6]

Welcome Teresa
My 12.5 year old mini dachshund, Apollo started on Trilostane in June of last year through Dec 2010, then I restarted end of February 2011 because his blood test should elevated results.
First of you have some time to think about this.
Below is a link with a brief explanation of Cushing with actual pictures before and after treatment
http://www.kateconnick.com/library/cushingsdisease.html
The test you should have are a full blood panel, an ultrasound of his abdomen, a urinalysis, and the ACHT STIM TEST. First realize there are three kinds of cushings. Trilostane is used for the pituitary type.
we would need to know what kind Eskimo has, and the results of his tests posted. It is important to know what kind Eskimo has, his symptoms which you have already posted. Only then do you decide which treatment option is best for Eskimo. The dosage also depends on Eskimo's weight.
When you know what kind of cushing it is we can go from there. Also if you what a good quality of life for Eskimo, you should treat the cushing.
Now take a deep breath. You will get through this and so will Eskimo.
You don't have to make a decision right away.
Hugs Sonja and Apollo

[Eskimo'sMom]

I was asked to post my tests numbers. I have 5 pages worth of numbers. One from a Urinalyis, blood panal, ACTH Stim test and Low Dex. Would you like to post them all? I am new to this forum but I am finding it very helpful! Also, why would you like all the numbers posted? Are some people able to understand them ? I really hope so bc when I look at all these numbers I begin to become frustrated now knowing what Im looking for? Some seem like common sense but I also read the Dr. Notes on the side that read "normal" or "No arthrites"

Here are Eskimos signs: she drinks ALOT of water, her back legs shake at times, she does jump on furniture but sometimes she is reluctant, as for eating, that is hard to determine cuz she's been begging for food since we got her. She tends to pant quite a bit also. Right now she is lying on the kitchen floor with her head on the floor and mouth closed... No panting, but then again, dont all dogs pant?

Moderator's Note: I have merged your new post about your pup's labwork into Eskimo's original thread. Normally, we like to keep all posts on a single pup in one thread as it makes it easier for other members to refer to the pup's history when necessary.

[StarDeb55]

Teresa, here's a late welcome from me & mine! When it comes to the "numbers", from the general labwork, we would like to see only the abnormal results, along with reporting units, & normal ranges. With the Cushing's specific tests, we need to see all results along with reporting units. For instance on an ACTH, there would be 2 results, a baseline draw, & 1 hour draw, after the administration of the drug. On a low dose, there are normally 3 numbers a baseline/pre draw, a 4 hour, & an 8 hour results.

Just to let you know, I'm a medical lab technologist with 30+ years experience, so I can help you sort out the general labs. I'm fairly decent at reading the Cushing's diagnostics, but there are other members who are better at reading the Cush specific tests than I am.

Looking forward to seeing those numbers.

Debbie

[Harley PoMMom]

I was asked to post my tests numbers. I have 5 pages worth of numbers. One from a Urinalyis, blood panal, ACTH Stim test and Low Dex. Would you like to post them all? I am new to this forum but I am finding it very helpful! Also, why would you like all the numbers posted? Are some people able to understand them ?

Although we are not vets, we do have a lot of experience analyzing those test results and giving you meaningful feedback, also, Deb, one of staff members has over 30 years as a lab tech.

For the ACTH stim test, there should be 2 numbers to post; a pre or base-line draw and a post draw, could you could both of these numbers.

For the LDDS test (Low Dex) there should be 3 numbers to post; a resting draw, a 4 hour draw and a 8 hour draw.

Urinalysis: any thing that is marked abnormal and could you post her specific gravity and PH.

Blood work: Any thing marked abnormal (L or H) and with the reference ranges and units of measurements; ie...ALT 150 (5-107) U/L. Numbers in parentheses () are the reference ranges...U/L is unit of measurement.

Love and hugs,
Lori

[Eskimo'sMom]

Blood Panal Sept 4, 2010

Eskimo is a 10 years old Australian Shepard; she weighs 63 pounds

WBC RBC HGB HCT MCV MCH MCHC = NORMAL
RBC MORPHOLOGY= NORMAL

there are other numbers but I will post only if needed from the above panal. They all are normal.

Ill post the numbers where now comments are typed or written
ALKALINE PHOSPHASTASE 507 ( HIGH) NORMAL RANGE 5-131 THEN A SIDE NOTE FROM DR OR LAB TECH NO ARTHRITES ( HAND WRITTEN NEXT TO THIS NUMBER , NOT SURE REASON)

GGT 17 (HIGH) NORMAL RANGE 1-12,
GLUSOCE 63 (LOW) NORMAL RANGE 70-138
CALCIUM 7.7 (LOW) NORMAL RANGE 8.9-11.4
TRYGLYCERIDE (HIGH)NORMAL RANGE 29-291
Then at the bottom of this test written by hand "Essentailly Normal"

NEW TEST: URINALYSIS September 5 2010
COLOR: YELLOW
APPEARANCE: CLOUDY
SPECIFIC GRAVITY: 1.017
PH 7.5 (HIGH) NORMAL RANGE 5.5-7.0
OCCULT BLOOD "TRACE" (HIGH) NEGATIVE
THEN HAND WRITTEN BY VET OR TECH "NORMAL"
HOWEVER THE APPEARANCE, SPECIFIC GRAVITY, PH HAVE ALL BEEN CIRCLED BY THE VET OR TECH.
Hyperadrenalortiusm/Cushings (sp) was ruled out due to the results of these tests. With a note by vet stating that the Urine was 1.017

NEW TEST JANUARY 20, 2011 ACTH RESPONSE (2 SAMPLES)

TIME 10:30AM
TIME 11:30AM
CORTISOL SAMPLE 1 4.9 REFERENCE RANGE: 1.0-5.0 UNITS UG/dL

CORTISOL SAMPLE 2 20.0 (HIGH) REFERENCE RANGE 8.0-17.0 UNITS UG/dL


NEW TEST MARCH 24, 2011 DEX SUPPRESSION ( 3 SAMPLES)
TIME 845
TIME 1252
TIME 508

CORTISOL SAMPLE 1 8.4 (HIGH) RR 1.0-5.0 UG/dL


CORISOL SAMPLE 2 DEX 6.6 (HIGH) RR 0.0-1.4 UG/dL

CORTISOL SAMPLE 3 DEX 5.9(HIGH) RR 0.0-1.4 UG/dL

Once the LOW DEX test was given, I got a call from the vet stating that Eskimo has a mild case of Cushings and would like to put her on Trilostate. I have yet to meet vet in person. She is out of town for 10 days.

Eskimo's Symtoms: Excessive drinking of water, noticed this in July of 2010, then noticed that her hind legs were shakey as if visiting a groomer or dr visit (eventually it goes away), she does pant heavily at times without excersing. She has always begged for food so can't tell if she is hungry more but my instinct tells me she is becoming more adement about it. Going into the kitchen after dinner is made and lying on the floor whimpering for left overs. I also noticed one day that she did not greet a friend of mine that she normally gets excited in meeting. All these were signs that something was wrong. Other than this, she appears normal, not bald spots, loves her walks, and wants to go out as always on car drives.

[Eskimo'sMom]

I went online to check out prices. WOW expensive! I really only checked out one place on line . I have yet to meet Eskimos vet but she recommended Trilostane. So I have begun my research on the med,.

Moderator's Note: Teresa, I have moved your post asking about where to buy trilostane into Eskimo's original thread. We normally prefer that all posts for a pup be kept on a single thread as it makes it easier for other members to refer to the pup's history. I have, also deleted the new thread you started with the lab values as you have already posted them in the original thread.

[littleone1]

Hi Teresa,

I have been getting Corky's Trilo from Diamondback pharmacy in Scottsdale, AZ for 1 1/2 years. I recently got 180 capsules of 20mg each for $90. which included the delivery fee. This is a 3 months supply for Corky, as he is taking 60mg TID.

Terri and Corkster

[apollo6]

Dear Teresa
First let the experienced lab techs give you input. I also buy my TRilostane from Diamondback in Arizona, which is more reasonable then most . But before you even think about the medication. We need to know which kind of cushing's Eskimo has. An ultrasound would either show both adrenal glands similarly enlarged which would most likely be the pituitary cushing. If one adrenal gland is a lot larger then the other it would be more likely the adrenal gland cushing which would require different treatment, (sometimes surgery is an option), and the last cushing is atypical cushing which also requires another treatment.
With cushings the CBC will show increased neutrophils, decreased lymphocytes, decreased eosinophils
Glucose increased
BUN normal/decreased
SGPT mild increase
ALK PHOS increase
Cholesterol increased
Sodium mild increase
Potassium mild decrease
ACHT STim-cortisol, increase
DEXamethasone Suppression Test cortisol, increase
Urinalysis- specific gravity decreased, ofter under 1.007.
Hugs Sonja and Apollo

[Eskimo'sMom]

what do you mean you got the med for 90.00 each. Each tablet is 90.00????? or the three month suppy is 90.00 total. are You from Arizona?

[apollo6]

Dear Teresa
You are being overloaded. I live in San Diego, Terry lives in Arizonia.Diamond back ships with in the United States. We get free shipping where we live. Terry means she gets 180 tablets of 20 mg(dosage) for $90.00. I get 30 tablets of 10mg for $47.00. Maybe she gets it cheaper because it is compounded( when a dosage is custom made for the individual pet's needs).
Sonja and Apollo

[Eskimo'sMom]

Got it. Whew!

[littleone1]

I'm sorry if I confused you. Sonja is correct. The total amount I pay for 180 capsules is $90.00, which is a 3 month's supply.

[Eskimo'sMom]

I opened up this forum this morning and am reading alot about dogs passing. Are they passing due to cushings? Im afraid to read them all in fear that it may be so:(

[Squirt's Mom]

No, sweetie. Most of our babies that pass do so due to other problems unrelated to Cushing's. It is a sad fact that Cushing's affects older dogs most often and they are also the ones who will be more likely to have additional problems, not to mention simple aging. :(

I had a hard time with this at first, too, but I came to realize that the people who come here do so because their baby is sick. Whether that turns out to be Cushing's or some other condition, parents of healthy babies just don't show up on forums like ours. Try to hold onto the good things you see and read, the good times with Eskimo. You will find that we celebrate our babies here as well as share our troubles.

How are things going for you today?

BTW, you are doing really good with posting! ATTA GIRL! :D

Hugs,
Leslie and the gang

[apollo6]

Dear Teresa
I am posted your post for other's to reply to

This is Teresa , Eskimo's mom. Im not sure how to reply to a message you placed on my thread so I figured this was the best way to do so.

I have posted Eskimos lab work on my thread. By chance can you look them over to help me understand them better.

ALso, why would Eskimo's vet tell me to get Trilostane if she isnt sure what type of Cushings she has? She has had 4 tests ( all posted) and with that she recommended Trilostane. However, it worries me bc you stated and Eskimo should get an ultrasound to make sure which type she has. On her LOW DEX test it stated that a vet will know which type of cushings a dog has by the way the numbers came up in the second and third dose. Is this not accurate?

Dear Teresa with the three types of cushings there are varies treatment options. It depends on the vet as to which drug they recommend. You are doing good posting. And keep asking questions on what you do not understand. Cushing is a very complicated disease, sometimes the symptoms for other issues may be similar to cushing.

Right now you are trying to gather information to make the right decision. Don't be afraid to ask your vet about the readings and why Trilostane and which cushing Eskimo has. Also keep copies of all the reports and readings to reference in the future.
HUgs Sonja and Apollo

[Squirt's Mom]

Hi Teresa,

The low dose dex (LDDS) is not used to determine whether a pup has the adrenal (ADH) or the pituitary (PDH) form. It is one of the diagnostic tests that help determine if Cushing's could be present. The high dose dex (LDDS) is used to deferintiate between ADH and PDH.

The ultrasound can also go a long way in making this determination - in fact, the HDDS doesn't seem to be used much any more. An abdominal ultrasound will tell much, much more than the HDDS as it looks at many other organs.

With ADH, a complete cure is possible via surgery. With PDH, life-time meds, usually either Lysodren or Trilostane, are the current treatment approaches most often used in the US. There is another form in which the cortisol is normal but the intermediate (sex) hormones are elevated. This form is treated with melatonin and lignans, plus sometimes a maintenance dose of Lyso is also added. Trilostane is not recommended in these pups. A fourth form of Cushing's exists that is caused by the use of steriods, either ingested or used topically over a period of time. This form is treated by simply weaning off the steroids and rarely requires any further attention.

The majority of dogs have PDH, the pituitary form of Cushing's. Some of these pups also have elevated intermediates, but the focus is on the cortisol - treating the cortisol with Lsyo will address most, if not all, the intermediates as well. If a pup has ADH, and surgery is an option, that is usually the best route. If surgery is not an option, the vets will determine whether Lyso or Trilo would be the best treatment to shrink the adrenal tumor.
Tr
As for why your vet suggested Trilo - there could be any number of reasons. It may be that she is more familiar with it's use; she may think it is safer than Lyso (it is not, by the way); Trilo is approved by the FDA (in it's brand name form, Vetoryl) while Lyso is not approved for veterinary use; she may have had a bad experience(s) with Lyso in the past. There could be reasons beyond our imagining for her reasons....the best thing is to talk to her and find out why she feels Trilo would be best for Eskimo. Remember, Cushing's is slow progressing so you have time to do little things like this so you are more comfortable with treatment once it begins.

Keep posting and asking! You are doing a great job! One of our resident gurus will be along soon, I'm sure, to help interpreting the test results you have posted.

Hugs,
Leslie and the gang

[jrepac]

Teresa,

your case reminds me of what I went through with my Aussie (terrier) who recently passed. You notice the changes in behaviors but initial testing is negative. But, several months later, you get a positive result. :confused: This is exactly what I lived through; it's a pre-Cushings stage, even if it is not formally recognized. But, good thing is that you picked up on it early and can treat it. No reason to be afraid of treatment; but do ask a lot of questions and keep informed. With a mild case, hopefully the meds will do the trick.

Jeff & Angel Mandy

[StarDeb55]

Teresa, depending on the results of the low dose dex, it may be possible to determine what type of Cushing's a pup has. How this is done is based on the % change in the cortisol level at the 4 hour & 8 hour blood draws when compared to the baseline draw. I will not go into the specifics of how to read a low dose because it can be very confusing. I still get confused at times. There are also times that a low dose will indicate that the pup does have Cushing's, but the results can't determine what type, this is when the abdominal ultrasound or high dose dex comes into play. As Leslie has already said, the high dose test seems to have fallen out of favor with most vets. An abdominal ultrasound actually gives you more "bang for the buck", as all of Eskimo's internal organs will be checked, & you can get a better idea of her overall health. It is always critical that you get a 2nd test done to confirma positive low dose result. The low dose is considered to be the "gold standard" for diagnosing Cushing's, but it has one big drawback, the test may yield a false positive result in the face of non-adrenal illness.

When it comes to the general labwork that you have posted, Eskimo has a couple of the typical elevations in liver function that our pups suffer from which are the alk phos & GGT. Most pups also have elevations in the ALT & cholesterol. Were the ALT & cholesterol normal on this bloodwork? All of these tests are considered to be liver function tests. Cushing's affects liver function as the liver becomes stressed from having to process all of the excess cortisol that the adrenals are producing. An elevated alk phos is what will frequently point a vet toward Cushing's, but it's important to understand that alkaline phosphatase can come from a number of organs in the body, not just the liver. It's very possible Eskimo may be in the early stages of Cushing's, some of the symptoms you have posted earlier are consistent with Cushing's, but could be from other diseases, too. Were diabetes & thyroid ruled out?

In looking at the low dose results, they do appear to be consistent with Cushing's, but the test does not tell us what type. IMO, the next step is to get that ultrasound done, & confirm the positive on the low dose. I would like a couple of other members to weigh in on the low dose results to confirm the way I'm reading those numbers.

There is no hurry to treat Cushing's as it's a slowly progressing disease that literally takes years to do its damage.

Hope this helps.

Debbie

[labblab]

In looking at the low dose results, they do appear to be consistent with Cushing's, but the test does not tell us what type. IMO, the next step is to get that ultrasound done, & confirm the positive on the low dose. I would like a couple of other members to weigh in on the low dose results to confirm the way I'm reading those numbers.

Debbie, I agree with your assessment of the LDDS results :). I, too, would recommend an abdominal ultrasound in order to try to determine the type of Cushing's, and also to view other internal organs in addition to the adrenal glands.

Teresa, if you'd like to better understand the interpretation of Low Dose Dex Tests, here's a link that may help you:

http://veterinarymedicine.dvm360.com/vetmed/Medicine/ClinQuiz-Interpreting-low-dose-dexamethasone-suppr/ArticleStandard/Article/detail/580093

Marianne

[StarDeb55]

Thanks, Marianne!

Debbie

[zoesmom]

Here's another place where the trilostane prices are very reasonable. I used them for over two years. They do not sell the name brand vetoryl. This is for compounded trilostane. But having used both versions (vetoryl for two years and compounded trilo for two) we never had a problem with the compounded from pethealthpharmacy.

Here are some prices from www.pethealthpharmacy.com's for compounded trilostane from a couple years ago.

60 mg capsules x 30 day supply is $32.40.
120 mg. capsules x 30 day supply is $48.90
175mg x 30 capsules is $64.02.

However, their prices haven't increased all that much because here are some more current prices for various other dosages of trilostane. They haven't gone up much at all.

30 caps x 63 mg = $34.65 (they have to do something other than 60 mg, because that's the Vetoryl strength, so that's how they get around it)
30 caps x 75 mg = $37.
30 caps x 90 mg = $40.65

Those first two average out to barely $1/day for a dog taking trilostane once a day. Shipping is minimal - $5-something, regardless of quantity ordered.

I have to say I was always happy with their customer service. Even when there were glitches with my order, they went out of their way to make things right as quickly as possible. (Really, only one glitch in 2 + years, and it wasn't really their fault, either, but rather my vet's office.) They are also good about responding to questions (e-mail or phone).

If your vet follows the 1 mg/1 lb. of weight dosing protocol, then that first price (for 63 mg) would be a likely dose. However,one thing I'd suggest(especially in the beginning) is to start off using something like a combo of 30 mg and 15 mg caps, or 45 and 15 mg caps so that you can have more flexibility in dosing (by combining or using those caps separately.) That is what we ended up doing in the beginning of my Zoe's treatment. That's because there can be some up and down adjustments to their doses in the early days of treatment. Once they settle in on a dose, then you can start ordering the exact dose they need. Might cost slightly more but by 3 or so months into tx, a dog is usually settled on a dose.

This pharmacy is online and requires a hard copy or a phone confirmation from the vet's office for the first prescription. After that, you can just go online and order and it usually comes in 2 - 4 days.

Sue

[Eskimo'sMom]

I'm concnered that Eskimo's vet may not know what she is doing since she told me over the answering machine that she wants to place her on Trilostane before knowing which type of Cushings Eskimos has??!!!

Eskimo HAS NOT had an ultrasound nor a high dose of dex to determine type of Cushings. So why would she recommend Trilostane before knowing the type of cushings she has? perplexing!

I am looking into finding an internal medicine specialist to treat Eskimo. I by no means can afford this but feel that Eskimo's vet might not be doing right for Eskimo . She did not mention to me that Eskimo should have an ultrasound. In fairness, I have not met with her dr yet bc she is out of town, but still worried.

BTW, today during Eskimo's morning walk, she placed her nose inside a fence to try to get something ( couldnt see what it was) and tried to eat it. Something she has never done before. Worried that she may be in that stage of Cushings where she will eat strange things!

[Eskimo'sMom]

Teresa, depending on the results of the low dose dex, it may be possible to determine what type of Cushing's a pup has. How this is done is based on the % change in the cortisol level at the 4 hour & 8 hour blood draws when compared to the baseline draw. I will not go into the specifics of how to read a low dose because it can be very confusing. I still get confused at times. There are also times that a low dose will indicate that the pup does have Cushing's, but the results can't determine what type, this is when the abdominal ultrasound or high dose dex comes into play. As Leslie has already said, the high dose test seems to have fallen out of favor with most vets. An abdominal ultrasound actually gives you more "bang for the buck", as all of Eskimo's internal organs will be checked, & you can get a better idea of her overall health. It is always critical that you get a 2nd test done to confirma positive low dose result. The low dose is considered to be the "gold standard" for diagnosing Cushing's, but it has one big drawback, the test may yield a false positive result in the face of non-adrenal illness.

When it comes to the general labwork that you have posted, Eskimo has a couple of the typical elevations in liver function that our pups suffer from which are the alk phos & GGT. Most pups also have elevations in the ALT & cholesterol. Were the ALT & cholesterol normal on this bloodwork? All of these tests are considered to be liver function tests. Cushing's affects liver function as the liver becomes stressed from having to process all of the excess cortisol that the adrenals are producing. An elevated alk phos is what will frequently point a vet toward Cushing's, but it's important to understand that alkaline phosphatase can come from a number of organs in the body, not just the liver. It's very possible Eskimo may be in the early stages of Cushing's, some of the symptoms you have posted earlier are consistent with Cushing's, but could be from other diseases, too. Were diabetes & thyroid ruled out?

In looking at the low dose results, they do appear to be consistent with Cushing's, but the test does not tell us what type. IMO, the next step is to get that ultrasound done, & confirm the positive on the low dose. I would like a couple of other members to weigh in on the low dose results to confirm the way I'm reading those numbers.

There is no hurry to treat Cushing's as it's a slowly progressing disease that literally takes years to do its damage.

Hope this helps.

Debbie

Diabetes was ruled out and so were liver and kidney failures.

[Eskimo'sMom]

what is IMO?

[Eskimo'sMom]

Just guessing: In My Opinion????

[labblab]

I am certainly never opposed to involving an internal medicine specialist in the Cushing's diagnostic process. Cushing's shares symptoms with other disorders, and it can be tricky arriving at an accurate understanding of a dog's medical situation. And I think that the input from a specialist would be especially valuable in the event that you would consider surgery if it turns out that Eskimo does have an adrenal tumor. Surgery can provide a permanent cure for adrenal Cushing's, but it is both a very expensive and very serious surgery.

However, if surgery would not be an option for you, I would not immediately assume that your vet is not knowledgeable just because she has told you that she would recommend trilostane as her medication of choice without first identifying the form of Eskimo's Cushing's. Vetoryl has received FDA approval for treatment of both pituitary and adrenal Cushing's, and some vets prefer Vetoryl (trilostane) for all of their Cushing's patients.

Eskimo has already had a mildly elevated ACTH test and a "positive" LDDS test. So along with her symptoms, both of those results are consistent with Cushing's in one form or another. As many of us have already suggested, an abdominal ultrasound has many additional general diagnostic pluses. So I do think it is worth discussing with your vet. But until you've had the chance to talk directly with your vet about these specifics -- the expense and advisability of an ultrasound and whether the results would influence a surgical decision on your part -- I wouldn't assume that she is not knowledgeable just because she is recommending trilostane as her medication of choice for either type of Cushing's.

Marianne

[Eskimo'sMom]

wow, Marianne, that is very clearly stated and has placed many things in perspective!

So what Ive learned so far:

All tests posted are consistent with Cushings or pre Cushings or mild form, her behavior is consistent with it as well.

She tood the Low Dex test was confirmed that it was Cushings by vet but still to be safe, a final test should take place to completely confirm it is Cushings.

An Ultrasound will be the last test needed to make certain it is Cushings that Eskimo has!

Cushings is a slow process disease so not need to rush but also should not PROCASTINATE!

Whew, I thing I got it ! YAY!!!!!

[mypuppy]

Hi Teresa,

Glad to see you are still around, and that things are starting to fall into place for you in order to proceed with the treatment you and your IMS are most comfortable with. Be patient as I stated a while ago because there is a world of more important information yet to be learned. And to add to your statement, Marianne is one of the many here to who so generously and lovingly puts things in perspective for those of us who do not have the cushings knowledge and experience--she and several others here are a blessing to us and our babies.

I hope as time goes by you will feel a bit more at ease about Eskimos treatment.

Warm regards and hugs. Xo Jeanette

[apollo6]

Dear Teresa
You are getting it right. We still need to know what type of cushing, Eskimo has.
this link explains near the bottom
http://www.vetinfo.com/canine-cushings-disease.html
It took me almost a year to decide on what treatment was right for Apollo, after a lot of research. Each case is different
An IMO is an internal medicine specialist
Below is a link. You can see if any are in your area. You can choose specialty for small animals, and location California.
http://www.acvim.org/websites/acvim/index.php?p=3
Some times a specialist can be more knowledgeable about cushing. But once again that is your chose.
Sonja and Apollo

[marie adams]

Hi Teresa,

You are lucky to be able to start early in this disease. Maddie had the shaking and the panting about 6 months before I knew what was causing it. Her eating habits made sense after we knew she had Cushings. At first she just seemed hungry, but she started to steal food off the table at night--which she never did. She would scout out the kitchen floor and sniff around even making pig snorting sounds--it was very odd, but I read on some Cushing's site that was one of the symptoms. Another thing she would do is lick the rugs in the kitchen--I guess because it had the taste of food sort of. Another thing we started to notice was she would sneak into my daughter's room where she fed her cat and Maddie would eat the cat food and also unmentionables in the litter box.

She pretty much had a soft mouth, but the longer this disease went on she almost started nipping our fingers when you gave her treats or food. I remember thinking at times I had forgot to feed her because she would lay with her paws on each side of her bowl and give me that look like when do I get to eat, but I had feed her--I thought I was losing it or I was having senior moments...

She got slower and slower on our walks--she wanted to go, but dragged behind me when she usually was in front. You could see her legs shake when we were out on the trail. I live near wetlands in Orange County by the beach. She loved to chase the coyotes, but I had to be careful because she could not move as fast as she use to.

We just didn't know or have any idea to have tests done. At least your vet knew about the disease. Maddie just wasn't sick so we didn't go to the vet very much. The vet was familiar with Lysodren so that is what we used with no side effects that I know of. It really is what you feel good about. The second vet we got like the Trilo, but worked with us because we were using the other.

I hope this helps a little since Eskimo is also an aussie like Maddie. Everything made sense once I knew she had Cushings.

Maddie died from some form of cancer and not the Cushings. The cancer took over fast so there wouldn't have been anything we could have tried to help her, but give money to the vets.

[Eskimo'sMom]

ah, the sniffing of the kitchen floor. Yes, Eskimo began to to this on Sunday, actually she may have started sooner but since reading the information about Cushings, I noticed it more on Sunday. We have a connecting garage with things that WILL harm her. She has access to this area but she NEVER goes in there. However now that I hear these stories she may get aggressive enough to go in there. I know we all think out dogs are angels. And they are, however, Eskimo really is a good girl. She listens, plays only with her toys even if there are others on the floor, has NEVER torn anything up in the house and has never stolen any food. If I tell her not to drink from the fountain in the park, she'll listen. However, I will need to dog proof my home now that she MIGHT start getting into areas she shouldnt get into due to Cushings. WOW, Im at work right now and scaring myself thinking she can simply go under the kitchen sink and ingest some of those chemicals!!!!! I need to get baby locks for them! Maybe Im being paranoid but better saft than sorry!

[Eskimo'sMom]

How do I post a picture of my Eskimo as others have done for profile?

[lulusmom]

Hi Teresa,

I don't know if anyone answered your question but IMO stands for "in my opinion". Here's a post that can walk you through how to upload your avatar.


The pic beside the username is called an "avatar". :)

Go to your "User CP" (upper left corner)

Then, click on "Edit Avatar" under "Settings and Options", put a dot in the little circle next to "Custom Avatar" and follow directions in the box for uploading a custom avatar. :)

Although you can use an image that is posted on any website, most of us use Option 2 - Upload Image From Your Computer.

[marie adams]

Hi Teresa,

I can tell you not to worry, but this I can say, Maddie didn't get into anything that didn't relate to regular food. She was fine--she also never chewed up anything except when she was a puppy. She had her toys and she still took care of them, carried them around, etc. So do not panic--it is all food related because their cortisol levels are high--once you get to a maintenance program they go down and the ravenous appetite goes away. I started giving her yogurt her last 6 mos. and that became a routine for her--like where's my dessert--she would voice her hurry up command bark--haha!!:D

Maddie was never the same dog the last year and I am not sure if it was just getting older combined with the cushings or what--she just slowed down so fast. We all have to take it in strides as they say. I can do the what ifs, but we still enjoyed her till the end. She continued as best she could on walks, still enjoyed her rides in her old suburban hanging her nose out the window driving down PCH.:p

You will notice everything now because you are always watching--you will get the looks from her like what are you looking at--you know the look with those eyes...:rolleyes:

Just enjoy her, you have caught this early...and don't stress too much.:D:D

[apollo6]

Dear Teresa
You can go to Home depot and get flip locks for the kitchen cabinets, that is what I did. Looking forward to seeing a picture of Eskimo.
Hugs Sonja and Apollo

[Eskimo'sMom]

Can any one tell me what I can do to better care for my "Cushings" dog. I placed the word in quotes bc although she has been dianoised with it, she has yet to get an utlra sound and treatment for it.

Can I feed her anything special : currently she is eating Canidae ( senior) with Stellas raw food patties. I place one small patty in her Canidae. I also give her Glucosimine (sp) from Trader Joes. She goes for walks..... Im looking for things that will help her... EX I heard or read flax seed is good????

Natural/organic is preferred.

[Eskimo'sMom]

All I need it an ultra sound to confirm Eskimo has Cushings. Her vet has already told me she has the disease but I want it confirmed with an ultra sound as suggested by others in this forum. Her vet has also wanted her on Trilostane which I have not begun yet due to the Vet being out. HOWEVER, I would like to know what I can do, preferably naturally and organically to help Eskimo stay healthy? For example, I read flaxseed helps.... I am NOT asking for a replacement for the trilostane but just what else I can do to keep her healthy.

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

[StarDeb55]

Actually, Teresa, it's not the flaxseed itself, it's a component of the flaxseed called lignans. Lignans + melatonin are really only used to help treat pups who have Atypical Cushing's where there is an increase in one or more of the associated hormones produced by the adrenal glands. These 2 products are mainly aimed at controlling elevated estrogen especially. I would not recommend that you start anything, even natural, homeopathic supplements without discussing this with your vet. Some of these hormones are made in very minute quantities by the body, & you do not want to risk inadvertently decreasing their concentration in the body which could possibly have serious consequences to Eskimo's health.

Now, I don't remember, but if Eskimo has elevated liver function studies, there are several supplements such as milk thistle which will help support liver function. A number of members do use these types of supplements. Again, I would strongly encourage you to discuss anything like this with your vet prior to giving them to Eskimo.

Debbie

[labblab]

Hi again, Teresa.

In advance of your being able to talk with your vet next week, I just want to add a couple more thoughts about an ultrasound. I don't want to mislead you into thinking that an ultrasound is guaranteed to finalize Eskimo's diagnosis. If Eskimo's Cushing's is being caused by an adrenal tumor, then it is indeed likely to be the case that an ultrasound will reveal visual abnormalities in the adrenal glands -- one gland will typically be enlarged and reveal a mass or growth, while the other adrenal gland will be smaller and even shrunken. However, even if Eskimo has pituitary Cushing's (which is far more common than adrenal Cushing's), the ultrasound may not reveal any visual abnormalities in her adrenal glands. Dogs with pituitary Cushing's often exhibit enlargement of both their adrenal glands, but this is not always the case. So to summarize, an ultrasound ought to be able to confirm adrenal Cushing's and it may be able to confirm pituitary Cushing's, but not always. However, it should also provide helpful information about the status of Eskimo's other internal organs, including her liver.

One other caution: the adrenal glands can be very difficult to accurately visualize, so the ultrasound should be performed on state-of-the-art equipment and the interpretation should be done by an experienced technician or professional. General practice vets often do not have the advanced equipment that is necessary, so referral to a specialist is often required. This may be another reason why your vet has not yet performed an ultrasound on Eskimo herself, and she may want to make sure that you are agreeable to the added expense and time involved in a specialty referral.

As I say, just a couple more thoughts for you to consider prior to talking with your vet again.

Marianne

[Eskimo'sMom]

I will be visiting Eskimo's vet soon. Her vet said she had cushing after 4 tests were completed on her ( all posted on this thread) Here are the questions and concerns I have so far for her:

How solid are we knowing Eskimo has Cushings? SHouldnt we do an Ultrasound to know for sure? Is she pre cushings or mild( as stated on answering machine), if so is it necessary to start her on trilostane? Why did you choose to prescribe tri vs other meds? What is Eskimo's prognosis now that she has Cushings? She acts healthy now except for water intake and shakey hind legs. Will trilostane make her appear or feel sick?..............

Anything else I should ask???? Personally, I ll be FRANK. I really think Im in a state of denial and may be asking questions that are silly. I have taken care of Eskimo very well. Yes sometimes we do feed her table scraps but we know what she can and cannot have.

[apollo6]

Dear Teresa
Once again, ask your vet which of the three types of cushing's Eskimo has. There are varies drugs used for each of the three. Go back and read the links I gave you.
Both trilo & lysodren can be used to treat both types of Cushing's. For example, Terri has been treating Corky's adrenal tumor with trilostane for 18+ months. The use of either drug is not limited by what type of Cushing's the dog has.


The overuse of steroids is called iatrogenic Cushing's. Atypical Cushing's is when one or more of the associated hormones produced by the adrenal glands is elevated. Some of these hormones may include progesterone, & aldosterone.

The ultrasound would show if any other organs are enlarged: liver, kidney. With pit cushing's, not all dogs will show that both adrenals are enlarged on an ultrasound. In fact, it's not that unusual for the adrenals to be the equally sized in pit Cushing's, with no enlargement


Medication lowers the cortisone level to a normal range and can help reduce elevated blood readings to a more normal range.
How solid are we knowing Eskimo has Cushings? SHouldnt we do an Ultrasound to know for sure? Is she pre cushings or mild( as stated on answering machine), if so is it necessary to start her on trilostane? Why did you choose to prescribe tri vs other meds? What is Eskimo's prognosis now that she has Cushings? She acts healthy now except for water intake and shakey hind legs. Will trilostane make her appear or feel sick?..............

The elevated cortisone levels would indicate Cushings. They symptoms: losing fur on both sides evenly, losing hair on the tail, skin liaisons , increased thirst, sometimes increased appetite, muscle wasting in the legs( shagging legs). The symptons will progress without treatment. I did try holistic for a year it helped a little but did not stop the cushing. If treated correctly , Eskimo can have a quality of life. Treating with the correct treatment can prolong her life. Each case is different. Ask all the questions you need. It is a lot to absorb. Find out which one she has first. It took me awhile before I started Apollo on trilostane. So you do have some time.
I have quoted Debbie to correct any misinformation I have given you.
Sonja and Apollo

[Eskimo'sMom]

Im from Southern CA and I have been listening to KRLA the Pet Show every Saturday morning at 1130AM there is a man on this show who is an animal specialist. I was fortunate to get on air with him yesterday ( exciting) and talk to him about Eskimo's Cushings. He suggested pretty much what I have already known. Get the ultra sound. However, he also suggested a place in Burbank/Glendale called the small animal specialty hospital who has top of the line technology. I figured he was simply advertising this hospital but later that day I went to the dog park and met a couple who took there dog there and had nothing but good things to say about it. We meet with specialist on April 25th!

Coincedently, Eskimos vet called that same day ( the one who did all the tests and concluded she has cushings). I do like her but asked her why she had not suggested the ultra sound and said she would have. Hmmmm, IDK.... I think Im taking her to the specialist for her Cushings. I believe I may hurt her feelings but I gotta do whats right for my baby. Love her too much. Her vet told me she has mild case and has dealt with the disease MANY times. She also told me there is no rush to medicate her yet. I can wait about a month. Whew!

She basically told me everthing that I have read in the forum and other research I've done.

One more question I have that I am confused about. If trilostane is used to treat for both types of cushings (adrenal or pituatary) why then must I need to know the type of cushings she has if this med will take care of both types? I read that the type of cushings she has will determine the treatment, however trilostane seems to take care of either type.

[littleone1]

Hi Teresa,

Lysodren and Trilostane are now used to treat both PDH and ADH cushings. If it is adrenal based cushings, surgery is the best option if your furbaby is a good candidate for the surgery. Once the adrenal gland with the tumor on it is removed, the cushings can be resolved. On rare occasions, cushings symptoms can return. We have several members here that have had successful adrenalectomies done. We also have at least one member who had success with her baby in having a pituitary tumor removed.

Lysodren erodes the adrenal gland, but if there is a tumor on it, there is no guarantee that the part of the adrenal gland where the tumor is will be eroded and the tumor will shrink or go away.

I'm glad you're going to a specialist that has experience in treating cushings.

Terri

[Eskimo'sMom]

I went to see a specialist yesterday. This place is WONDERFUL! Here are the results after Ultra sound and blood pressure test.
1. Likely pituitary cushings. I questioned the word "likely" and dr stated she had to say that bc she could not see entire adrenal glands which is normal on some dogs due to position of them. But since one adrenal was slightly swollen, it was concluded as pit. since this one would have shrunk if it was adrenal.

2. Diagnostic procedures: abdominal ultrasound: plump appearance to the left and right of adrenal gland. Only able to evlauate the caudal pole of the right adrenal gland due to the position. Blood pressure: elevated systolic pressure 177-193mmHg. But this can be part bc she was nervous. Eskimo was very anxious.

3. Recommendation 60mg trilostane Give one capsule by mouth every 12 ours for adrenal gland suppresson.

I was told that if there is a cushings to have, pit is the one to have bc dogs can live their normal lives with treatment and no negative effects! Adrenal will require surgury or the tumor can intefere with other organs

Dr. told me that some choose not to treat the cushings bc a possible side effect is addisons disease.

If I treat, her symptoms will go away OR she might (low %) get worse.

The funny thing is is that I read that if I dont treat it she will (not might) get worse. But this Dr. stated that this might be the worse Eskimo gets which is drinking lots of water and shakely legs.

I asked her if her organs can get damaged? She said there is a chance of that but we really do not know.

Any advise will be helpful here. I am torn on whether to treat or chance she does not get worse. She still runs, plays, acts like herself except for the drinking and shakeyness.

I LOVE HER SO MUCH! This responsibility on whether to treat her or not is a BIG DECISION. Her life is literally in my hands.

I am in a cross roads? Do I TREAT OR NOT?

If I choose to treat I will begin in summer since I will be home to monitor her!

Moderator's Note: I have merged your update on Eskimo into Eskimo's original thread. We, normally, prefer to keep all posts on one pup in a single thread as it make it easier for other members to refer back to the pup's history when needed.

[mypuppy]

Dear Eskimo's mom,

I just read your post and frankly you brought it all back for me when I was in your same position as to whether to treat or not since I too received two different opinions. The gp who told me not to treat had no idea my dog even had cushings. Thank God I found this forum because it allowed me to take my time and educate myself with all this in order to make the best choice for my baby. Long story short she has been treated successfully for over year now on Vetoryl and is doing well so far. I know how very scared you are right now, as we all were when we first came here. There are others here who know a world of valuable information related to this condition, and I can only suggest to stick around in order for them to provide their inputs. We are all here for one reason, and it is to help our dogs because they mean the world to us. I certainly do so hope you consider the consequences which I am sure someone will point out soon if you choose NOT to treat your dog. I wish you patience, guidance and offer you my support during this not so wonderful journey.

Tight hugs and belly rubs to Eskimo.

jeanette and Princess

[addy]

I think we need deep calming breaths!!!;);)

It is so much information to take in at once, we go on information overload.:eek:

Do we know how much Eskimo weighs? Dechra is the manufacturer of Trilostane/Vetoryl. Did we give you that link? If not, I'll go look for it. They recommend starting at 1mg per pound once a day though Dr. Allen from Dechra did tell me I could also start my Zoe on twice daily dosing. I will let others with experience with the drug comment.

Did you read the Questions and Answers with Dr. Feldman article? It talks about educating people in treating their dogs.

Perhaps Eskimo's symptoms are not yet bothersome to you, not strong enough to cause you concern. I have to tell you, I have not yet started treatment for my Zoe other than melatonin and lignans. It is a long story and she has colitis and was having flare ups and I could not start durring a flare up. It has been just about a year. She did not have strong symptoms, mostly hair/coat. Hers was not a clear cut case when to start to treat. All her blood work was normal.

I have watched her change these last months, the hind leg weakness, how she looks, how she acts, she is just not the same dog she was a year ago. I worry about what the cortisol is doing to her inside, where I can't see. Her hunger is getting worse, she is starting to drink more water, all the signs that were not there are now showing up. It is not easy to watch. It is very sad. At some point you have to decide do you put aside your own fears and go ahead or continue to watch the decline?

I don't mean this to sound like a sermon. You have time to decide what is best for you and your dog.

Take a deep breath, put Cushings in a drawer and lock it away for a bit. Come back to it when you can.

We are here for you, every step of the way.

Hugs,
Addy

[littleone1]

Hang in there. Cushings is a slow progressing disease, and summer is not that far away. I totally understand you're wanting to be at home to monitor Eskimo's treatment.

When Corky was first diagnosed with cushings, I was told it was better if I didn't treat it. However, I got a second opinion, and was also in contact with a vet in CA. I was told by them that I should treat it, or it would result in many of the internal organs failing. Even though Corky has an adrenal tumor, and it is invading the inferior vena cava, he has been doing very well on the Trilo. He was diagnosed with cushings almost 2 1/2 years ago.

I know this is very diffficult to deal with and understand, but we have a terrific family that really help us get through it.

[Harley PoMMom]

I believe if the clinical signs are there and the diagnostic tests have confirmed Cushing's, then one should treat their dog for this disease.

I tried treating my boy, Harley, for this dratted disease. We first tried Lysodren but because of Harley having pancreatitis, his pancreas could not tolerate the Lysodren.

After a two-month wash-out period we moved on to Vetoryl. After only 10 days on the Vetoryl, a Chemistry panel was done and it seems that the Vetoryl unmasked kidney disease in Harley.

So after that we could not treat Harley for Cushing's at all. Soon after, my boy was diagnosed with liver failure and then heart failure. Elevated cortisol did that to my boy.

I had to release him last week and I miss him very much.

Love and hugs,
Lori

[Eskimo'sMom]

@ Lori, OMG!!!! I am SO deeply sorry that you little boy went to HEAVEN last week. I cant help but weld up with tears!!!

@ Addy's mom: once the changes became worse for Addy, did you place him on treatement?

One of my questions to the vet was that if it gets worse I can then decide to treat. She gave me a look I could not read except that to say that at that point it might be too late.

Im leaning toward treating.

ANother thing. Trilostane at Diamond back will be 175.00/MONTH!!! The person I spoke with stated that she can compound it which really means give me the EXACT same thing but in a different dose due to copy right infringments. Eskimo weighs 63 pounds. Vet prescribed 60mg twice a day (total 120/day) If I get 57mg or 63ng I will pay 72/month at Diamond Back Pharmacy. HUGE DIFFERENCE. not to mention the monitoring that will take place 15-30-180 days from first intake with ACTH stim test.

What makes me lean to treating is that too much Cortisol is probably not good for the body.

[labblab]

Dear Teresa,

Whichever way you go in terms of the medication -- brandname Vetoryl or compounded trilostane -- I strongly encourage you to talk to your vet about ordering it in a smaller dosage "unit" to begin with, perhaps more like 30 mg. rather than 60 mg. capsules. This will allow you greater dosing flexibility in the event that you need to make changes. You cannot safely and accurately open and split the contents of capsules, so if it turns out that Eskimo needs a bit more or a bit less of the medication, you're "stuck" if all you've got on hand are the 60 mg. capsules.

It is not at all uncommon for dogs to require dosing changes during the early weeks of treatment. And I'm especially mindful of this in Eskimo's case, because the technical representatives at Dechra (manufacturers of Vetoryl) are now verbally recommending to vets and owners that dogs be started on the medication using a formula of only 1 mg. per pound as a daily total. So for Eskimo, if your vet wants to proceed with twice daily dosing, that would probably work out more closely to only 30-40 mg. twice a day rather than 60 mg. twice a day (or perhaps some combination such as 60 mg. in the morning and only 30 mg. in the evening).

This verbal recommendation does represent a change from the published dosing chart that is included in the U.S. Product Insert for Vetoryl. Per the published chart, 120 mg. is indeed the daily dosing recommendation for a dog of Eskimo's size. But if you or your vet would like to speak directly with the specialists at Dechra, they will be more than happy to talk with you about their newer, lower, revised dosing recommendations. Several of us have called them directly to talk, and most often have spoken with a vet named Dr. Tim Allen. He is really nice and really helpful. Here's Dechra's contact information:

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

I just want to mention all this before you place your trilostane order. Because the medication is an expense, without a doubt. So you want to make sure that you are receiving a capsule size that you will be able to use, no matter whether or not Eskimo ends up needing a dosage change either early or later on. Also for your information, here's a link to that Vetoryl Product Insert:

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

Marianne

[addy]

Addy's mom: once the changes became worse for Addy, did you place him on treatement?

We will be starting our treatment. I had to wait to see how her new daily doses of metronidazole controlled her colitis. She was very ill in November and December, losing weight, we could not get the colitis under control so wanted to give her a few months to recoup as well.

Treating her could unmask problems and make her colitis worse but I am going ahead with the treatment. I hope that won't happen with her colitis. I may have to allow her cortisol to be higher than what I normally would. We can only try and see what happens.:)

You need to be comfortable with your treatment. If you need to wait until Summer to get that comfort zone, then do it.:)

Hugs,
Addy

[marie adams]

Hi Teresa,

I treated Maddie with Lyso just because the vet at the time was familiar with that drug. I did not have the time to wait to medicate or not because by the time I knew she had Cushing's it was very far advanced.

Maddie started with the panting and shaking. I did not notice the water intake, but I am pretty sure it was there. The panting and shaking I noticed in June of 2009 because this is when we went to the vet to get something for her nerves for the 4th of July. At that time we asked about the panting and shaking--just told "getting old". By November of 2009 is when we noticed the loss of underfur and saw her energy level slowed down quickly during this 5 month period. Then she had trouble jumping up on the bed or into the car. All this was gradual, but it was the progression of the disease. I figured it out from the internet towards the end of January 2010 and she had 85-90% of the symptoms by then.

So if this helps you make the decision to treat or not -- at least I hope it helps you understand what takes place. Each dog is different in how they progress or react. I never noticed the energy level coming back to what it was before--could that be Cushing's and getting older--maybe. Lowering the cortisol levels can unmask arthritis and that could be why Maddie's energy level didn't make a big improvement, but she was comfortable and calmer about food.

I think I paid almost $170 for 30 500mg pills of Lysodren from Costco, but I only had to give 3x a week. She had no side effects at all.

I hope this helps you and you will make the right decision. Also, by watching and monitoring her you won't have any problems with the Addison Disease that is only if you over medicate with the medicine.
Everyone here will help you through all of this along with your vet.

Take care!!!:)

[Eskimo'sMom]

WOW, this informaton is priceless! I have a call out to the vet.

Questions I will ask vet
1. should I get a lower dosage? I was thinking more like 57mg/day so that I can get the compounded price, but am now thinking even lower than that but still at a compound dosage so that I can afford it.

2. Daily recommondation is 60 mg / day (verbally) which contradicts the written portion. How familiar are you with this product? Do you think we are risking addisons with such a high dosage?

3. I know we will check her levels two weeks later, but wouldnt it be safer to start at the LOW end and adjust to high end?


NOT A QUESTION FOR VET: but I cant help but wonder, how knowledgeable is she? Now Im starting to question her ability as a Dr.
I must say, when I first saw her she looked SO YOUNG and I was immediatley put off by that! then I read her experiences and continued with the vet visit.

In case you havent noticed... Im now leaning toward treating Eskimo for a few reasons:

1. Ultra sound stated her liver was inflamed; not a good sign in my opinion
2. I have read , if left untreated, this is a death sentence ( but then of course I heard the opposite of this too)
3. Each time I see her drinking water, I ask myself, what is her body doing that is making her need to drink so much?
4. When I see her lie in a certain position, she does appear lethargic.
5. Too much cortisol is NOT good for the body.

[addy]

Hi,

What does Eskimo weigh? If you start at 1mg per pound, does she weigh 60 pounds?

Dechra recommends starting low as Marianne explained.

Hugs,
Addy

[lulusmom]

Eskimo weighs 63 lbs and as luck would have it, Sue listed the great price of $34.65 at www.pethealthpharmacy.com for 63 mg compounded Trilostane.

[Eskimo'sMom]

Just spoke with vet: She will lower dosage to 40mg =80mg/day.
Vet stated that there is so much info out there with trilostane that she prefers to keep it midrange for a starting point.
She also pointed out that compound pharmacys have NO REGULATIONS, so people are not always sure they are gettign what they asked. But I think Diamond Back is repretuble, right???

[littleone1]

I've been getting Corky's Trilo from Diamondback Pharmacy for 1 1/2years now, and I've never had a problem with them. Corky's had to have various dosages compounded. I personally trust them.

Terri

[apollo6]

Dear Eskimo's mom
You are doing and feeling the way most of us did at the beginning. It took me from January2010 until June of last year to make the decision to put Apollo on Trilostane. I tried holistic for a year but it got worse.
Once on the Trilostane after a few months I saw that his coat started coming back, some of the skin issues resolved themselves, the eating was hard to determine because being a dachshund he always had a big appetite. It can slow down the muscle wasting of the hind legs,which can occur. Like you I was tormented about what to do.
Apollo's ultrasound also showed an enlarged liver, scarring on the pancreas, and enlarged kidney-due to cushing. The last ultrasound
done did show improvements on the organs. Each case is different. But know you have confirmation. So you are doing the right thing.
I have used Diamond back Drugs also.
Hear is the link from the manufacture Dechra which produces Vetoryl/Trilostane. http://www.acvim.org/websites/acvim/index.php?p=228 You can read up on it and even email any questions you might have as to the correct starting dosage, etc. You can also download the brochures at the bottom of the page.
Sonja and Apollo(San Diego)

[Eskimo'sMom]

Eskimo's vet stated that she will place her on 80mg per day (40mg in two dosages) vs the 120 she originally stated.

Eskimo weighs 63 pounds. I still think 80mg per day is too much but she assured me this was midrange for her and a good starting point.

I mentioned what I read what Drech stated that total should be her body weight, but this did not phase her too much. She stated that it is a new drug and so many opinions out there. She is going based on experience so I agreed with 80/day , nervously.

Eskimo whimpers at night sometimes. I caught her doing it last night. I woke up and checked to see what she was doing and she was lying on the floor at the foot of the bed on her side, eyes opened and just letting out small whimpers. I WISH DOGS COULD TALK! I couldnt help but wonder if she was fed up with her body begging for water or food. or hating the urge to go potty again. Maybe she was hurting inside, her organs doing something. IDK but broke my heart.

She has access to water everyday and if she runs out, she lets us know. She also has indoor and outdoors access. Food, no. We feed her only twice a day.

Im at 90% that I will treat by this by summer.

I love her SO MUCH!
Animals are so special to us, but the bond between canine and human cannot be matched. They are able to make us see things in a new way, allow us to experience things we couldnt without them. Open up our hearts and allow us to purely love them unconditionally, become advocates for those whom have no human parent or are treated cruelly. My heart has changed since I got Eskimo. I have taken strolls to the beach with her, made friends at dog parks bc of her, taken chances I wouldnt have done if not for her. For example, on my way to her specialist, I thouhgt I had to hit a freeway I HATE and NEVER get on. I pulled over to the side before getting on it and said to myself... well maybe you just wont make it to the vet afterall. I turned looked at Eskimo and said to myself.... Girl, stop this silliness, youre really going to avoid seeing this specialist because of freeway?!
Well.... as you know.... I made it to the specialist.

Eskimo,

Mommy loves you with all her heart, and will do what is best for you! I will use my intelligent and well educated brain to make the best decision for you. I will try hard to avoid second guessing myself and avoid procrastinating for you, my love, deserve better than that. You are my heart and best friend and are worth my best self in making the right decision for you. You know I hate making these types of decisions, but I came upon this crossroad for a reason.
And I know that whatever I decide, you will love me either way. I dont want to harm you , I want to make you all better. And that will be my goal.

Hugs and kisses, my love!

[lulusmom]

Just spoke with vet: She will lower dosage to 40mg =80mg/day.
Vet stated that there is so much info out there with trilostane that she prefers to keep it midrange for a starting point.
She also pointed out that compound pharmacys have NO REGULATIONS, so people are not always sure they are gettign what they asked. But I think Diamond Back is repretuble, right???

There is a lot of information available about Trilostane and we have posted the most reliable sources in our Helpful Resources. Source number one would be Dechra, the manufacturer of Vetoryl. While they have not revised their published dosing recommendations, Marianne confirmed with the technical representatives at Dechra that they are verbally advising pet owners and vets to begin at the very lowest end of that published dosing range, 1 mg. per pound. Source number two is U.C. Davis who developed their own treatment protocol based on their own clinical trials. U.C. Davis is a reknown veterinary teaching hospital and they have treated hundreds of dogs with Trilostane so they have extensive experience with the drug. Their dosing recommendation is even lower than Dechra's at 1mg per kilogram of weight.

Based on Dechra's recommendation, Eskimo should be started on no more than 63mg once daily and based on UC Davis, maximum once daily dose should be approximately 28mg. The reason that the recommended starting dose has been lowered substantially is because experience proved that higher doses were a lot more likely to make a dog sick. While rare, there were even cases of adrenal necrosis resulting in death. Trilostane is a serious drug and because no two dogs respond identically to the drug, there is no such thing as a safe middle of the road dosing. That's why Dechra and UC Davis recommend much more conservative starting doses. It's always safer to start low and adjust if necessary.

When my dogs started on Trilsotane, Dechra did not have a small enough dose for my tiny guys so I have always had to have their meds compounded. I've dealt with Diamondback Drugs for years and yes, they are very reputable. My dogs' internal medicine specialists as well as a few general practitioners in my neighborhood use Diamondback Drugs routinely.

[Eskimo'sMom]

So, I probably should call back the vet ( a third time) and tell her to lower the dosage even more. (?)


I m afraid I will now be stepping on her professional ability.

[Eskimo'sMom]

but really when it's the life of Eskimo.... well you know... I probably should.

[lulusmom]

Marianne PM'd me and asked if I was aware that Eskimo was going to be starting on twice daily dosing. I realized then that perhaps I should have explained things a bit better so let me try again as well as make a suggestion that may make you feel better.

I was aware that twice daily dosing is planned for Eskimo and I should have told you that my concern is that at some point during the day, there may be an overlap when Eskimo is going to feel the full effects of an 80mg dose. Being that 80mg is greater than either Dechra or UC Davis recommends as a starting dose, I am concerned about that. It is entirely possible that 40mg twice a day may be inadequate but I personally would rather figure that out after figuring out that 30mg twice a day is too low.

You mentioned that you were 90% sure that you would start treatment before summer so since we have some time, how about this idea. I believe Marianne has already provided you with a link to Dechra's contact information. Why don't you give them a call and ask them if a twice daily starting dose of 40mg is reasonable for a dog weighing 63 lbs. If Dechra says yes, I'll hang my head in shame but I'll also feel a lot better about things and so should you. If Dechra says you should start Eskimo on a lower dose, then call your vet and ask that she reduce the dose to whatever Dechra recommends. I don't think you would be stepping on her toes at all and she should appreciate the fact that you are a proactive participant in Eskimo's care. FYI, I have called Dechra a few times and I prefer to talk to Dr. Tim Allen. Let me know if you need the contact information again.

Glynda

[Eskimo'sMom]

I do listen to what everyone in here has to say. I take everything I read as educated advice but I know that what ever I choose to do is up to me.... so if someone says one thing that contradicts something else I heard or read.... Then it is my responsiblity to research it more. The contradiction is a stepping stone for me... It allows me to REALLY become familiar with the disease through research.

I appreciate EVERYTHING I read in here.... if not for that... I would not have seen a specialist or gotten an ultrasound. I would have begun treatment right away.... even though my gut would have told me that something didnt feel right. Once I went the extra step thanks to all the advise Ive read in here I felt so much better about the disease.

[lulusmom]

I do listen to what everyone in here has to say. I take everything I read as educated advice but I know that what ever I choose to do is up to me.... so if someone says one thing that contradicts something else I heard or read.... Then it is my responsiblity to research it more. The contradiction is a stepping stone for me... It allows me to REALLY become familiar with the disease through research.

This is music to my ears. Knowledge is power so good for you!

[addy]

Just stopping buy to wish you a Happy Friday and to have you give Eskimo a pat from me and Zoe.

You are doing just fine:):):)

Hugs,
Addy

[marie adams]

Hey Teresa,

You are doing a great job with getting all the info and making an informed decision. You have to be the one to speak for Eskimo and if it is questioning the vet, then do it because it will make you feel better and calmer you asked. As I look back to last year there was a lot of stress caused by the vets because they just didn't know enough and their hearts were not connected to my Maddie as yours is to Eskimo. I had a hard time understanding that to this day. I paid them lots of $$ to run tests, but to not think I wanted results back to me when they said they would be back was just ridiculous. I do not treat my customers that way...

Keep doing what you are!!:o An Aussie is a special buddy that just "GETS" you. We never thought we would have time for a dog, then we got Maddie and how our lives were enriched beyond belief!!!:):)

Have a great weekend--it is suppose to be beautiful here!!!:):):D

[apollo6]

Dear Eskimo's Mom
If and when you do decide on treatment for Eskimo , you can start at a lower dosage than (forgot what you mentioned)
I started Apollo on 10mg. of Trilostane and he weights between 9.5-10 lbs. I listened to my hunches. I was told to start at 30m.g which I felt was way to much. So once again ask, listen to your gut feelings, get as informed as you need to be to make a decision.
Could you give us your name?
Hugs Sonja and Apollo

[Eskimo'sMom]

Spoke with Dechra ( Dr. Tim) this morning and told him my 63 pound dog was asked to take 120mg/day then changed to 80/day after I spoke with specialist. He stated that 80/days may not be too bad but keep an eye on her.

HE ALSO STATED that I MAKE SURE I am NOT getting the compound because it is not in a PURITY form. UGH!!!!!! I was planning on doing compound bc it is SO MUCH LESS EXPENSIVE TO DO SO and affordable.

However, I must keep in mind that I am speaking with a person who works for Vetyrol.

Please tell me your thoughts on compound vs vetyrol.

Also, why does Eskimo shake, it is not longer just her legs; sometimes it is her entire body. It tends to happen when we are on outtings. SHE LOVES OUTTINGS.

[Eskimo'sMom]

My name is Teresa.

[Franklin'sMum]

Hi Teresa,

I used the compounded trilostane for Franklin. Would it be possible to ask your vet/IMS for the pharmacy info where the trilo would be coming from? You could then speak to the phamacist and find out the purity. Just a thought :)

Jane, Franklin and Angel Bailey xxx

[Harley PoMMom]

HE ALSO STATED that I MAKE SURE I am NOT getting the compound because it is not in a PURITY form. UGH!!!!!! I was planning on doing compound bc it is SO MUCH LESS EXPENSIVE TO DO SO and affordable.


Please tell me your thoughts on compound vs vetyrol.



I believe one should purchase the Trilostane from a reputable compounding pharmacy, here's a link to another member's thread in which the question of using compounded trilostane vs. brandname Vetoryl has been discussed: http://www.k9cushings.com/forum/showthread.php?t=2620

Love and hugs,
Lori

[littleone1]

Hi Teresa,

I'm a little surprised by Dr. Allen's comment about compounded Trilo. I have spoken with him several times, and he never once mentioned not to use compounded Trilo for Corky. I spoke to him recently when Corky's behavior started changing, and he felt that it wasn't the Trilo, which it wasn't. Corky was diagnosed with CCD.

Terri

[lulusmom]

Please tell me your thoughts on compound vs vetyrol.


I think I may have already mentioned to you that both of my dogs treated for two years on compounded trilostane purchased from Diamondback Drugs. My dogs are tiny so Dechra didn't offer doses small enough for either of my dogs so compounding was not an option, it was a necessity.

It's a long story but I switched my dogs back to Lysodren. If I had to do over, I don't think I would have done it and I would still be getting their compounded trilostane from Diamondback. Instead, they get their compounded Mitotane (Lysodren) from Diamondback. FYI, Diamondback is a reputable compounding pharmacy used by a whole lot of veterinarians countrywide, including two of our gp vets and our internal medicine specialist. None of these vets blink an eye when I ask them to call in my prescriptions to Diamondback.

I am not advocating that people should purchase compounded trilostane in lieu of Vetoryl; I'm just saying that there are reputable compounding pharmacies out there and if being able to afford the medication makes the difference between treating and not treating, I personally would choose compounded trilostane in a heartbeat.

[Eskimo'sMom]

I know. I did not prompt him to speak about compounding, Dr. Tim brought this up himself. I guess he did so bc I said I was going to get 80/day 40 each capsule. He must have known I was thinking of doing compound.

So.... Now this..... My brain is hurting..... Now have to research compound vs vetyrol. Which I have lightly and found one article stating that I should go with vety. But then, is this written from a spokesperson from the company?

I m calling Diamond Back. Again

[Eskimo'sMom]

Spoke with Diamondback Pharmacy. The woman told me that they sell about 5-10% Vetyrol and the rest in Compound form. That to me speaks volumes!

She did say, however, that some vets prefer Vety. Makes me wonder reason.

Eskimo's vet said compound is okay too.

Whew....

[labblab]

Teresa, I don't know if you've had the chance yet to take a look at the thread that Lori pointed out to you in her reply this morning. But here's a link to a post of my own that is contained in that thread. I think it will give you a better understanding as to why some vets prefer to prescribe brandname Vetoryl rather than compounded trilostane:

http://www.k9cushings.com/forum/showthread.php?p=42036

I personally agree with Glynda's earlier statement:


I am not advocating that people should purchase compounded trilostane in lieu of Vetoryl; I'm just saying that there are reputable compounding pharmacies out there and if being able to afford the medication makes the difference between treating and not treating, I personally would choose compounded trilostane in a heartbeat.
But I also want you to be aware of the legal issues that are involved, and how those issues may affect a vet's prescribing decision.

Marianne

[Maya]

Spoke with Dechra ( Dr. Tim) this morning and told him my 63 pound dog was asked to take 120mg/day then changed to 80/day after I spoke with specialist. He stated that 80/days may not be too bad but keep an eye on her.

HE ALSO STATED that I MAKE SURE I am NOT getting the compound because it is not in a PURITY form. UGH!!!!!! I was planning on doing compound bc it is SO MUCH LESS EXPENSIVE TO DO SO and affordable.

However, I must keep in mind that I am speaking with a person who works for Vetyrol.

Please tell me your thoughts on compound vs vetyrol.

Also, why does Eskimo shake, it is not longer just her legs; sometimes it is her entire body. It tends to happen when we are on outtings. SHE LOVES OUTTINGS.

I think the shaking is just part of the cushings deal. Maya's tremors would get really bad at time, but since starting Vetroyl they have drastically subsided.
Regarding the compound vs vetoryl, I don't really know as I am in Italy, so it is not available to me. I have to buy Vetoryl. From what I've heard, it's just as good. Remember....it's all marketing at the end of the day!;)
Leah and Maya

[labblab]

Regarding the compound vs vetoryl, I don't really know as I am in Italy, so it is not available to me. I have to buy Vetoryl. From what I've heard, it's just as good. Remember....it's all marketing at the end of the day!;)

I just want to clarify that here in the U.S., there are more differences between brandname drugs and compounded drugs than marketing -- the entire manufacturing process is different. Many people think that compounded drugs are the same thing as generic drugs. But that is not the case. As is the case with brandname drugs, generic drugs are approved by the Federal Drug Administration and are manufactured by pharmaceutical companies in compliance with a specific govenmental regulatory framework. Generic drugmakers must submit testing results that confirm that the active chemical composition of their product is identical to that of the brandname drug.

Compounded drugs are instead prepared on-site by individual pharmacies (not drug manufacturers) by prescription to fit the specific needs of a specific patient when there is no FDA-approved drug available in a dose or form that the patient requires. Compounding pharmacies operate under the oversight of state licensing boards, and not the FDA. Compounded drugs are not FDA-approved, and their production has not been subjected to the same manufacturing or testing criteria. Here is another post that may help explain the production differences:

http://www.k9cushings.com/forum/showthread.php?p=1254#post1254

Marianne

[addy]

So.... Now this..... My brain is hurting

You just need a brain massage:D:D:D;)

You are doing so well, you really are. Look how far you have come in such a short time.:)

Hugs,
Addy

[marie adams]

You will get there with your decision...:) It is always good to weigh all the options. I do not think there is any one that will be a wrong decision. You just need to know them all and feel comfortable with what will work best for you.

I agree with the shaking getting better once you start treatment. If I remember, Maddie's shaking wasn't as much once she got into the maintenance phase. Arthritis can also contribute to the shaking after you start treatment because this starts to show up when the cortisol levels get under control. Always something....

Take care!!

[Eskimo'sMom]

dont know if I mentioned this, but ultrsound confirmed with 99% accuracy that Eskimo has Pit Cushings

[apollo6]

Dear Teresa
The trembling can be caused by muscle wasting.
Also, why does Eskimo shake, it is not longer just her legs; sometimes it is her entire body. It tends to happen when we are on outtings. SHE LOVES OUTTINGS.
As for compounding as Glynda said as long as you have a reputalble pharmacy to go to, with the help of our members you have already been given one. I just started using Diamondback also because it is on the west coast.
The reason for compounding is because Trilostane/Vetroyl only comes in 3 dosages, I think. And often a small increase is all that is needed to help our fur balls get better control of the cushing. I have used compounded also for Apollo. Your doing a great job.
Sonja and Apollo

[Eskimo'sMom]

So Cushings will deteriorate muscle? This is why sometimes her entire body shakes. What can I do to strengthen her muscles?

[lulusmom]

So Cushings will deteriorate muscle? This is why sometimes her entire body shakes. What can I do to strengthen her muscles?

Yes, the catabolic effect of excessive cortisol causes muscle wasting. One of my dogs trembled constantly and was so weak, he would almost fall over at times. I didn't really do anything to help him strengthen his muscle. Like most dogs, he regained his strength and muscle tone over time once he was stabilized on treatment. Muscle wasting and skin & coat issues are usually the last symptoms to resolve, taking up to six months to improve, so don't get nervous if you don't see improvements right away.

Glynda

[addy]

Just stopping by to see how you and Eskimo are doing.

Hugs,
Addy

[apollo6]

Just checking in on how you and Eskimo are doing. You will get through this.
Hugs Sonja and Apollo

[Eskimo'sMom]

Well, Eskimo has a cut on her abdomn. I think it came from the shaving needed for the ultra sound. She was placed on Climinax(sp) and some ointment. I checked on it today. Looks bruised. I know cushings delays healing so will keep an eye on it. Other than that, she is doing very well except for the excessive drinking and sometimes trembling. We have NOT placed her on trilostane yet. Waiting for Summer and then will place her on compound version. But then again.... will we???? she looks and acts so good that I dont want to make her worse. My only reason for treating is so that the cortisol does not mess up her organs.

[lulusmom]

If Eskimo were my dog and she was looking and feeling good, I'd put off treatment indefinitely. If you are concerned about the effect on the organs, you can always have a mini blood panel done quarterly to check the liver and kidney values. Honestly, most experienced vets will not not prescribe treatment until the symptoms become a problem for the pet owner so I think you're correct in questioning whether you will start treatment this summer.

Glynda

[Eskimo'sMom]

Ah, really? so if I decide not to do treatment, then I can get a panel done periodically to check her organs and make sure she is still doing well? BC in reality Cushings is the over production of cortisol and the over production of cortisol has a negative effect on the kidneys and liver only, is this correct? so if I get these checked, and they are ok then I do not need to treat!

On the other hand, during the ultra sound, her liver looked swollen.

[StarDeb55]

Cortisol can affect all internal organs, not just the liver & kidneys. One of these is the pancreas, & that is why our pups are more prone to pancreatitis. The other problem is that Cushing's suppresses the immune system leaving our pups open to infection, or infections that can be very slow & difficult to heal.

Debbie

[Rene]

Hi Teresa,

Unfortunately, my Snoop went through all the above. By the time she was diagnosed she lost her gall bladder and her spleen. We thought she just suffered from cronic pancreatitis and was getting old. She was tested and her cortisol and intermediates (sex hormones) were elevated. By the way, have Eskimo's hormones been tested yet...as this can make a difference as to what type of medication you choose as trilo can raise alrealy elevated hormones, contributing to the problems.

Anyways, all this contributed to the loss of her organs, cronic pancreatitis, muscle wasting & weakness, hair & hearing loss, pot belly appearance, abnormal blood panels, reduction of eyesight, enlarged liver & adrenals, increased thirst & hunger, the list goes on.

Once we got the cortisol and the hormones under control with medication, a needed worming and a diet change all of these symptoms, with the exception of the loss of hearing, are resolving rapidly! In fact, three days ago the little dear was out of my sight for a few minutes and she ate part of a dead rotted rabbit she found! Pre-medication she would have been the the hospital for a week with pancreatitus. So I guess it is safe to assume that her pancreas is no longer cronically inflamed by the excess cortisol and stress caused by the intermediates!

Cushings is a slow progressing disease however, in our experience, once the outward symptoms were apparent it had already done its damage. If Eskimo's cortisol and possibly intermediates are elevated and she is showing the signs you mentoned (enlarged liver, panting, shaking legs, increased thirst, looking for food on the floor, disintrest in greeting company) then it is already effecting her to some degree.

Also, to answer one of your other questions, ask your vet about L-Glutamine. I noticed it helped right away with Snoops shakes and stability and this was before she got properly loaded on her Lyso. It also is suppose to help with the pancreatitis by healing the digestive tract.

Rene & Snoopie

[Eskimo'sMom]

I didnt know disinterest in company was a symptom. That did happen twice a while ago. I new something was wrong back then... Do you know why this occurs?

[Rene]

Teresa I can only guess, but here is my theory.

I didn't realize how much Snoopie had changed due to the cortisol and elevated hormones because it took time to creep up and I just thought she was getting old.

Once I got Snoop loaded it was immediate how much better she felt. More energy, she stopped her preoccupation with food, was more intrested in people and toys, she literally got her personality back in a week or two.

So, I would imagine that this condition really makes them feel crappy like any other disease. Snoop was just more intrested in being left alone and feening for food! Now she is more social and less food oriented.

Rene & Snoop

I have also noticed that due to the thinning of her skin she is also sensitive to the touch. I am careful how I pet her. This may also have something to do with avoing company as they do not know how to touch a cush pup.

[Eskimo'sMom]

I was looking at Eskimo under her fur on her spine. She has a lot of dry scapes there. My first impression was to take her to the groomer, but then I thought it could be a result of Cushings. I want to make sure that anytime I see something wrong with her I dont immediately jump to the conclusion that it can be a result of Cushings. Can this be realted to Cushings?

Also, ready to start treatment. Out of school for summer vacation ( teacher)... Have a call out to internalist bc I have two prescriptions with me... one by specialist the other by reg dr. One is for 40 mg / twice a day , the other from reg vet is 25mg twice a day. I prefer the lower but was told by receptionist at specialty hosptial that if I want specialist to manage Eskimo I should go with her suggestion which is 40 ( 80/day)...and I m doing compound cuz frankly is less expensive!

[StarDeb55]

Cushing's frequently causes a lot of skin/coat issues, so it's possible. Without actually seeing the lesions, it would be really hard to say. The only way to get an accurate diagnosis is to let the vet take a look, & they will probably want to do a skin scraping at a minimum, & depending on what they see, they may want to do other things, such as a culture & sensitivity.

Debbie

[Eskimo'sMom]

Ordered a two week supply of compounded trilostane. Supposed to come in today. Only two weeks cuz dosage may need adjusting in two weeks. Ordering from Diamond Back . Did you know they sell all over the world and have very good prices? We have a compound pharmacy in CA but the price was 3 times that of Diamond Back. They seem to have a really good reputation. My vet in Southern Ca like them.

[Eskimo'sMom]

With treatment, should I expect to see her do less panting and less leg shaking and water consumption?

How will I know if she is having a bad reaction to meds?

[Eskimo'sMom]

Just got the meds in the mail.... OMG and the pharmacy included a biscuit for her. She gobbled it all up :)

[Harley PoMMom]

With treatment, should I expect to see her do less panting and less leg shaking and water consumption?

How will I know if she is having a bad reaction to meds?

Sometimes it will take a couple of weeks before symptoms have abated when first starting the Cushing meds but all dogs are different and can react differently.

Too low cortisol symptoms include: vomiting, diarrhea, lethargy, and/or Eskimo just not acting like herself.

Love and hugs,
Lori

[addy]

Hi,

http://www.dechra-us.com/Topmenu/Products/Products-1.aspx?pcatid=PROPFIELD465&catid=PROPGRP37&fid=PROPFIELD469


If you go on Dechra's website they have a ton of information you can read through, link above. They will list which symptoms may be the first to resolve and what to look for regarding a bad reaction.

Resolution of symptoms will largely depend on the dog. Water consumption will usually improve in the first two weeks. Panting will improve at some point.

My Zoe has been on a very low dose of Vetoryl now for three weeks. I have seen improvement in water consumption but she was not drinking buckets before. It was one of the first things I noticed after we started treatment. I have seen an improvement in her balance when walking, her hind legs were getting pretty weak. I have not noticed an improvement in her appetite:rolleyes::rolleyes:
but as I said, she is on a very low dose and her cortisol at 10 days was not in the target range, a few points higher. We are allowing that because of her colitis. It flared the very first day:eek:

I reread the Dechra information quite often. It is a good starting point.

Wishing you luck and if you get nervous, just post as often as you need to. Someone is always around.

Hugs,
Addy

[apollo6]

good luck.
Be patient. It will take a little time to see changes.
Sonja and Apollo

[Eskimo'sMom]

Day 2: Second day on meds. I have already scheduled an ACTH Stim test for the second week to adjust dosage if needed. She is taking 25 mg twice a day.

She still panting a lot but I understand that results take about 2 weeks to manifest.

[addy]

Hope Day 3 goes well:):):):):)

Hugs,
Addy

[Rene]

Hi Teresa,

How are you and Eskimo doing on the meds?

Rene & Snoopie

[apollo6]

Hi Teresa
Haven't checked in on you lately. How is Eskimo and you doing?
Sonja and Apollo

[Eskimo'sMom]

Eskimo went in for her first ACTH stim test yesterday after taking two weeks of Trilostane. They are going to up her dosage from 25 mg to 35mg twice a day (70mg /day) . I am about this bc she weighs 63 pounds. However... the 25 mg (50 /day) did show SOME improvements in her engergy and numbers but she still drinks quite a bit and legs still tremble.

THe vet said she wanted a number to be below 5..... The papers are in the car so Im not sure what number needs to be below 5.... I just got an I dea. Ill call the vet and have then fax to me the results of the acth stim test and post them!

[lulusmom]

THe vet said she wanted a number to be below 5..... The papers are in the car so Im not sure what number needs to be below 5.... I just got an I dea. Ill call the vet and have then fax to me the results of the acth stim test and post them!

That's a great idea!

[Eskimo'sMom]

results of Tuesdays ACTH stim test will be faxed shortly then I will post.

BTW... Eskimo has a new vet. Her specialist left and this new one told me she IS NOT a fan of compounding. She stated that in a test they took several compounding meds and with a high percentage, most came back with different mg of what was being stated was on package ex. 35mg came back at a higher or lower than 35mg.....This has me CONCERNED!

I called diamandback in AZ and asked them about this research and how they make sure this does not happen with them, and they stated they test their batches periodically to make sure it does not happen... however still concerned...

[Eskimo'sMom]

Eskimos 2nd ACTH Stim test since starting Trilostane ( two weeks later)
July 13, 2011

Cortisol sample 1 1.7 Reference range 1.0-5.0


Cortisol Sample 2 7.6 (Low)Reference Range 8.0-17.0 ug/dL


Now Please help me..... Eskimos vet wants to up her trilostane from 25mg twice a day to 35mg twice a day.... BUt If I am reading this correctly.... Looks like both samples are within normal range. Her vet stated that she wanted the number to be at 5!!!! Doesnt it seem that the 25mg twice a day is working? Eskimo still does shake a bit and still drinks a bit and food issues but I am more concerned that her Cortisol levels are good so no inside damage is done.

BTW..... Dilima..... Her vet has already called in the NEW prescription so I already paid for it.... I dont have it yet which means she did NOT take any meds today since her last 25mg pill ended last night. According to vet , she can to a few days without pill BUT if once I speak with vet and she agrees with me that the 25mg is working, then what?!


YIKES!

[StarDeb55]

The reference range you have posted on the post number is for a normal pup who is not under going treatment for Cushing's. Dechra states that an acceptable range is from 1.45-9.1, they would prefer an upper number of around 5. 9.1 is acceptable as long as the pup's clinical signs have resolved. From what you say, Eskimo's signs have not resolved yet, so it looks like a tweek upwards on her dose may be warranted.

Debbie

[addy]

She stated that in a test they took several compounding meds and with a high percentage, most came back with different mg of what was being stated was on package ex. 35mg came back at a higher or lower than 35mg.....This has me CONCERNED!

My IMS told me the same story. It seems there are only about 200 IMS nationwide so it is a small group and they all attend conferences together and "talk among themselves";);) When I heard it she told me it was 10 mgs but I think she just remembered that part wrong.:rolleyes: She also said keep in mind Dechra (manufactures of Vetoryl) did the test. It was six agencies they tested and Dechra did not name the compounding agencies. Our members seems to have had good experiences with Diamond Back in AZ. I did 10mgs Vetoryl and 5 mgs compounded from a compouding agency here in Milwaukee. Costs more but my Zoe has a weird tolerance to some drugs and colitis so I wanted to change things gradually.

Hugs,
Addy

[Eskimo'sMom]

OMG, Thank you so much Addy and Debbie!!!!!!!

I was awake all night wondering....WHY WOULD THIS IMS UP HER DOSAGE FROM 25MG TO 35MG WHEN THE NUMBERS CAME BACK LOW????!!!!! I thought about the HUGE jump Eskimo had from pre trilo (20)(second sample) back in January to 7.6 post trilo ( second)? and Eskimo weighs 63 pounds. 70mg seems too high. It all didnt make sense to me!!!

My Complex Thoughts Wandering all night:
I thought " Who is this IMS do I know more than her? Does she think I cannot read the results and come up with conclusions?" ( I asked them to fax results to me and is when I started analyizing the results and questioning ) " Why should I pay her when I keep catching her mistakes?" BUT THEN I was also thinking..." If all I have to do is test Eskimo with an ACTH Stim test and look at the numbers cant I recommend dosage? Why do I need an IMS for????" but then I was also thinking " Well she is the expert... I MUST be missing something... It cant be that easy... Can it?" Ha ha ha.... WOW! The worry we go on without pets!

Debbie, you are saying that even though her ACTH stim test number sample 2 came back at 7.6 ( LOW) that you CAN see why the vet would still want to up her dosage and agree with her?

Today I am supposed to get her new prescription of 35mg. I wasnt going to give it to her until I spoke with her vet ( mind you she hasnt taken anything since THurday night since I ran out that night but vet said she can go with out trilo for a few days). But after reading what you stated, which makes sense, I will give it to her.... But again.... Eskimo weighs 63 pounds and she will be taking 70mg / day. UGH this contradicts what Dechra states..

And Abby, did you go from compound to Vetyrol bc you heard about the same clinical testing that was presented to me???? What is you thought about compounding after hearing the study?

I look at it this way. I can only afford the compound so its that or nothing! And I called Diamond Back Pharmacy and asked them about this study. THe pharmasist stated that they get their batches tested periodically.
UPDATE:
< Just got a phone call during this typing session" Spoke with my IMS's intern.... She stated that bc Eskimo is not a" normal " dog and has Cushings, and she still has clinical signs of Cushings... We do need to up her dosage.. and a normal number for Eskimo who has Cushings would be 5!!!!> Ditto what you stated Debbie! ( WHEW!)>


Thanks for hearing me out!



..

[StarDeb55]

As a reminder from my earlier post, the normal range you posted which flagged Eskimo's post cortisol as low is not correct. That range is for a normal, healthy pup who doesn't have Cushing's. You need to look at the suggested range from Dechra. Since Eskimo is still symptomatic, this is why the IMS wants to up the dose.

When it comes to compounding pharmacies, I have used Diamondback for a number of years. I will say that I never had trilo compounded as both of my boys were treated with lysodren. Harley's lysodren was from Diamondback exclusively. They also prepare several prescription eye drops for me as the commercial eye drops are about 2 1/2 times the price of the compounded. I have never had a problem with them, & continue to use Diamondback to this day. None of my vets have a problem with them, & this includes my GP, a derm specialist, & eye specialist.

Debbie

[Rene]

Hi Teresa,

I am so sorry you were awake and are stressed. We have been keeping up on Eskimo's progress and send very warming thoughts toward his success.

You are not alone.

Love,
Rene & Snoopie

[addy]

Hi Teresa,

Zoe was already taking 10 mgs of Vetoryl. I added 5 mgs compounded to her current dose only because of her colitis, not because of the study.
I would have faith in Diamond Back. So many of our members use their drugs successfully.

As for the dose increase Dechra states that if the post is 5.4 to 9ug/dl continue on same dose if symptoms are controlled. If they are not controlled, increase the dose.

Dr.Peterson advises the following:


Vetoryl (Trilostane); Dr. Mark E. Peterson

Dose adjustments
The post-ACTH stimulated cortisol concentration is used to guide dose adjustments. This table
provides a useful protocol, but decisions are also influenced by the patient's clinical status,
physical examination and recent history.
POST-ACTH STIM CORTISOL DOSE ADJUSTMENT
< 2.0 μg/dl Stop VetorylR for at least 48 hours
Restart at 50% of previous dose when signs
of HAC recur
2.0-7.5 μg/dl Continue present dose
> 7.5 μg/dl No increase at first 10-14 day recheck . If
still high at 30 days or later, increase the
dose by 50-100%

He told me they have found that some dogs will continue to drift downward for the next 2 weeks and that I just wanted to check at 14 days that Zoe did not go to low.

Hopefully Glynda or Marianne will stop by and give their thoughts.

I have been slow with Zoe because of her colitis and history of drug sensitivity. This means I incur more ACTH tests which is hard on her and my pocketbook;);)

Hugs,
Addy

[Eskimo'sMom]

When I began Trilostane treatment about two weeks ago.... I was told I would need to do and ACTH Stm test 14,30, &90 days to check her levels....

So Far I have done the two week test July 12 ( two weeks and one day after I began treatment)

I have another ACTH Stim test set for August 2nd.... NOW mind you that this is not exactly 30 days later so I am perplexed about this. I was told by vet that the test is 30 days from treatment not from last ACTH stim test.... and I think.... I may change it to August 12 bc that really is 30 days later.... AND Eskimo is NOT on meds right now... She ran out on Thursday so she hasnt had any for three days. I was pretty sure her meds would have been in by yesterday, but nope! HOPEFULLY TOMORROW. According to dr., Eskimo can be off meds a few days with no negative effects.

[Eskimo'sMom]

and Addy, I hear you on the hard on the pocket book. Each ACTH Stim test is 275.00 where I live and if I want to speak to the specialist... another $66. But, it's what I have to do.

[lulusmom]

Hi Teresa,

We have seen a lot of dogs on Trilostane whose cortisol continued to drop on the same dose well into 30 days and sometimes longer after starting treatment. What we've seen definitely confirms what Dr. Peterson mentioned about cortisol continuing to drift downwards for 30 days so no dosing change should be done until the 30 day acth stim test. I personally would not feel comfortable increasing my dog's dose with a post stim of 7.6 ug/dl, even if s/he was symptomatic. If you go with the 35 mg twice daily dosing, keep a very close eye on Eskimo for signs that cortisol may be too low.

Treatment monitoring protocol calls for an acth stimulation test 14 days after starting treatment and 30 days after starting treatment. Sorry to be the bearer of bad news but every time you make a dosing change, you start over and do an acth stimulation test 14 days after starting the new dose, then 30 days, etc.

Glynda

[Eskimo'sMom]

Eskimo is currently on her third day of the new upper dosage of Trilostane (35mg twice a day).

All is going well, except she continues to lick her elbow and it looks raw. Now, I know I cant blame Cushings for everything, but I cant help wonder if it has to do with Cushings? It could be a Hot Spot that she NEVER got before until recently ( coincedently).

She still pants a lot but her drinking seems to have slowed down. I need to check out her legs to see if they still shake. This tends to happen when we take her out which we havent done in a while.

We will be going on vacation next week and Eskimo will be going with us. Last year I placed her in a pet hotel only bc we took a train and they wouldnt allow her on it, but this time we are driving so she can come with us.

[Eskimo'sMom]

Eskimo has had her third ACTH Stim Test. I cant help but feel that I am being treated like some type of moran due to all the questions that I ask her INTERN even though I AM PAYING A SPECIALIST TONS OF MONEY to treat Eskimo! I took Eskimo to see a SPECIALIST hospital to treat her Cushings vs keeping her at her regular vet. I am not happy with the service but second guess myself thinking that maybe this is the way all hospitals treat their patients! Ok , enough said. Off my soap box and on to what is important!

Eskimo weighs 60 pounds and she is on 35mg twice a day of compounded tri from Diamondback Pharmacy (70/day). Her third ACTH Stim test results came back yesterday with these readings:

Coritsol serial 2 ( ATCH)
Time 1 Pre 1
Time 2 Pre 2


Cortisol Sample 1 <0.7 ( LOW) Reference Range 1.0-5.0
Results verified
Cortisol Sample 2 2.4 (Low) Reference Range 8.0-17.0 ug/dL


I am alarmed at these numbers. I tried speaking with senior dr for Eskimo but got her intern. He said the numbers are GOOD! but bc he is an intern I cannot trust this to be accurate ( my hang up , I know) The numbers seem TO) LOW. He stated that Trilo came up with a new range. of 1.0 -9.0 for Cushings dog vs 5.0 as stated a month ago. Can someone help me with this? ALso Eskimo weighs 60 pounds which I asked Intern if we were over meding her since I was told she should get 1mg/pound. UGH, too many contradictions. All I want is for Eskimo to LIVE a good healthy long life.

I do have another call out to Senior Dr for Eskimo. I NEed to make sure she is doing well as stated by intern. I do not want her to get Addisons disease.

[Squirt's Mom]

Hi Teresa,

The normal ranges given are for a pup who does NOT have Cushing's. 8.0 -17.0 ug/dl is the normal range for a normal pup - not for a cush pup under treatment. The normal ranges change once treatment starts. The normal range for a Trilo pup is as your intern stated - up to 9.1, as long as signs are well controlled. Ideally, the post number will be around 5 and signs well controlled, but running a bit higher is ok for a Trilo pup who's signs are under control.

A post of 2.4 ug/dl is ok for a Trilo pup. How is Eskimo doing? Are her signs gone? Do you see any indications that the dose is too high and therefore her cortisol is too low? Any lethargy, vomiting, diarrhea, loss of appetite? If she is acting happy and not showing signs, I would say she is doing well. :)

I don't know how well I would handle not being able to talk with the doctor. We have been so lucky in our vets for the most part and I really feel for those who struggle with the very ones who are supposed to help.

Hope you enjoyed your vacation and that Eskimo had a good trip, too!

Hugs,
Leslie and the gang

[labblab]

Just to further expand on what Leslie has said above, you need to take a look at the link below in order to see what the desired post-ACTH range is for a dog being treated with trilostane. As Leslie says, it is different from the normal range that is given for a dog who does not have Cushing's. Please take a look at the ACTH monitoring chart in this Product Insert published by Dechra (manufacturer of brandname Vetoryl):

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

According to Dechra, you will see that the ideal post-ACTH range is between 1.45 and 5.4 ug/dl. So at 2.4 ug/dl, Eskimo falls right within that range, and no dosing change would be recommended at this time. As long as symptoms are being well-controlled, it is even OK for Cushpups to have post-ACTH results as high as 9.1 ug/dl without needing a dosing change. But if symptoms are remaining and the post-ACTH result falls between 5.4 and 9.1 ug/dl, then a dosing increase can be considered.

Having said all that, Eskimo's resting cortisol does seem low since it tested at less than 0.7. Normally it is the post-ACTH result that is used for making decisions about dosing, but I agree with you that I would want to confirm with the specialist that the resting cortisol level of less than 0.7 is really ideal. How is Eskimo acting? If she is looking and behaving well, then there may not be any concern. But if she is not acting very perky, it may be the case that she would benefit from being allowed to run a cortisol level that is a bit higher. So I do think that is a reasonable question to ask the specialist.

Marianne

[Cyn719]

Hi Teresa - I understand how you feel about the Addision Disease - my dog went into Addision Disease because her numbers dropped to low - .8 because my vet waited to long to do the stim test - but do not worry about that - right now the numbers are fine - just watch Eskimo closely - if she stops drinking - stops eating - doesnt want to get up - seems lethargic - then you know you have to stop the trilo - I assume you have the predisone for emergencies - this forum is great - I had no idea about any of this and one night Penny was sick and I came on they told me to stop meds and give the predisone -- I dont know what I would of done without them because my vet was no help at the time at all!!! It sound like she is doing good for now - I called and spoke to Dr Allen at Dechra and he really help me alot - I also spoke to Dr Peterson but he does charge 250 dollars a phone call and he helped but I cant do that again cause it was too expensive and I have to pay for all the testing and vet visits as you are also doing and its really alot - but I feel that Dr Allen helped just as much and his calls are free - you are doing a great job keeping on top of things!!:)

[Eskimo'sMom]

Eskimo's specialist and I are having issues! Each time I call to speak with her, she chooses not to speak with me. When I do get her on the phone, she tells me that I must speak with the intern. I read the hospital's Mission statement and she is not abiding by it. I have found many errors in the hospital that came highly recommeneded. 1. mistakes on Eskimo's medical records which contradicted what the dr said to me orally, ( record was eventually cleaned up once I told them about it) 2. I was told when I showed up for my second acth stim test appt that my appt was made in mistake ( I drove an hour to get to the appt) 3. I was given meds that had a year old expiration date on it for a skin infection ( manager told me that the meds were good and computer had given a default date), and was yelled and humiliated by one of the receptionst on the day I showed up for my "mistaken" appt.

I have been writring and speaking with the administration about these issues. But most importantly , I have been worried about Eskimo's health since the dr on Eskimo's case stated, to my surprise, that she and I did not have a good working relationship. Wow, news to me.As I told administrator, if this was the case I would not have LEFT ESKIMO IN HER CARE! Wow, how much more can I take from this recommended hosptital?!

New Plans: I am pulling Eskimo from this place. I am taking Eskimo back to her original vet. One who wanted to treat her cushings from the very beginning. She is NOT a specialist, but she told me from the beginning that she cares for many cushing dogs. Am I DOING THE RIGHT THING HERE? UGH, so many things to think about! But Eskimo is worth it.

It sounds like Eskimo , from what I read since my last post, is doing well. Her behavior is good even though her number (pre) was alarming. Thank you to all who posted and put my mind to rest.

I hear what you are saying about Vetoyl. But does this apply to compounding as well? My common sense tells me it does bc we're looking at trilostane not the med itself.

Another issue with this vet is that she stated that Eskimo's numbers are low bc she is on compounding meds and compounding pharmacies change mg dosages so that I could be getting a different dosage each time. I have called Diamond Back Pharmacy and asked them about this issue. Each time I speak with someone over there they REALLY seem like they know what they are doing and state that EACH batch is TESTED. I told this to Eskimos vet and she stated "Of course they would say that, what did you expect them to say?" I have to trust DiamondBack Pharmacy. They too come HIGHLY recommended and each time I have spoken with someone over there, I have gotten the BEST care and mind was put to ease.

BTW, Eskimo has scabs on her abdomen. Dr ( intern) gave her antibiotics for this saying it MIGHT be due to Cushings or could be flea bites or allergies.

Ok.... well here is where I am presently: Recap

Eskimos numbers, IMO, are low, but according to her vet and what I read here, she is doing well and her numbers are in the norm. Whew!

I am changing vets. Going back to her old vet who is not an internal specialist and a bit worried about it bc she is not a specialist.

Eskimo is still taking 35 mg twice a day ( 70mg) as prescribed by her internal specialist.

I am communicating with the administrator at the hospital about Eskimo's vet and her treatment towards me.

I REALLY appreciate this Forum! I do not know what I wouldve done if I had to handle this alone.

BTW
It is six in the morning, I am in my home office and in the distance I hear coyotees howling while Eskimo and my hubby are sleeping peacefully. Maybe I should focus on what is happening now rather than what I anticipate might happen. Once again, thank you all for your help. I love Eskimo so much as I know you do your own canine children. I just want her to live a long , happy, painless life.

Peace!

[Harley PoMMom]

Hi Teresa,

I truly believe that in order to treat a dog effectively and comfortably, the dog's owner and the vet/IMS have to be a team. They need to be able to communicate in an open manner. If a dog owner is uncomfortable with the treatment that the vet/IMS is providing and or if the vet/IMS does not regard your views with respect and consideration than one needs to find another that will.

Even though Eskimo is not displaying any signs of her cortisol dropping too low I would still keep an eye on her, we have seen dog's cortisol drop too low that were on the same dosage over a period of time. When is her next ACTH stim test scheduled?

If one is purchasing their Trilostane from a reputable compounding pharmacy such as Diamondback, I do believe that the dosage and strength can be trusted as correct. Now having said that, some dogs will do better on the brand-name Vetoryl because all dogs are different and can react differently.

We are here for you and will definitely help in any way we can.

Love and hugs,
Lori

[addy]

Hi Teresa,

Your specialist is probably referring to a lecture the Internal Medicine Specialists attended at one of their conferences. They were told that six different compounding pharmacies were tested and the tested compounded Trilostane came back in doses other than what they were supposed to be, some higher, some lower. They would not tell them which pharmacies were tested. At least that was the story I heard from our IMS. She has mentioned that it is also possible for a dog to absorb compounded trilostane better or worse than brand name depending on the compounding agents used. Zoe actually did better on a dose of part compounded and part name brand, so you just never know.

For what it is worth, in my opinion, run as fast you can away from that place. The fact that they deem you "difficult" when you are trying to be an advocate for Eskimo is not good, You don't need them.

I'm sorry you are having such a bad experience. We have been through quite a few vets prior to Cushings and if I thought it best, I would change again if I had to!!!!

Hang in there and watch your pup.

Hugs,
addy

[Eskimo'sMom]

Thank you for your support. Eskimos next ACTH stim was to be in December , 3 months after the September one. However, bc I raised concern the IMS 's intern said then maybe I should come in in two months rather than 3 months.

However, bc I am switiching doctors. I feel I may go visit new dr in two months.

What do you all think of Eskimo seeing a vet rather than a specialist?

This is the freightening thing for me. But I am justifying it as seeing that her new vet has stated she has treated many cushings dogs.

[addy]

Hi,

In my opinion you are better off with a vet, even a GP, you can communicate with and have him/her be part of a team. If the GP has experience, hey, go for it. There are members using GP's successfully. And there are Internal Medicine Specialists that are just plain awful.

Dr. Allen at Dechra is always available for advice and you have this forum as well.

If you have a good feeling about the GP, well, go for it!:D

Hugs,
addy

[Rene]

BTW
It is six in the morning, I am in my home office and in the distance I hear coyotees howling while Eskimo and my hubby are sleeping peacefully. Maybe I should focus on what is happening now rather than what I anticipate might happen. Once again, thank you all for your help. I love Eskimo so much as I know you do your own canine children. I just want her to live a long , happy, painless life.

Peace!

Teresa,

Very wise member's here said, "Shut the door" & "Close the glove box."

When I had my Snoopie I told my self I would not obsess and spend more time on the computer researching this awful disease than with her. When I would catch my self, I did just that. Shut the computer OFF.

I took her wabbit hunting, to the dog park, a car ride, walked around the pet food stores, even just a nap with sunggles when she was sick. Now that she is gone I am so glad I took the extra special time :o.

Next time, climb back in bed, make hubby a "Eskimo pie" let the coyotees lul you back to sleep. You will be glad you did. ;)

Enjoy,
Rene & Angel Snoopie

[Keiko's Mom]

Hi. I've been with my vet since 1971...Keiko is my third dog to be under his care. When she started having problems...we weren't sure what was happening and after a few tests...he sent us to an internal medicine/cancer vet. She was very nice to begin with....did ultrasound, checked sugar, read x-rays, ruled out cancer and decided that we were going to treat with Lysodren. We did alot of research and decided that we wanted to use Vetoryl. She became snotty and told us why she knew better. It wasn't going to be a good relationship....we went right back to our regular vet. He only has one other dog with Cushings. We keep researching, read this forum, call Dr. Allen at Dechra and we are in good hands. The Dechra company wants the vets to call them, too. Our vet has spoke to them. Go with your head and heart. You know when someone doesn't do their job or business with your best interest.

[Cyn719]

Teresa - I agree with Keikos mom - call Dr Allen and discuss this with him - I also did - he is wonderful -- he really helped me alot and Penny right now is doing good -- get some input from him and then maybe your own vet can also call him - its a free call it cannot hurt:)

[Eskimo'sMom]

Update,

Eskimo is still on 70mg of trilo / day. I am looking for a GOOD GP to care for her. One came recommended but she is on vacation. When I looked up the Hospital she worked for, I read bad review ( on Yelp), but I am going to check it out anyway. BC this particular doctor came HIGHLY recommended.

[addy]

I hope you have good luck with the new vet :)

HUGS,
Addy

[Cyn719]

Wishing your good luck - I know its hard to find the right vet

[Eskimo'sMom]

Eskimo has a new General dr who is EXCELLENt and a new specialist. Eskimo went for another acth stim test on tuesday and blood panal to make sure she was doing well on her meds. Her numbers came back very good. I will post them as soon as I get them. She will remain on 35mg twice a day of trilostane.

It was discovered t hat she has a heart murmur. They did an xray to make sure she does not have heart failure. SHE DOESNT! whew.

All is good with her. I am slightly concerned bc we ordered her new meds on tuesday and havent gotten them yet. She will go two days without meds. Today and Sunday. Her old specialist at one time said a few days without meds should be okay. But I am noticing that she is DRINKING alot of water today. Today she did not get her dose in the morning of evening and will not get them tomorrow. I hope her meds show up on Monday.

[Eskimo'sMom]

Eskimo had a complete blood panal a few days before THanksgiving and a new ACTH stim test bc the pre cortisal number was low.

Her test results came back, and she is doing well. :D

all of her numbers look good and she is on the correct mg of trilostane.

[Squirt's Mom]

Hi Teresa,

Sounds like things are going well in your world! That is good news! I know you are relieved.

Thanks for the update...especially a good one! :D

Hugs,
Leslie and the gang

[lulusmom]

You must feel pretty darn good about getting such good news. I love updates like yours.

Can you get a copy of the acth stim test and post the results here? It's always nice to have those numbers for future reference.

Happy weekend!

Glynda

[Cyn719]

Teresa - so happy for you that things are going well!!!!!!!! :) Nice to get good news!!!!!! Hugssss to you and Eskimo xo