Dad of Lulu - sweet Lulu has crossed The Bridge

[LabDad]

Greetings,

Lulu has posted her picture, it says it failed, however I see it in my User CP settings.

Anyway, Lulu is a 10 1/2 year old yellow Labrador. She has enjoyed a great life in the country, on 20 acres in farming country close to Port Huron, Michigan. She came to us with a red color, (still have it saved) and she was about 4 to 6 months old, early Nov. 2000. She has been a smart, head strong and lovable lady.

She was diagnosed with Cushing's Disease in Nov.-Dec. 2010. She had tests and them was put on Lysodren for about a week. She became weak and did get a bit sick during the treatment. It was stopped about a week into the treatment, after testing showed she was possibly going to go into Addison's Disease. So for about 4 months now she has been off any medicine's for the disease. She has been doing fairly well, and we want to take her in for a recheck. And it is costly, about $200, and we are waiting for the money to come in to do this. We aren't rich. Her dad (me) programs computers and designs websites. But it has been rough for us, as it has been for many. We do plan on a test, and we also have been thinking of a second opinion on her treatment, and that I will explain in future posts. We don't doubt that she has had some Cushing's Disease. But our present Vet's office had a turnover, with veterinarians, ours retired in November, and then the Vet that took over in December, relocated to Wisconsin, leaving us with yet a third vet. We became a bit worrisome that perhaps a more experienced veterinarian, with knowledge of endocrine disorders might be warranted. And I believe I may have found a good alternative.

Anyway, another problem Lulu has had is she has suddenly become nervous when we have night time thunderstorms. I have had to give her a tranquilizer supplied by a veterinarian, which works in about 40 minutes, but then she is a bit of a zombie for the next 12 hours. Warren Eckstein , who has a radio show for pets, and a guest on national tv shows, sent me a bottle of Calm Down to try. I did, and it seemed to have an immediate affect, though it didn't last. Warren also suggested downloading thunderstorm sounds, and also smoke alarm sounds, which Lulu doesn't take a liking too either.

Lulu, is gifted in a way. I think she senses our fears and she often mimics us. In fact she is my blackberry picking companion, who started picking berries some 9 years ago when she first saw me pick them. She of course eats them her self. LOL.

Anyway, let me stop here. I have given Lulu's intro, and I will be on here more to learn more about Cushing's Disease. At the present Lulu seems to have a mild case, where as last December, she had some aggressive symptoms, including a very strong desire to eat, almost a demand. That is less prevalent at the moment.

[Harley PoMMom]

Hi and welcome!

So glad you decided to join our Cushing's family but I am so sorry that circumstances prevail that you need to be here. We will help you and Lulu in any way we can.

The best way for us to help you help Lulu is to tell us more information about Lulu and her Cushing's treatment. You see, the more information we know the more meaningful our feedback will be, ok? ;):)

So I guess the 20 questions will start with me! :eek::)

What symptoms led you or your vet to test Lulu for Cushing's in the first place? What test/s were done on Lulu to confirm her Cushing diagnosis? If an ACTH test was done, could you post the results here. What loading dose of Lysodren was Lulu on? Is Lulu taking any other herbs/supplements/medicines? Has Lulu's electrolytes been checked? The electrolytes are usually found on a Chemistry blood panel and include her Potassium, Sodium, Chloride, Calcium, and Phosphorus. Was there any thing marked abnormal on her Chemistry/CBC blood panel? If so, could you post these abnormalities with the normal references ranges.

As far as the thunderstorm phobia, my boy, Harley, used to be the same way until he started taking melatonin every day. He was taking 3mg of melatonin twice a day and this seemed to cure him of being scared of thunderstorms. The melatonin has to be the regular kind not the fast-reacting or time-released variety but please seek the advice of your vet before adding any supplement/herb to her diet.

Please ask all the questions you want and we will try our very best to answer them. Looking forward to hearing more about sweet Lulu.

Love and hugs,
Lori

[Squirt's Mom]

Hi Dad and welcome to you and Lulu! :)

She is a beauty! Your story of finding her with that collar on reminded me of how our Ruby was found - running down a gravel road with a length of rope tied to her skrawny neck. :( That was the day her luck changed forever and she was loved every minute of every day for the rest of her life. I think she, too, was gifted in a way - or maybe it's just that she was so grateful.

Lori has covered our 20 Questions so I will simply say that I am glad you found us and look forward to learning more as time passes.

You and Lulu are no longer alone - we will be with you every step of the way. Don't hesitate to ask any questions you may have and we will do our best to help you understand.

Hugs,
Leslie and the gang

[littleone1]

Corky and I also want to welcome you and Lulu.

You have found a wonderful group of very caring, supportive, and knowledgeable people.

Corky is also afraid of thunderstorms. I use to give him Acepromazine, but I no longer give him that because of his cushings. I also give him Melatonin, and I use T-Touches on him which really help to calm him down. This was recommended to me by one our members.

Terri

[addy]

Welcome !

Glad you found us. My Zoe is also afraid of thunderstorms. Originally, I took her to a holistic vet who practiced Chinese Medicine. She put Zoe on "Shen Calmer". It did help her. Currently, she is on melatonin for her Cushings and it has the added benefit of helping her fear of thunderstorms. She is much better about them.

We are here for you. I am so glad Lulu has you for a dad:)

Hugs,
Addy

[LabDad]

Thanks Lori,

Will have more info, and thanks on melatonin. And the drug I have used acepromazine Terri. I cut the pill in half, usually. But I wasn't told you couldn't use it with Cushings. I try to use sparingly. Last night I tried something different and it worked last night, and I had a bright eyed lab this morning. More on this later, and the lab results from the tests Lulu has had to come.

[LabDad]

Will pull out Lulu’s chart. First, on the Melatonin, that interests us. My wife has some peppermint flavored sublingual melatonin, 2.5 mg tablets. I suppose we could use these pills?

Now on the diagnosis and treatment for Lulu.

Lulu went to see the vet in November for her yearly shots, and we went to see Dr. Vnycke, our vet of 20 plus years. But he retired. We then were referred to Dr. Sarao, one of the two doctors that had taken over. I mentioned that Lulu was a big drinker of water. That was a symptom of Cushing’s disease. And perhaps the things Lulu was doing, such as a ravenous appetite and panting at night. We often on warmer days, would have to increase the ceiling fan, or put a fan blowing at her in the window sill, and of course use more air conditioning at times, to keep her comfortable at night in the summer. This had been a bit of a problem for a couple of years, along with the times when she just couldn’t get enough water to drink.

There was a lab test that was done which __________??? She also had one of her liver enzymes elevated. I think this is a side effect of the disease. It escapes me now which one, and if I find the info, will post. The vet got the records from and it was elevated. So this led the doctor to believe Lulu might have Cushing’s Disease.


Test results: Jan 4, 2011

Dex Suppression (3 Samples) – 8 hour test

Cortisol Pre 6.0 micro grams/dl
Cortisol 2 1.0 micro grams/dl
Cortisol 3 3.8 micro grams/dl

Interpretation of ACTH Stimulation Test:

If the 8 hour post dex. Cortisol level is greater than 1.4 micro grams/dl than a differential test can be used to differentitate. Our vet prescribed two 500 mg Lysodren tablets in the morning and two 500 mg Lysodren tablets in the evening. We gave Lulu this dosage for 8 days, having started on Jan 6 or Jan 7.

Now on Jan 14 Lulu had 4 hour ACTH Stimulation Test. I believe the results for the post should be in the 1- 5 mg/dl range.

Lulu’s results:
Pre 0.7 mg/dl
Post 1.0 mg/dl

This meant that Lulu should be taken off the Lysodren, which she was. The doctor was concerned that she the disease may have gone into Addison’s Disease.

On Feb. 17, 2011 Lulu was retested with the 4 hour ACTH Stimulation Test. I believe I had Lulu back before the 4 hours were up. When I took Lulu in, I found out Dr. Sarao had left and went to one of the new clinic owner’s other clinics in Wisconsin. Lulu was seen at their Port Huron clinic.

So another vet.

Pre 2.6 mg/dl
Post 4.4 mg/dl

The vet said Lulu appeared to have normal results. So no further medication necessary. She said Lulu should have the test repeated in about 4 months.

Lulu at the time in February was having trouble with her back legs, which I hear can be a problem both with Cushing’s and Addison’s disease which fully confused us. Lulu was also shedding a lot at the time. We would brush her often with much fur coming off.

Now in May 2011, Lulu is not shedding as much, her legs are stronger. She still drinks plenty, though her drinking is not as pronounced. This is a condition that seems to change and there are times she is drinking more.

Lulu’s weight is probably just under 90 lbs. It was 85-88 lbs last time weighed. She has trimmed a bit from February, though she could probably lose about 3 or 4 pounds. She isn’t as pear shaped as she was in January and February.

She continues to have a fair amount of energy, especially for a 10 ½ year old large dog. I have been able to walk her 1 to 2 miles at times, though I try not to overdo. The warmer weather is a bit harder on labs anyway.

Well that is all for now. I do want to try her on melatonin to see if this helps her with the thunderstorms. You see I have noticed it is not just the thunder lately, but if she starts to see lightening in the distant she senses a coming storm and will start to get anxious.

And the trick that worked a couple nights ago, because I didn’t want to have to give her apromazine two nights in a row. I brought up her old cage I used when she was a pup. It is still roomy enough for her and laid a bed in there and put her in the bedroom next to ours with a night light. One of our cats kept her company, and though she didn’t sleep much the rest of the evening, she lied in the cage fairly calm and she wasn’t in a stupor in the morning but alert.


Below are things I said on another forum that I belong to on dieting.


(Jan. 3, 2011) “I'm taking Lulu in to the vet this morning at 8 am (now 7am) for a Cushing's Disease test. It's a low dose (Dexamethasone) Suprression Test, I believe it is. they take I believe 3 blood samples in an 8 hour period, so we will pick her up after 4 pm.”

(Jan. 13, 2011 ) ” Lulu is doing well also, she goes in for her two hour ACTH test tomorrow morning and then I assume her dosage will drop from 4 tablets a day to something like 4 or so a week. It has to be monitored to keep the dosage right, but so far so good.”

(Jan. 17, 2011) ” Lulu is 10 and she is doing well now that she off the 'induction load' of Lysodren. She will start a much lower maintenance dose when the Vet Dr. tells me to start. She has what we think is kennel cough, which in hindsight we should have got the nasal spray for her before she started treatment.”

(Jan. 20, 2011) “Lulu is hanging in there. Her kennel cough has subsided and her appetite is down, but she is eating. We are not giving any medicine for her now, but will wait for a retest Feb. 16. I take her on walks but I don't try to push her, and she still brings toys to us. But she is a bit more playful.

The thing to watch now is to see if the Cushing's becomes Addison's. I hope not. There is controversy on which is better. I think I would prefer Cushings over Addison's. The treatment is different too, with Addison it is primarily steroids such as prednisone. I would imagine if prednisone is used that the minimum needed would be used.”

(Jan. 21, 2011) “Update on Lulu,

She had a burst of energy this morning, demanding play time from me, and grabbing her bone. She went out to get the paper with me and took a stuffed pig outside. I brought her in through the basement as I was getting ready to talk to a client on the phone. She went toward the first floor of the house, the independent dog that she is. But she wanted to grab her stuffed pig, (she got in Wisconsin in 2003) and met me a the basement door. It sure feels good to have her feeling better. She isn't out of the woods yet, but this was a step forward.”

(Jan. 24, 2011) “Lulu has been improving but it's not a straight line, but rather one with some dips. She has had a bit of a problem with steps, so we encourage her to stay on the main floor during the day and when I'm in the basement she can go outside and go down the hill to the basement door.”

(Jan. 26, 2011) “Lulu has done quite well last night and this morning. She seems almost normal. But she has a ways to go. The disease Cushing's and what it could become Addison's, which is the opposite. She seems to be not having much Addison's if she has any, and that could be temporary.”

(Jan. 27, 2011) “Lulu's legs are still a bit weak, but improving. If we can keep her weight down then that will help. We also are looking into the lactose supplements, plus increasing her glucosamine. She and I both take the human pills, and I have the percentages she needs, but they are a bit different then hers, but I don't think that critical, just have to get the right dose. The important thing is to get the Cushing's Disease under control and keep her trim.”

(Jan. 31, 2011) “I ordered one bottle of Glucosamine, 150 chewables, will be here Wed, though because of snow I am thinking it will be on Thur. Then I can switch Lulu off the human (mine) and on her own, which has the more correct ratios of the three important ingredients. (also Chondroitin and MSM)”

Also, note Lulu is bionic, she had both back legs operated on for ACL surgery in 2005-2006 and made a startling and very successful recovery.

(Feb. 7, 2011) “Lulu is doing okay. She got hot last night and we put the ceiling fan on higher. That is a symptom of Cushing's, not sure that did it, but she occasionally does get a bit restless once in a while. She has been fine this morning. I still want to contact the Vet this week to confirm up her text next week.”

[lulusmom]

Hi Lulu's Dad and welcome to the forum.

Was February 17 the last acth stimulation test that was done? I ask because there was a marked increase in Lulu's cortisol levels from Jan 14 to Feb 17 which means the adrenals are regenerating. At that time your vet said that levels were normal and no further medication is needed, which is confusing. The goal of treatment is to maintain post stimulated cortisol levels within the therapeutic range of 1 - 5 ug/dl and Lulu was in the high end of that range in February. Unless your vet put her on a maintenance dose of Lysodren at that time or shortly thereafter, I suspect that her cortisol levels are markedly higher now and it will be a matter of time before you start to see Lulu's symptoms return. Did your vet tell you any of this? If not, I think you may be right about seeing a specialist.

I'll be waiting to hear more about your Lulu.

Glynda (Lulu's Mom)

[LabDad]

Lulu's mom,

Yes, I have been confused by all this. I am trying to see if a vet clinic a bit closer to us, has a veterinarian that has experience with Endrocrine disorders, especially Cushings Disease. This office is a satellite office, Wilson's Veterinary Clinic, whose main office Lulu has been to, for her ACL surgery. They have lots of vets and have been reasonably priced. We have a different veterinarian for our cats, but he is farther away, and very busy. There is a lady veterinarian at the Yale, Michigan Wilson clinic that I hear is very good.

I am hoping that we can get some good care for Lulu. I don't know the cost, but we were very pleased with the quality of care with Wilson's Main Clinic and the price was very reasonable, even cheaper than our Port Huron vet had been.

The turnover at the Port Huron office was unfortunate. The doctor that had taken our vet's place, seemed to have some knowledge of Cushing's and she was in touch with an endocrinologist. She is an East Indian doctor, but was having a problem culturally in our area, which doesn't speak well of our area. She didn't feel at home here, and moved to Wisconsin to one of the owners other clinics. I do here from her on Facebook and have told her that Lulu has been doing fairly well.

The last couple of days I have seen Lulu a bit more sleepy during the day, but it has been a rainy week and weekend. She is still pretty playful for a 10 year old lab. I just want her to have a good chance at a healthy retirement age.

I do programming and website design and people can see some of the work I do as I have added them to my signature. The Soldier website is one I started thinking I might do a book on but presently decided to just put up on the Internet. I haven't had a chance to work on it lately, since I have to work on paying sites to support myself, and that is my challenge.

I have a source of funding for some of Lulu's expenses, otherwise I would probably not be able to afford the tests and pills. But I do want to take Lulu to someone that can reassure me that they will put in the effort to help her. She's a great dog. Wilsons' Veterinary Clinics told me that a consultation would be about $30, so that doesn't sound to bad a price.:)

[LabDad]

We see our second opinion vet Tuesday night. He is Dr. Wilson of Wilson Veterinary Clinic, the owner and the doctor that did Lulu's ACL very successful surgery on Lulu's back legs in 2005. I don't think he is an endrocrine expert, but he has a staff of some 15 to 30 (approx) doctors in at least 4 locations, one of which is 10 miles from us. I hear all good (well one sourpuss didn't like them - such is life:mad:).

Also, I have heard from you all about melatonin. We have some subliminal my wife has, would that be okay to give Lulu? :cool:

[Harley PoMMom]

Will pull out Lulu’s chart. First, on the Melatonin, that interests us. My wife has some peppermint flavored sublingual melatonin, 2.5 mg tablets. I suppose we could use these pills?



I googled the peppermint flavored sublingual melatonin and seen that this is a time-released product.

What has been recommended is the regular melatonin, not a fast-reacting or time-released product.

Love and hugs,
Lori

[addy]

Hi,

If you have a Walgreens near by, they carry Nature's Bounty melatonin, plain melatonin and it is not expensive. Sometimes they have buy one get one free.

Hugs,
Addy

[LabDad]

Thanks Addy,

Will look next time I'm there.

[Harley PoMMom]

When I was giving my boy, Harley, melatonin I purchased it at The Vitamin Shoppe. One can purchase this product on-line, here is a link in-case you are interested: http://www.vitaminshoppe.com/store/en/browse/sku_detail.jsp?id=VS-1336

Love and hugs,
Lori

[LabDad]

Thanks Lori.

[LabDad]

As I said Lulu's other vet, left Michigan and joined a satellite office in Wisconsin. She wrote me when I mentioned a second opinion:

"Good to hear back from you. I have seen lots of Cushing's disease dogs and its very common for them to become Addisonian after the Lysodren treatment and that's what happened with Lulu. I think if Lulu is not drinking excessively or urinating excessively then I would not worry about it but if she is drinking and urinating a lot then I would do ACTH Stimulation test for her. Dr. Barr always talks to the endocrinologist specialist for these kind of cases. I mean its your choice if you want to go to Dr. Wilson but I would say even if you talk to Dr. Barr regarding the ACTH stimulation test she will be able to do that test and accordingly decide whether Lulu needs Lysodren or not. Also whether she is still Addisonian or Cushing's is coming back or she is normal. ACTH Stimulation test is the only test for that."

[LabDad]

Well I have printed up the lab tests for our vet visit this evening for a second opinion.

I also added the notes from Lulu's doctor that left to go to Wisconsin before the last test was done on Lulu Feb. 17, 2011. She seemed to believe that Lulu's Cushing Disease had become Addison's Disease. She said that the veterinarian that we have now has been in contact with an endocrinologist, and I think maybe she felt it wasn't necessary for us to seek another opinion, although she respects our decision.

My feelings are I will listen to Dr. Wilson in Romeo, Michigan, he did excellent ACL surgery on Lulu in 2005 & 2006 and is the owner of the very successful Wilson Veterinary Clinic with it's four other satellite offices. They not only are good and have 24 hour care, they are very reasonable and do not usually charge the 'upscale' prices though I consider their facility to be very modern, clean and friendly even on a Sunday afternoon.

I will ask Dr. Wilson about the melatonin and may also get another dose of flea and tick spot, (Frontline probably) as we have had a very bad spring with ticks this year, worst ever! :(

:)

[Harley PoMMom]

Addison's disease comes in three forms: primary, secondary and atypical.

With primary Addison's disease, the dog's adrenal glands fail to produce enough of steroids called glucocorticoids (cortisol) and mineralocorticoids (aldosterone).
Mineralocorticoids maintain the body's potassium and sodium balance. Glucocorticoids aid in regulating a dog's blood pressure, stimulate the metabolism and help maintaining a calm state.

The secondary and atypical forms of canine Addison's disease finds the dog's adrenal glands producing adequate levels of aldosterone, but not enough cortisol.

Have Lulu's electrolytes been checked recently?

Love and hugs,
Lori

[LabDad]

Thansk Lori,

Not only did we do the right thing having Dr. Wilson see Lulu, we discovered he is very knowledgeable about the disease. He told me to look up Trilostane on the Internet, which I will do. He had used Lysodren in the past. He said Trilostane is expensive, but they have used a version of a generic, he said it was compounded or broken down, not exactly sure what he meant, except that cheaper generic type drugs I believe in 'most of the time'.

I have scheduled Lulu for next Tuesday morning for a one hour ACTH test. I also will bring in a urine sample, however I just remembered I forgot to get the container from them. So I will probably use a butter dish that I have cleaned out, I'm sure that will be okay.

And yes, electrolytes Dr Wilson said should be checked. He doesn't believe she is in Addison's state. We agreed that it is worth the extra 10 miles to have Dr. Wilson see her than one of his closer Vet Clinics vets. I think he feels that Lulu is doing fairly well and was happy that I have been able to find ways to calm her during storms, such as putting her in her cage for example.

Also, the ACTH test will be one-half the cost as our Port Huron Vet office was charging, and they had taken a hundred off the cost as it was. So we are very happy about this, and we wonder about the prices that are charged sometimes?

Dr. Wilson said 3mg of melatonin twice a day is okay. We picked up two for the price of one at Rite-Aid today, that is 250 pills times 2 or 500 pills for 13 dollars.

Lulu and I (hey I want to see if it helps me sleep) will take a melatonin tablet tonight.

:)

[Harley PoMMom]

Our Resource Thread has a lot of information about Trilostane/Vetoryl.

Here is a link to that info:Trilostane/Vetoryl Information and Resources. (http://www.k9cushings.com/forum/showthread.php?t=185)

Love and hugs,
Lori

[LabDad]

Thanks Lori, I will look at. I see they talk about the compounded product. Sow we can discuss this with Dr. Wilson, if it turns out that she needs to be on the drug.

As I write this our Lulu meant her young girlfriend from the farmer next door, a 1 1/2 year old female Jack Russell Terrier. It makes me wish that we had a small friend of our own for her. :)

[LabDad]

Well Lulu had a long day. Actually she was at the vet for 2 hours. She had her ACTH test and hopefully tomorrow or Thursday I should know the results.

She had a urine test, specific gravity. Dr. Wilson said the concentration of urine was not indicative of Cushings Disease, but will await the ACTH test.

Lulu's Na is 159.0 mmol/L (normal 144-160)
------ K is 5.0 mmol/L (normal 3.5-5.8)
------ Cl 118.0 (normal 109-122)

Lulu was glad to get back to me and we had a walk in the field by Wilson Clinic where the fasting Lab had a late breakfast of a plain McDonalds cheeseburger. :cool:

[LabDad]

Let me post the great :) news on Lulu's lab results here, then I have to paste them on two other sites, seems Lulu has quite a following!

Dr. Wilson called and talked to me about half an hour ago, he's an evening person. Lulu's pre-ACTH result was 3.3 ug/dl (normal 2-6 ug/dl) and her post-ACTH was 9.5 ug/dl (normal 6-18 ug/dl)

Dr. Wilson said that Lulu may have had Cushing's earlier, and the Lysodren decreased the adrenal glands function. That could come back and he said to repeat the test in 90 days. If Lulu relapses into Cushing then Trilostane should be given.

I have decreased Lulu's melatonin to just at night, but that could change if the weather gets stormy. The funny thing about storms, I was sitting on the front porch watching the lightening the other day, just before sunset, and Lulu was lying on the driveway and not bothered. She hears well and when we turn on our new tv, (lcd) we notice that she is hearing the initial turn on, which we don't hear, it kind of startles her. She also tries to moisten her mouth with her tongue often. She has done this for about a couple of years now, as her throat is dry maybe.

Anyway, I see by the new posts that seems like 10 years of age seems to be the entrance exam for Cushing's Disease.

[LabDad]

Just wanted to update on Lulu, almost a month later from her ACTH test. This is what I posted on my diet forum.

You know Lulu is doing fairly well with the disease in remission. But I think that it may come back again. But who knows. Cushing's Disease is a baffling one to treat, but fortuntately there are forums for it. The warm weather is harder on labs whether they are young or old, hence their name Labrador. Lulu was shedding back in January and February, so I think her fur is a bit thinner, and maybe that is good for summer. Part's of her fur is curly. She does take her tongue and act like she has a dry mouth. And she has done this for well over two years. But that is probably part of the disease and why they often drink more. Right now her drinking is fairly normal.

Lulu, seems a bit more subdued, not as playful at times and maybe a bit more laid back. She is 11 and I do give her a melatonin in the evening. I haven't given her one in the morning because of this laid backness. Though we are expecting some storms the next couple of days, so I may give her the morning dose. Many on the Cushing's Forum have mentioned this helps. http://www.k9cushings.com/forum/

Then Lulu is usually playful every day, but moves a bit slower now that the weather is warmer. She is more frisky on cool days. :)

[frijole]

Another good reason to give melatonin this time of year is the 4th of July! Scares my poor girl to death. So a bit of melatonin helps both with storms and fireworks. Glad Lulu is doing well. You are doing a great job! Kim

[LabDad]

Yes as I write we are having a bit of a light storm. I have my-cast radar open in the basement using my laptop on battery power. The storm is supposed to end in less than half hour. Lulu is doing okay, playing music on my desktop computer while the thunder roars in the distant. It is soothing us both not to have to pay attention to the storm. :)

[lulusmom]

Lulu's cortisol has consistently risen since January and according to the post stim numbers, I wouldn't say she is in remission. Her adrenal glands are regenerating and it is just a matter of time before she becomes symptomatic again. When I switched my little Lulu from Trilostane to Lysodren, she did not become symptomatic again until her post cortisol was 25 ug/dl and it took weeks and weeks for it to get that high again. It was nice having the time off during the washout period.

Please keep us posted.

Glynda

[LabDad]

Our second opinion vet, who did remarkable ACL surgery on Lulu 5 years ago wants to use Trilostane instead of Lysodren. He said he used to use Lysodren, but he and I and my wife seemed to think that Lysodren is a scary drug to use. But other vets use it, so I guess it's a matter of opinion.

Yes, I am enjoying Lulu's temporary remission. Maybe it will last a while. The vet wants her checked in 90 days, about two months from now.

[Squirt's Mom]

Cush pups drink a lot because the cortisol makes them pee a lot. Just as it stimulates the appetite to a frenzy, it stimulates the kidneys to function over-time. So cush pups drink to stay hydrated because the amount of fluids they lose via urination will quickly lead to problems if they don't.

If your vet is of the persuasion that Trilo is "safer", please know that is absolutely incorrect. It is just as dangerous and has the potential to cause all of the "scary" things that Lysodren does - from mild to fatal. Please don't be mislead if your vet tells you it is a safe alternative to Lsyo. ;) The safety of either med is directly related to a correct diagnosis, proper administration and monitoring by the vet, and diligence and knowledge on the part of the parents. Both are extremely powerful drugs, both are life-savers.

I hope the break you and Lulu are experiencing will continue for a long time!

Hugs,
Leslie and the gang

[LabDad]

I guess the fact that Lysodren destroys adrenal gland tissue and is a strong cancer therapy drug, makes it scarier. There are shortfalls to any drug. And I'm sure better drugs will be around in 5 years, usually they are. Dr. Wilson said to research Tristolane on the Internet. And it can be more expensive, but he has had good luck with compounded (generics) though there will always be those that say to stay away. He has a lot of experience with this disease, which I wasn't aware of, because he is such a darn good surgeon, I didn't know you could both be a 'pitcher and a home run hitter' in the same person.

Anyway, the disadvantages ot Tristolane are of course more frequent dosing, and other things. It really is a judgment call, but I think the trend has been to going to less toxic drugs in the future.

I used to be a medical technologist in my past, so very familiar with drug dosages and interactions in the blood. I haven't been in that line of work for over 20 years, doing computer programming, though some of it in the new EMR field. I have to do the research on the drugs just as I did as a medical technologist.

Yes, Lulu seems to be doing better, though more laid back, which may be a result of the melatonin. I still have her on just evenings at 3 mg. Maybe a bit less I will try in the future when there is a long trend of fair weather.

And it isn't the storms themselves that bother Lulu, it's where she is at and possibly when the storm hits. She was in front of our garage on the concrete when a storm was approaching, with some lightening, thunder and wind, and she was as content as could be.

But you send out a tone in the frequency of a smoke alarm and it upsets her. I think I will take Warren Eckstein's (renownded animal expert from television) advice and download some audio of storms, wind and smoke alarm high pitched tones and put them on a cd, and play them at an increasing volume while massaging her. Can't hurt.

[labblab]

Dr. Wilson said to research Tristolane on the Internet. And it can be more expensive, but he has had good luck with compounded (generics) though there will always be those that say to stay away. He has a lot of experience with this disease, which I wasn't aware of, because he is such a darn good surgeon, I didn't know you could both be a 'pitcher and a home run hitter' in the same person.
I am afraid that it may seem as though I am harping about a "small" point :o, but I just wanted to clarify for you that compounded drugs are not the same thing as generics. I just posted another reply about compounded drugs on another thread this morning, and so I wanted to offer this additional info to you, as well.

In the U.S., both brandname and generic meds are made by pharmaceutical companies according to FDA guidelines and regulations. Generic equivalents are not permitted until the original patent has expired on the brandname drug. Dechra still holds an active patent on Vetoryl, so no generics are being made at this time.

Compounded versions of trilostane are prepared by individual pharmacies based upon the prescription needs of each specific dog. Depending upon the manner in which the vet writes the Rx, the compounded version may or may not use brandname Vetoryl as the effective ingredient. As is the case with your Dr. Wilson, there are many vets who feel very comfortable with prescribing compounded versions of the drug, and we have many members here who are using them with great success. But I do think it is important for people to know that there is a difference between a generic drug and a compounded drug. Here's a related quote from the American Veterinary Medical Association:

"Veterinary Compounding" Brochure (http://www.avma.org/issues/drugs/compounding/veterinary_compounding_brochure.asp)


Compounded drugs are not the same as generic drugs. Generic drugs are FDA-approved. To receive FDA approval, generic drugs must demonstrate bioequivalence to the "pioneer brand name" drug. Generic drugs can be identified by the ANADA number on their label and by cross-checking with a drug reference, e.g. the FDA Green Book of Approved Animal Drug Products. In contrast, compounded drugs are extemporaneously prepared products that lack FDA approval. The concept is that compounded drugs with their possible flaws are better than no drug at all and suitable for a small patient population.

Marianne

[LabDad]

As is the case with your Dr. Wilson, there are many vets who feel very comfortable with prescribing compounded versions of the drug, and we have many members here who are using them with great success. But I do think it is important for people to know that there is a difference between a generic drug and a compounded drug. Here's a related quote from the American Veterinary Medical Association:

"Veterinary Compounding" Brochure (http://www.avma.org/issues/drugs/compounding/veterinary_compounding_brochure.asp)



Marianne

Noted, it was just easier to relate to a generic. Living close to a border town, Port Huron and it's Canadian neighbor across St. Clair River at the mouth of Lake Huron, we used to get drugs in person, rather than trust the stuff on the Internet. I am cautious where we buy the things we need as far as medicines, dog treats, etc.

A bargain isn't a bargain if you buy generic bleach 15% water and Clorox is 10% water. I've seen it.

[LabDad]

July 2011 Update.

Lulu is doing well. She will be due an ACTH test the end of August, or sooner. I do notice at times a bit more appetite, but not as much as when she was in flow blown disease last Dec-Jan.

Her fur is curlier, and though I like the rich brown color she has, she is still beautiful. She of course is showing her senior with white around the eyes. She still has lots of energy. But she doesn't like this week of 90° +. Thank goodness we live in the upper Midwest, Michigan which usually gets refreshing cooler days even in summer.

Lulu is drinking an average amount of water, though she does drink it. I don't think she is drinking more than 2 to 3 liters a day. I will be very interested in her serum values on her next test.

She does have a large fatty tumor which seems to go down in size when she is a bit thinner. I am going to switch her dry food to one of the lower calorie foods and try to substitute some carrots for treats in her treat toy, which is a green three lobed rubber toy you squeeze a treat in, she loves it, and it makes her work for the treat.

We are going to get the thunder jacket for her, I have heard nothing but good from three of our friends with their smaller dogs, and I can't figure out how that helps from storms but it seems to work. :)

[LabDad]

Well, a quick update on Lulu, she is hanging in there, with the hot summer. She does well at night, though usually at least once or twice she will pant a bit. We keep fans going, and like tonight the air is on, since there is a hint of rain.

Her tumor is bigger, the one on her abdomen. Dr. Wilson aperated it, and said it appears to be a cyst, recommended having it removed. He ran blood work, and all normal except alkaline phosphatase was about 490 something. It should be under 200. And it was elevated he said about a year or so ago.

Now on the surgery he recommended a liver biopsy while doing the surgery. He said it is safe, and I doubly asked him, if he really recommended it, and he said I think it will put your mind to rest. He said it will determine for sure if it is Cushing's or possibly it could be something else. I thought previous testing showed it must be Cushing's. But since we had the other Vet doing the original Cushing Test and I believe she has left the United States and may have gone back to her homeland, I believe either India or Pakistan.

Anyway, the extra biopsy will cost another 150 dollars or so, but we do have a financier paying, and he has said to go with it. We do trust Dr. Wilson. He is liked very well by lots of dog owners when we see him. The biopsy does concern me a bit, though I know that it is supposed to be safe to test.

[littleone1]

Hi,

Just a quick note. Corky's liver mass and adrenal tumor were aspirated over two years ago without him being under anesthesia. I had to bring him in about an hour after it was done, just to make sure that there was no bleeding. It was a safe procedure for Corky.

Terri

[LabDad]

Thanks Terri, that is reassuring. I believe then we will do that. I'm not sure if Dr. Wilson will want to biopsy the adrenals, but that is good that the liver biopsy is not that serious. ;)

[LabDad]

Lulu did well on her surgery last Tuesday. She is back to being her bossy self. Now when I took Lulu in, I mentioned to the technician that she also had a couple of other cysts or tumors, but they were beneath the skin more. The vet removed three altogether, the large cyst, gave an incision 6 inches long. I will be glad when the staples are removed in a week. Dr. Wilson, I don't believe charged us much more for these other tumors. I bet he sure was busy. I told my wife, who likes to bake that she might want to bring some cookies next Sunday when the staples are removed.

We will get the biopsy report later this week, we are keeping our fingers crossed. I think the vet believes the large cyst is not cancerous.

[littleone1]

I am so glad that Lulu's surgery went well. Corky and I are keeping paws and fingers crossed that the biopsy report is a good one.

Terri

[LabDad]

Thanks Terri,

I will post as soon as we know.

[Harley PoMMom]

So glad to hear that Lulu's surgery went well. Keeping all various body parts crossed that the biopsy report comes back good...keep us posted!

Love and hugs,
Lori

[addy]

Crossing all our paws too for good news for Lulu. So glad surgery went well.

Sending hugs for all of you,
Addy

[Squirt's Mom]

You are just tooooo quiet! I would have been posting so much my laptop would have gone up in smoke if Squirt underwent these surgeries! :p

I am glad Lulu has done so well and hope the results are perfect! Please keep us informed...even if you don't wail and moan and carry on like I do. :p:rolleyes:

Hugs,
Leslie and the gang

[LabDad]

I thought I had posted Lulu's pathology results this morning, but I see that I must not have checked to make sure it was sent. Well here goes. Lulu got her stitches out yesterday and she was happy, the veterinarian was pleased, and we talked about having her retested for Cushings in a month. She pants at night when it's just a hint of warm. We do our best to keep it like a refrigerator in our room at night, and fall is coming with cooler temps.

The liver biopsy was benign, but she did have a grade II tumor mast cell, but the prognosis is good, in fact my research confirms Dr. Wilson's. He did excellent surgery.
************************************************** *
Below is the report I typed up this morning.


Okay, on Lulu and I am typing this into a Word Document, so that I can submit this to two Cushing Forums and to an AnneCollins.com weight loss web site, and other people interested in Lulu, our 11 yr. old yellow Labrador.

She had three masses removed Tue. Aug. 16, 2011. The largest mass, a ‘cyst’ that Dr. Wilson of Wilson Veterinary Hospital in Romeo, Michigan, aspirated and did not find any indication that it was cancerous after staining and looking under a microscope.

The mass which had grown since December of 2010 had been indicated by Lulu’s Port Huron Michigan veterinarian to keep a watch on. At this time, the Port Huron veterinarian had sensed that Lulu may have Cushing’s disease and suggested testing. We did this, though it can be costly, but is a viable for dogs that have more pronounced Cushing’s Disease symptoms. Lulu had increased water intake, frequent urinating, panting often which requires more ventilation, fans, a bit more air-conditioning, at times an aggressive appetite and in February experienced a much increased shedding of her fur.

Lulu hasn’t shed much since March of this year, though her fur coat has taken on a curlier and perhaps slightly coarser appearance on parts of her back. Perhaps her fur may grow back in this area. But she is still gorgeous and whether she has a permanent curly hairdo or again becomes a golden blonde is not that important and is very compatible with a loving and comfortable life.

Now Lulu’s three tumors, as well as a biopsy of her liver using ultrasound was done during the surgery.

We went in Sunday, Aug. 28, 2011 to have Lulu’s staples and stitches removed. She was very happy, and we let her bring her bright orange soft bone chewy into the vet hospital. I highly recommend doing this with your pet if they have doctor anxiety; it really helps reduce the nervousness. One other tip is DON’T park in front of the hospital if you can help it and it’s not an emergency. But rather park facing away from the building, because you see your dog is smarter than YOU are and ME!

Anyway, on to the pathology:

The liver showed a mild diffuse vacuolar change with several areas of benign nodular hyperplasia scattered throughout the parenchyma. Hematopoiesis is noted in very small amounts in the hepatic sinusoids. No significant inflammation appears.

The abdominal mass consists of a loosely demarcated and moderately cellular mast cell tumor which extends throughout the connective tissue stroma. There is mild to moderated secondary eosinophilic infiltrate throughout the mass. The tumor cells are well-differentiated, demonstrating abundant fine basophilic granules, minimal pleomorphic nuclei, small to absent nucleoli, and a mitotic rate of about 1 per 10 high power (400x) fields.


Microscopic Interpretation.

Liver: Moderate vacuolar hepatopathy with benign nodular hyperplasia

Abdominal mass: Mast cell tumor Patnaik grade II
(Low—well-differentiated type), complete excision
Additional tissue: No mast cell tumor is seen.

Comments: The liver lesions are typically incidental and may create a nodular appearance on ultrasound or grossly. I do not appreciate the presence of any hepatitis or hepatic fibrosis. Vacuolar change may be associated with a number of potential etiologies and is typically an incidental finding. There is NO EVIDENCE of mast cell tumor in the liver. (MY COMMENTS- THIS IS A GOOD THING)

Abdominal mass: The mitotic index is 1.

The tumor was classified as grade II with grade I being low grade, II being intermediate grade and III being high grade.

Grade I has the best prognosis with an excellent survival rate. Grade III has a poor prognosis. Grade II (which Lulu has been rated) is of course in between. I have heard (see below) that she would have an 80% favorable prognosis. BUT to even paint a rosier picture, Lulu has a LOW mitotic index of 1 (1 per high power (400x) fields. Mitosis is the process that body cells make new body cells, and it is ‘out of control’ mitotic division that cancer creates that is devastating to mammals that get cancer.

So in my conclusion and Dr. Wilson is very confident based on the laboratory findings, Lulu has a very good chance of living another 5 years. LOL

Now nothing in life is certain, and Lulu has lived the best of life, and she has probably had a better upbringing than my wife Linda and me. She has had a great 11 years with us. We found her when she was 4 months old as she came here on her own, though she had a collar. We never found out who owned her, and we checked newspapers, the neighborhood and bulletin boards. My wife had wanted a yellow Labrador girl and wanted to call her Lulu. That is how Lulu became ours.

The report goes on further to state that if we want to see an oncologist for additional consultation that they would help us find one if we wanted. We presently feel that at this time, with the great surgery of Dr. Wilson and the age of Lulu that currently we are not considering this. We will keep a watchful eye.





Below is from a website I found of a Dr. Dressler answering dog owner with mast cell tumors.
__________________________________________________ ______________________





Dr. Dressler January 9, 2010 at 7:32 am
William
the ultrasound is a good idea. Painless, good information. If the scan is clean a wide excision, as you brought up, is a very good idea. Vaguely 90% of grade 2 mast cell tumors are cured with a wide excision (no radiation). Median survival time of dogs receiving conventional veterinary care with grade 2 mast cell tumors having a mitotic index under five is 70 months. Mandy is 8 years old. 70 months added on to that is 13.5-14 years of age. This is perhaps a year under average life expectancy (as a guess) for a dog like yours, in other words, close to a full life. Bottom line, I would look at these stats and decide whether radiation makes sense for you in the overall analysis of life expectancy and median survival times.
“However, there is some concern that even if they perform the second surgery, the pathologist won’t be able to determine conclusively if there are “clean margins.”” This is due to micrometastasis:
http://www.dogcancerblog.com/dog-cancer-what-is-micrometastasis-and-why-do-we-care/
Hope this helps,
Dr D

[LabDad]

All right, it was time for Lulu's ACTH test, so let me go through what the printed results show, because I'm not sure how to interpret. Dr. Wilson has said that she needs no medication at this time as results were low. On Oct. 6 Lulu had the one hour test. Her Pre-ACTH was 2.8 ug/dl and her Post-ACTH was 3.5 ug/dl.

ACTH Reference Range:

2-6 ug/dl for the Pre-ACTH
6-18 ug/dl for the Post-ACTH

>22 Post-ACTH Cortisol consistent with hyperadrenocorticism
<2 Post-ACTH cortisol consistent with hypoadrenocorticsm
1-5 Desired pre- and post-ACTH cortisol on Lysodren therapy.

The report goes on to say: ACTH response test is only clearly positive (>22) in 30% of dogs with hyperadrenocorticism (HAC); equivocally positive in another 30% of dogs with HAC, and normal in 40% of dogs with HAC. If the ACTH response test is normal and HAC is still suspected, proceed with a low-dose dexamethasone suppression test.

It goes on to describe dogs with iatrogenic Chshing's disease.

The report also showed gross lipemia on the pre and post specimens, requiring ultracentrifuation. Fasting wasn't required, though Lulu did have some breakfast.

On Oct. 18 Lulu had a fasting urine sample with normal specific gravity of 1.045 thought cloudy turbid with some cocci bacteria. She had normal electrolytes, with the chloride slighty elevated, but not a concern.

Lulu is doing well, after her surgery and her symptoms of Cushing's are not as pronounced. I asked the vet if Addison's could be a possibility and he said it could, but did not recommend any prednisone at the time based on her test results.

Lulu does have some limping the last few days I have treated with Deramaxx and gentle massaging of her legs. She had tpl surgery on both back legs 6 years ago.

Lulu has a thundershirt which we have used for high pitched smoke alarm type sounds she hates. We haven't had a good storm to test her. She likes her coat as we have tested on her when she has gotten upset.

[Cyn719]

So glad Lulu is doing good - thank God she found such wonderful parents!! Will be checking in on Lulu to see how she progresses and ?? of Addisions -

[Harley PoMMom]

All right, it was time for Lulu's ACTH test, so let me go through what the printed results show, because I'm not sure how to interpret. Dr. Wilson has said that she needs no medication at this time as results were low. On Oct. 6 Lulu had the one hour test. Her Pre-ACTH was 2.8 ug/dl and her Post-ACTH was 3.5 ug/dl.

ACTH Reference Range:

2-6 ug/dl for the Pre-ACTH
6-18 ug/dl for the Post-ACTH

>22 Post-ACTH Cortisol consistent with hyperadrenocorticism
<2 Post-ACTH cortisol consistent with hypoadrenocorticsm
1-5 Desired pre- and post-ACTH cortisol on Lysodren therapy.


2-6 ug/dl for the Pre-ACTH and 6-18 ug/dl for the Post-ACTH are reference ranges for healthy dogs that do not have Cushing's and are not being treated with either Trilostane/Vetoryl or Lysodren/Mitotane.

1-5 Desired pre- and post-ACTH cortisol on Lysodren therapy are the reference ranges for a Cushingoid furbaby being treated with Lysodren/Mitotane.

Is Lulu on Lysodren? If she has not had Lysodren for a period of time than her ACTH results would concern me a bit.


On Oct. 18 Lulu had a fasting urine sample with normal specific gravity of 1.045 thought cloudy turbid with some cocci bacteria. She had normal electrolytes, with the chloride slighty elevated, but not a concern.

Dog's with Cushing's disease will usually not have concentrated urine and seeing that Lulu's USG is 1.045 is confusing to me but it doesn't take much to confuse me! :eek::)


Lulu is doing well, after her surgery and her symptoms of Cushing's are not as pronounced. I asked the vet if Addison's could be a possibility and he said it could, but did not recommend any prednisone at the time based on her test results.



So happy to hear that Lulu is doing so well and please keep us posted.

Love and hugs,
Lori

[LabDad]

Thanks Lori. I will try to keep informed more on disease. Lulu has not had ant drus for Cushings since January. I am wondering abt the 8 hr. Test some time in the future? I aam going to monitor her water intake this winter to see how much she drinks. She should drink abt 2 liters a day for her 85 lb. Weight.

[LabDad]

Lulu does have some limping the last few days I have treated with Deramaxx and gentle massaging of her legs. She had tpl surgery on both back legs 6 years ago.



I took Lulu to the vet one week ago because her front left paw she was limping on we saw what looked like a cut paw. This was strange because it came all of a sudden and not really inflamed and she didn't like us looking at it. The vet came back with a relieved Lulu, who had a corn that was a quarter inch long and narrow which had been growing causing it to push into her paw. She is walking much better, with an occasional misstep because it is still a bit sore.

We take her with us from (Port Huron area) to Cleveland tomorrow, since I have a every two year surgery I had for Colitis 25 years ago. We will be staying at the same nice Red Roof Inn nearby we were at two years ago after visiting with some Cleveland friends of ours.

[LabDad]

Just a quick note, to say that Lulu is doing well. She thinks she is a pup, and I don't tell her otherwise. She had to have surgery for the corn, which turned out to be a non-viral wart I believe. Then she has had a chalazion cyst in her left eye which the vet has squeezed twice. I'm afraid she will have to have it removed surgerically.

Though I think Lulu may still have symptoms of Cushings she hasn't had any medicine for it in over a year. She seems to be coping well, though I do watch her water intake, and of course she has healthy appetite. She has stayed in good shape, and physically she appears to be as healthy or more so than she was a year ago.

I will arrange for the two hour test when I can get a chance. It's funny with the surgery she had in last year, her fur started to grow back and then it seems stunted in parts. It doesn't look bad, and I wonder if that is permanent?

You know it's what is best for the pet, and sometimes if the disease isn't serious sometimes no treatment may be better than treatment. I'm taking it day by day! :)

[Harley PoMMom]

Thanks so much for the update on Lulu. If Lulu is not displaying strong symptoms than not treating is a choice I would probably make myself.

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

Love and hugs,
Lori

[jmac]

So glad to hear Lulu is doing so well! That is fantastic!

My Hannah has only mild symptoms and is doing pretty well, so I also have chosen not to treat at this point.

Thanks for sharing the great news!

Julie & Hannah

[Cyn719]

So glad you gave an update on Lulu. Sounds like she is doing good for all she has gone through....way to go Lulu:)


Keep us updated...nice to hear good news

[Squirt's Mom]

Thanks for the update on Lulu - and what a great update it is! :D

If her signs are not obvious and she seems strong and happy, I would hold off treatment, too. I think you are taking a wise approach. ;)

Please to check in and let us know how she is doing.

Hugs,
Leslie and the gang

[LabDad]

I see that I haven't posted on this thread in a year, and we have been lucky in having Lulu another year. She had a long overdue retest of her Cushing Disease and the 8 hour Low Dex test the vet surprised me with a week ago Tuesday. Well I was glad to have this test, and at 96 dollar, send the results to Michigan State that was money well spent, a bargain! Well the results were high after 8 hours, normal before, with a result of 140 with 0-30 the norm. The doctor has okayed the Trilostane, a powder that would be put into 50 capsules for just over 200 dollars, I believe 50 days worth. Now I am not sure the directions of the vet, will have to make sure I check. I know after a week she is to have an ACTH check. Now I read that the drug is Vetoryl. I'm not sure how much more it would be. Does anyone have experience with either of these. I believe the doctor said the dosage would be started low. We do have a person that is going to pay for this, at least until I get started working again full-time. This is a big cost. I do want the quality of Lulu's life to be better. She is handling pretty well, but she definitely come back with classic symptom. Fur that doesn't grow back quickly, water drinking, very hungry and panting. She has a bit more weakness in her legs, so even though she is 12 years old she has been a very strong dog, still shows she is tough, but we see that she needs the proper medicine.

I just wonder as the vet wants to put her on Trilostane, have others had good results with this? Is the cost that much more with Vetoryl?

[LabDad]

Just going to say hi here. I haven't posted much on Lulu, but she has been on Trilostane since July 7, 2012. Wow, it seems longer than a month. But she is doing much better. She doesn't pant as much and her eating is down. She still has some trouble with her back legs, but I think there is improvement. I have her on Dasuquin glucosamine, chondroitin with MSM. I highly recommend it to all senior dogs that are having a bit of trouble with their limbs. I will call the vet this week to schedule a one month recheck of her two hour ACTH test. :)

[Harley PoMMom]

So glad to hear that Lulu is doing so well. I was just wondering if you could tell us what dose of Trilostane Lulu is taking and could you remind us of her weight?

Trilostane is the active ingredient in Vetoryl. Many members use a compounded form of Trilostane and are having great success with it plus it does cost a lot less that the brand-name Vetoryl.

Has Lulu had a stim test done after being on Trilostane for 10-14 days? If so, could you post those results, thanks! Did your vet tell you to give the Trilostane with food and that the stim test needs to be done 4-6 hours after the dosage of Trilostane?

If you have any questions please feel free to ask, and here's a handy link to Trilostane info: Trilostane/Vetoryl Information and Resources (http://www.k9cushings.com/forum/showthread.php?t=185)

Love and hugs,
Lori

[Squirt's Mom]

How are the hot spots doing? Let us know what you learn with the ACTH! This isn't the first one since starting the Trilo is it? Lulu should have had one at 10-14 days....if not, you may want to get her in soon. ;)

Hugs,
Leslie and the gang

[LabDad]

Really quickly now, at a job site, but Lulu pre ACTH test was 3.3 ug/dl and Post-ACTH 1.8 ug/dl. Reference range is 2-6 pre and 6-18 post. So the vet was happy with results. Lulu was scheduled for another ACTH test but we are postponing for a month. I am switching pharmacies for the 100 mg. trilostane. We got 50 pills for 240 dollars total 20 miles away very convenient, but still expensive. We ordered the next 50 from a place in Kentucky and will start her on these within a week. Lulu weights about 81-87 lbs. She appears to be doing much better. Her hind leg(s) does give her some problems, but seems to be getting better. She seems less Cushing's but she still has her moments. Seems to be a quieter dog more. I have stopped giving her morning melatonin for the moment. I am wondering if that might be adding to her more docile nature. But all and all she is more like her old self again.

More later. Hope I answered most questions. I do give Lulu her trilostane about half hour after breakfast and roll it in some sliced cheese. I didn't know about having the 2 hour ACTH 6-8 hours after getting trilostane. I will ask Dr. Booth/ Dr. Wilson about that.:)

[mypuppy]

hi Lulus dad,

so glad to hear your girl is doing well on her treatment. you may want to price out several online vet pharmacies and end up with a ton of savings. I know I did. Here are two.

Valleyvet.com 800-419-9524
Diamondback 866-578-4420

BTW, i give my girl her Vetoryl immediately with her morning meal. I've learned here it is best to give with food for better absorption and to avoid tummy upsets. As to the stims, This is the 2nd thread I have read indicating having the test performed within 2 hours after dosing, wherein I have always been recommended to do 4 to 6 hours post pill. That is how I've always had her stims done. Hope someone can reconfirm this for us.

good luck to you and Lulu and may I add my gratitude to your uncle for his sacrifices for our country. My husband is sgt 1st class US Army, deployed 1 yr in Iraq in 2004.

Warm regards. Jeanette and Princess

[addy]

but Lulu pre ACTH test was 3.3 ug/dl and Post-ACTH 1.8 ug/dl. Reference range is 2-6 pre and 6-18 post. So the vet was happy with results.

The reference range seems high to me, how long has Lulu been on this new dose?

We have never done the 2 hour ACTH test. We have always done the one hour test 4-6 hours after the dose. The first draw is done for the pre, injection of stimulating agent is done and second draw for post is done hour later.

Hopefully our administrators will be along soon to clarify.

Glad to hear Lulu is feeling better. I am just a tad nervous with her post at 1.8 and no more stims for a month but I am sure the experts will chime in on all of this so hang in there. They know far more than me:):):):)

[Squirt's Mom]

Hi,

The reference range is incorrect for a dog on Trilostane (Vetoryl). The range for these pups is 1.45 to 5.4 ug/dl and can go up to 9.1 ug/dl if all signs are under control. The post number of 1.8 ug/dl is getting down there so keep an eye on her for any signs that her cortisol is lower than is comfortable for her.

The optimal time to test a pup on Vetoryl is 4-6 hours after the last dose and the dog should NOT be fasted.

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

[LabDad]

Hi,

The post number of 1.8 ug/dl is getting down there so keep an eye on her for any signs that her cortisol is lower than is comfortable for her.

The optimal time to test a pup on Vetoryl is 4-6 hours after the last dose and the dog should NOT be fasted.

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

We have our new pills, and I believe by Sunday or Monday I will have started her on these pills. Will keep an eye on. The vet, Dr. Booth wants to wait a month to redo the 2 hour ACTH test.

I do notice some periods of increased appetite and increased water intake. But much better than before.

Her legs, especially the hind legs are weak, but getting better. Some of this is psychology. As I have been transporting her up and down the basement via the walkin sliding door, thank goodness we don't have a Michigan basement! But she surprises me by coming upstairs to the second floor by herself, though her method of operation is to stay on a single floor for longer periods, usually she stays on the first floor while I'm at work, if I'm not at home working. :)

[molly muffin]

So glad she is doing better. Slow walks, getting longer, to build the leg muscles back up.

Hugs,
Sharlene

[LabDad]

Slow walks, getting longer, to build the leg muscles back up.

Hugs,
Sharlene

That is what I am finding. It's been two weeks on the new pharmacy compounded Trilostane. I am wondering if perhaps this pharmacy's preparation is not as strong as the more expensive local place we got the first 50 days!

I have noticed that Lulu does still pant at night, though a bit less with the cooler weather. She owns the room fan and I always keep it on at least low speed directed toward her.

Too, I notice that she is a lighter sleeper. She could be dead to the world a year ago the senior citizen dog she is. But since being positive for Cushing's Disease again, could that be a symptom of or perhaps a side affect of the drug?

Her left rear leg is a bit weaker, so I keep up the glucosamine, occasionally give her Duramax for pain. and massage her leg. The back legs were operated on for ACL 7 years ago successfully. I am thinking I may have Dr. Wilson, same place that Dr. Booth is at treating her Cushing's now examine her legs. That and just plain old arthritis of an older dog can make it harder to walk.

A year ago she would still be able to walk 2 miles or a bit more, but now I am keeping it under 1/2 a mile, and sometimes less. She does have a harder time eliminating and has to squat a couple times or so to get it all out. LOL ;)

[labblab]

Hi, and I'm sorry that I have not had a chance to reply to you earlier about Lulu's first monitoring ACTH results:


Really quickly now, at a job site, but Lulu pre ACTH test was 3.3 ug/dl and Post-ACTH 1.8 ug/dl.

As Addy mentioned earlier, Lulu's post-ACTH result was right at the very low end of what is acceptable for a dog being treated with trilostane. According to the manufacturer of brandname Vetoryl, the drug should actually be temporarily discontinued and then the dose lowered if the post-ACTH result drops any lower than 1.45 ug/dl. Since Lulu's test result was this low after only one month of treatment, I do worry that it may continue to drift downward even further in the coming month.

Please do watch her very, very closely. If she exhibits any symptoms of low cortisol (lethargy, loss of appetitie, vomiting, diarrhea), I would stop the trilostane immediately and take her in for testing right away.

Marianne

[LabDad]

I am going to call Dr. Booth and let him know her walking problems. I am a bit confused. So if the dosage were reduced or stopped even she might improve. I thought that the dosage would be started low and then to see how she is doing. I have a call in to Dr. Booth to express my concerns. Lulu is not throwing up. Her appetite is more normal and not as ravenous as it had been.

[labblab]

Sorry I was gone yesterday afternoon and didn't see your reply until this morning. I want to clarify that Lulu may be doing just fine on this dose of trilostane, and her rear-leg weakness may only be from arthritis that has been "unmasked" by her decrease in cortisol. But her 30-day post-ACTH result is low enough that you really do not want it to drop any further. Individual dogs metabolize the drug at different rates, so what may be a "low" dose for one dog may turn out to be a "high" dose for a dog of the very same weight. That is why the monitoring ACTH tests are so important in terms of making dosing adjustments. The initial dose is indeed calculated on the basis of weight (the makers of brandname Vetoryl recommend a formula of 1 mg. per pound). But that is just a starting point, and the dog's appearance, behavior and subsequent blood testing all guide the subsequent dosing.

I think it's great that you are seeing so many improvements in Lulu. And as I say, this dose and ACTH level may prove to be just fine for her. But I wanted you to be aware that you do not want her cortisol level to drop any further. If it does, you will need to decrease her dose. Here's a link to the U.S. Product Insert for brandname Vetoryl. It contains a lot of helpful info re: monitoring and potential side effects to watch out for:

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

Marianne

[LabDad]

Thanks Labblab,

Thanks for the link. Lulu is scheduled for her ACTH test next Thursday morning. They said they want her from 9 am to 1 pm. So will work out good for me, as my project I am working on is 3 miles away.

I am thinking that most of the weakness in her back left leg is due to muscle weakness from Cushing's Disease. This happened a year and a half ago and got better when she went into remission. These back legs were operated on for ACLU 7 years ago which helps to complicate plus the fact that the vet then said she would get some arthritis too. I am thinking that massaging her back legs may be therapeutic to her. I help an guide her to go upstairs at night and also downstairs. There is a mid-landing so I make her stop there, even though she wants to do it in one fling. She can do the steps but now mostly waits for me. Even if it's just two steps sometimes! :)

[LabDad]

Lulu has been having trouble eliminating and tends to get in position, but doesn't hold still when she poohs. She tends to walk it out. But lately she has been a bit constipated, and her stools tend to be a bit looser. I don't know if this is because of the trilostane, or just her muscles are weak yet from Cushings. She is going? Is there a good stool softener or something like Metamucil to give? I don't think she is having a blockage though I am watching just in case.

[Harley PoMMom]

Metamucil or canned pumpkin (not the kind with spices for pies) can be used for constipation/diarrhea in dogs.

Here are two links that provide the dosages: Metamucil: http://www.vetinfo.com/dogmed.html
We usually recommend using 1/4th teaspoonful of Metamucil per 20 lbs of body weight twice a day but there is a wide variation in recommended dosages and it is probably safe to use slightly more than this.


Pumpkin: http://www.earthclinic.com/Pets/constipation.html
Pets who weigh less than 15 pounds = 1 - 2 teaspoons
Pets who weigh 15 - 35 pounds = 1 - 2 tablespoons
Pets who weigh 35 pounds and up = 2 - 5 tablespoons depending on size

Hope Lulu feels better real soon...keep us posted!

Love and hugs,
Lori

[Squirt's Mom]

Hi Fred,


But lately she has been a bit constipated, and her stools tend to be a bit looser.

If the stool is loose, she isn't constipated. A constipated pup will have very dry, hard poop, go for several days or more without a BM, and strain to eliminate when they do go. I wouldn't take any action to help constipation if the stool is loose.

How is her appetite? Any accidents, more frequent urination, or more water intake lately? Any signs of nausea? Is she displaying more weakness in her back end in general? Has she eaten anything different lately? Any new meds, supplements or herbs? Has she been checked for parasites recently? Just some things to look at....

Hugs,
Leslie and the gang

[labblab]

As a sidebar note to anybody who does use Metamucil with their dogs: just as is the case with humans, the Metamucil probably should not be given within two hours before or after any other medication. The Metamucil can affect the absorption/effectiveness of other drugs if they are taken too close together.

Marianne

[LabDad]

Thanks we tried some pumpkin with Lulu, about 4 tablespoons as she is 82 lb. She had to be encouraged to use it, by putting in a couple of small treats, then she ate it all. I am going to take her out right now and see if she goes. The reason I think she is constipated is because she just goes a small bit. Sometimes she has a normal stool. But I haven't seen in the last couple of days. She may have gone on her own. But she is trying to go, often and she is straining. I just see a bit of stool and it is soft.

Her normal habits have been she waits to go until I walk her morning or evening. She will go and has a normal stool. Sometimes she will go again and that stool often is a bit softer.

She is having a hard time bending and going. She had major surgery on both back legs, ACL surgery. Now with the muscle weakness she is having, the same thing a year and a half ago when her Cushings was full-blown. I am thinking that, the extra assistance of a gentle laxative is all she needs. I will watch her. She isn't nauseous or vomiting. She eats okay, though her appetite is down since she has been on the medicine. She seems quiet now, and that is why I am taking her out to see if she is still trying to strain and go.

I will update here! :)

[LabDad]

Good results with the pumpkin. Lulu had two bowl movements late this afternoon, and though soft, they were formed and just about normal size for her. I did not see her trying to go since. She almost did not get the first movement out as she tried to go without squatting. Then she did, and I can see she has a hard time doing this. I think Cushing's must also affect the muscles in the rectum too. She was a bit tired today, and rested. I did take her out for another walk after dinner and she did fine, and she did not have a need to squat. I am anxious for her to have her test, which is scheduled Thursday. :)

[jmac]

Hi there,

I only read the last several posts and have not gone back very far, but my dog has had some BM issues as well. My vet told me to give her about a 1/4 tsp. of Miralax (I gave a little less) twice per day and she is 12 lbs. She was not going often, and when she did, she would strain and push and her poops were hard. After the Mirolax they were a little softer and she was not straining. She sometimes has a little worm-like poop at the end that she has to strain to get out. Not sure what that is. Now she is on several meds and the poop is softer anyway so I am not adding the Mirolax.

Anyway, I was also wondering if you think there is any chance your dog has any back or leg pain. Hannah was having back issues and that made it really difficult to poop. She also has weak back legs, so I wasn't sure what the main issue was. She also sometimes would start to poop before squatting. She has had acupuncture and laser treatment several times for her back (and legs) and it has REALLY helped. She can maintain a squat again with no problem when she barely could go at a ll a few weeks ago. I don't know if laser or acupuncture are options for you, but I highly recommend it. I'm wondering if it is more pain from the position (either back or leg) rather than actually having difficulty defecating. Again, I didn't read back really far, so maybe this is not the issue, or something you already know, but I wanted to mention it in case it would help.

Hope things continue to improve regardless!

Julie & Hannah

[LabDad]

Jmac, thanks for post. The pumpkin has worked. I looked at the link Harley PoMMom gave. I am thinking maybe a slight bit less tomorrow. Lulu has been more tired today. I have been concerned about her ACTH levels that I wonder if I should try to get her ACTH test moved from Thursday to Wednesday. I know it's only one day. But I want to know as soon as possible if her post level is lower. She laid around on the cool floor more today. But you know too I was home more. I will be tomorrow too.

I like the idea of acupuncture. There used to be a lady that did this in the Thumb of Michigan. I will have to look into. I know at Wilson's Hospital there is a therapy center across the driveway for dogs. So I could check there. But I'm not a rich person, so I don't think I could afford. Lulu has had ACL surgery on both back legs and that complicates the pain. Yes, she has some, the Cushing's, the affects of the ACL actually turns the bones so it gives the dog sort of like a bowed leg appearance, which happens after surgery but this gives the dog tighter connections for the bones and ligaments, hence they aren't crippled when they walk. The surgery was so successful in 2005-2006 that Lulu had to let the dog world know that she was Queen of the homestead. She would fly off the porch at night, especially during the cold and snowy winter evenings and bark at other dogs and herself, as her bark bounced off a neighbor's barn and she thought it was another dog! LOL.

And finally Dr. Wilson who performed the ACL surgery said she would still get arthritis.

So yes, the defecating problem is pain induced, and softening of the stool with pumpkin has helped today. I hope it continues to work tomorrow. I'm taking that one day at a time.

My main concern now is keeping a close eye on her, because I want to know what to do if she should become more tired before her next test and results are in.

She came up the stairs fairly good tonight and seemed relaxed, and she does pant a bit, so the fan is on. She seems comfortable and relaxed tonight. So will report again tomorrow. It's almost 11 pm. I want to do just 10 minutes of programming, for one of my jobs, and then set coffee up for morning, clean the kitty litter. Yes we have two beautiful blonde and reddish blonde cats, the same color as Lulu.

[jmac]

Sounds like you have a great plan!

I paid $80 per treatment for acupuncture and they said it is best to do 3-4 initially, one per week. So it was a bit pricey initially, but it really helped her and we didn't have to do it again for several months. The laser treatment is a bit cheaper than that here. I was paying $60 for one or $150 for 3, but at another vet they have a tech do it and it is $35 for one and $180 for 6. It can provide significant relief for arthritis too. That might be something to look into. My husband and I are both teachers so money is not unlimited for us. :) I am lucky we are able to do the acupuncture and laser treatments from time to time, but we are also not currently paying for meds or ACTH tests, which I know are pricey. Hannah has had a few rounds of acupuncture in the last year, but now the plan is to do something every month or two to maintain things, rather than to wait until she has another problem. It is certainly something you could check out and see what the cost is by you.

For now I am glad to hear the pumpkin worked. I have some in our cupboard for Hannah in case we need it. I hope Lulu will perk up, but I think it is great that you are watching her so closely in case she needs to be seen earlier. I'm sure someone else will come along to give you some good advice on that.

Julie & Hannah

[addy]

I wanted to share an experience:

My Zoe has IBD/colitis so diahrrea is her usual problem. A few years ago her colitis flared and then she got constipated. She would go outside and strain to go and nothing would come out. Zoe would strain for a long time. When she would finally get something out, it was very loose stool, not alot. I took her to the ER and they said it was diahrrea. I told them this is not what normally happens to her and I also thought Zoe was constipated. The ER vet said no, so kept pressing and insisted on an xray and sure enough, she had stool blocked up. She was given a medicine, I dont rememebr which one, I could look for it in my notes, to soften her stools. It took us a few weeks to get normal again with normal stools and it never happened again.

If the pumpkin does the same thing, that is really good news. Julie has so good feedback on acupuncture.

Hope things keep improving.

[LabDad]

Addy, glad things worked out, so to speak for Zoe. Lulu seems perkier today, though she has strained a bit. She has gone, and the stools are more formed, but slightly smaller in diameter. The pumpkin has helped so I am going to get my wife to measure out some more pumpkin. :)

I did call Dr. Wilson's office this morning and move the ACTH test from Thursday to Wednesday. That way maybe we can get the results before the weekend, and I just feel that each day is important. If the dosage needs to be changed or stopped I want to do it as soon as possible. :)

[LabDad]

Lulu about the same. Good spirits. Tomorrow is her test, so will be up early for her. Let you know how she fared tomorrow evening. Pumpkin has been working fairly well, as she does eliminate and the continual straining is greatly reduced! Yeah!

[addy]

I am glad things are looking up for Lulu.

Keep us posted:):) I hope the test goes well.

[LabDad]

Long day for Lulu and me! Results of her ACTH test in a couple of days, I hope! :)

[Steph n' Ella]

Crossing fingers for good numbers!

[Boriss McCall]

Same here! :) Boriss had his test today. I picked Boriss up from the vet & brought/snuck him back to my office. He is SO tired..

[LabDad]

Thanks Steph & Borris. Good luck with Borris' results. Yeah Lulu was tired yesterday and I think maybe today. My wife said she pooed good and the vet called her and said the pre was 3.5 and post 5.5. So he is happy and said repeat in 6 months. He said she appeared great for 12 years. But I know she was tired after the testing and being caged for several hours. She had a harder time getting up. He seemed to think prob. arthritis. However, she was weak in the hind quarters a year and a half ago. And her legs started getting weaker quickly the last two or four months. I notice that with the ACL surgery, some arthritis and the Cushings it's just three things into one. When she has been on the floor for a long time and it's hard floor, her back legs kind of turn a bit before she stands, sort of like a beginner on ice skates and your feet tend to splay outward.

So time will tell if her hindquarters improve. I believe they will as long as the disease is under control. But what I've heard it can take weeks and months.

[Boriss McCall]

That is what i read too. Muscles take the longest to get better. We are lucky Boriss just now started showing muscle weakness before he started his meds.

Your poor baby has been thru a lot with her legs. I hope you see improvement soon. I am glad her numbers are good! I hope things are only going UP from this point for LuLu. ;)

[LabDad]

Thanks Boriss, And Lulu was antsy this morning. She has been trying to pooh, and I don't really know if she was productive. So with the pumpkin we give her, I am thinking maybe adding some Metamucil. I am going to look at the link sent me as mentioned a few days ago. I also am inquiring to the vet, called again this morning to Dr. Wilson, as Dr. Booth is gone for a week. I want to talk to him, he's the owner and the one that did her ACL surgery. I hear that Adequan works wonders. I also want to mention about the straining with possible constipation.

Did not give Lulu Duramax today, since we thought that if she were to get the injection, we probably don't want to do both?

Lulu didn't want me to go to work this morning, and though I am 3 miles from the vet (at home we are 25 miles) she was trembling a bit. And my wife said she stopped after I left. She misses me, maybe because I do most of the walking with her. But my wife (Linda a.k.a. Moo) is with her. And if the vet says to bring her in today, I would leave early from work. But I am still waiting. Otherwise Lulu is doing okay, able to walk and can get up the steps, it's just seems harder.

I don't know is Trilostane has side affects like constipation, but I do know that the strain is hard for Lulu since she has to put power into her leg muscles which I can see, but I know the intestine has muscles along with the sphincters to eliminate.

She had a nice formed pooh yesterday, so if there is blockage it isn't really bad, but it concerns me. She isn't bloated, and in fact in belly looks leaner as she is down about 5 pounds since being on Trilostane.

Well back to work, but I am the IT guy for this plant when I'm there working on a project for them, so will be monitoring and waiting for the vet to call.

[punksmom]

Hi Lulu's Dad! Just here to 2nd that emotion with regard to the melatonin - I was giving it to Punk at the beginning of her Cushing's diagnosis and kept her on it because she used to have MAJOR thunderstorm panic and it has really helped. She still gets a little nervous now but just lies down until its over, rather than panting/shaking/climbing/total freakout like before the melatonin. Good luck!

[LabDad]

Hi Punk's mom. You know I just stopped temporarily giving Melatonin, and have been only in the morning. I stopped this morning because I heard on the news something about melatonin, those teaser stories, stay up till 11. I didn't and fell asleep (LOL). And there weren't any storms lately.

Moo just texted Lulu is in family room watching tv, so she is doing okay for now. I still am waiting on hearing from Dr. Wilson. He usually calls in the evening.:)

[molly muffin]

Hi, LuLu could be a bit constipated, but if her rear legs are weaker, then it also might be more difficult for her to push as hard as she needs to all the time.

whoo hoo, LuLu is having tv time. :)

hugs,
Sharlene

[addy]

My wife said she pooed good and the vet called her and said the pre was 3.5 and post 5.5. So he is happy and said repeat in 6 months.

I am glad Lulu had a good test and is improving. My thoughts are hovering about that six month test. Usually that is the period of time for testing dogs on Lyosdren.

It seem too long for a Trilostane dog to me. I dont remember reading anything about the recommended testing every three months changing.

Just call me the forum worry wart:D:D:D:D:D

[LabDad]

Thanks Addy, just heard that Andy Williams died. He is about the last of the wonderful voices that I liked during my rock-and-roll years. http://www.youtube.com/watch?v=5p_ArLvatRA&feature=related

Thanks on the tip for 3 months. I will keep that in mind. Dr. Wilson called me, finally and agreed on the Adequan shot. I got him to call the Romeo, Michigan office and I drove Lulu there, so she has her first shot. I forgot to buy the Metamucil, so I gave her one of my generic pills that has the Psyllium in it. I will give her another one in the morning. She usually drinks water at the outside pump after I feed her. So I'm hoping that helps her. Dr. Wilson seems to think she might have a bit of colitis since I said her stools are more narrow. I know that colitis can cause yo to feel like you have to go more often and I think he's right, since Lulu is going and she isn't bloated.

Boy this Cushing's isn't your 'run of the mill' disease to have. This forum is great. There is so much information on here along with it's Facebook page, too. :)

[lulusmom]

That Andy Williams song brings back some memories. I was 11 years old when that song was climbing the charts. There were very few songs back then that both children and parents liked and that was one of them.

[LabDad]

Finally, I fed this morning and she came down the steps herself. I usually try to keep her slowed, and fortunately there are landings on both the upstairs and basement steps. But the great news is she was prancing when she went out, she had a hot to her gait, as she barked at the neighborhood and it's dogs. I think the Adequan is working! Then she poohed and a bit of flatulence but she was able to bend her legs better and she had stool, soft though. And then again and this time more formed. Sorry about the details, but I am posting this paragraph on the Cushing's Forum. The metamucil tablets that I take might just be working, as the vet seems to think she may have some colitis. Metamucil is the over the counter drug of choice for this.

[Steph n' Ella]

N/P about the poo! The forum is a get record if you ever forget how things were going at a point in time.

[LabDad]

Lulu had an active day yesterday, my wife said she was concerned about diarrhea. I wasn't as concerned. We stopped the pumpkin and I only gave her one metamucil capsule yesterday. I might increase to two. I will try to buy some powder today, though maybe the capsules are easier as she eats them in her food in the morning. I add extra water to her food then.

She pooED a bit this morning, soft, but firm and good color. And she didn't strain after that, that I could tell. She is out in the dark barking, so will bring her in soon. I am going into a work project in Romeo this morning.

[labblab]

Just wanted to pop in to remind you that Metamucil has a label warning that it should not be taken within two hours of other drugs:


Laxatives, including bulk fibers, may affect how well other medicines work. If you are taking a prescription medicine by mouth, take this product at least 2 hours before or 2 hours after the prescribed medicine.
If you are giving the Metamucil with Lulu's breakfast, I am just concerned that it is at the same time as her trilostane. If so, I think you need to switch the Metamucil to another time.

Marianne

[LabDad]

I will have to delay this. I have given Lulu her Trilostane about an hour later, so will switch. Thanks.

[LabDad]

I will have to delay this. I have given Lulu her Trilostane about an hour later, so will switch. Thanks. Thought I sent this. It's been sitting here for three hours. Well now it's sent!:cool:

[LabDad]

Well Lulu got her second Adequan today. I saw young Dr. Booth today. I hadn't seen him before, as I usually see Dr. Wilson who did her ACL surgery. We like the Romeo Wilson Vet Clinic and it's a 24 emergency care and reasonable prices. But they can be busy.

Lulu has problems lying down and getting up, especially getting up from our slippery kitchen floor, it helps if she is on a rug. She has a big problem being able to lie down, because of pain. Dr. Booth was able to see that in her left rear leg, which is the leg that has been giving Lulu her problems. He took an x-ray and said that it looked good. He saw the metal plates from her ACL surgery 6 years ago and said she looked good, the x-ray was good, there was some arthritis, but no more than you would expect at 12 years. He said that along with muscle weakness are causing that. The Cushing's Disease can cause that and I think Trilostane has a side affect too about muscle weakness.

Dr. Booth recommended Tramadol 50 mg twice a day, so I have started Lulu on this. I can still give Lulu Duramax and he drew blood, so will get results tomorrow. Not too bad with a cost of under 200 dollars for all this and I didn't have an appointment with Dr. Booth when I came in but he was the walk-in doctor today so I of course wanted to meet him. I was impressed with this young doctor and told my wife she would like him. He manipulated the muscles in Lulu's back legs and up on her back. He said she is in pretty good shape for a 12 year old. She even lost more weight, as she isn't as ravonous. She now weighs 72 lb and had been 82 - 86 lbs normally. I think the lower weight will help.

I am hoping this injection of Adequan helps like the first and that she starts being her old self more again.

Will go out and see if she wants a bit of a walk, but I'm not pushing her.

Oh, the doctor said to give her two teaspoons Metamucil twice a day, the unflavored kind.

[molly muffin]

Your young Dr. Booth sounds like a winner. :) It's good to have a place to go with Lulu that you are very comfortable with.
Hoping the Adequan helps. :)

hugs,
Sharlene

[LabDad]

Haven't been on in a week. I am getting flack from everywhere, but accomplishing a lot, who isn't these days. But Lulu does seem to be progressing with her legs, she can get up and lie down a bit easier. She goes in for her third adequan shot and they seem to help. But there could be more improvement. MY main concern now is her bowls. She has spent time trying to eliminate and I have her on Metamucil, trying the capsules instead of the powder, but may switch back to powder, it's just that she wasn't eating the powder on the food.

The diarrhea she had concerns me, she had an accident, had to go out early this morning, but I think she feels better, it might have been some rice and salad we gave her. She had been getting a dirty butt and I was able to clean it up a bit. Usually when I do try she feels the need to go and tries. Now one who had ulcerative colitis I have to agree with Dr. Wilson-boss vet and owner of the huge Wilson Veterinary Clinic and satellite offices. He felt the metamucil would help with what he thinks is colitis. And colitis acts like this, the urge to go.

We are stopping the pumpkin for now as the stools are loose enough, too loose.

Stay tuned, more later!

[LabDad]

Lulu got her third shot. I think she is liking these and she is walking better. We mentioned that she is having diarrhea and have stopped the pumpkin. So the doctor prescribed an antibiotic and I donated a stool sample. Dr. Booth said no worms, but she has a bacterial infection, clostridrium. So the Metronidazole is the antibiotic she is getting, 375 mg / twice a day for a week. I am wondering if Lulu got this from the cat litter as one of our cats has pancreatitis and had some diahrhea and we have to keep the two kitty litters pans cleaned often!

[LabDad]

Update on Lulu, she seems more with it. She moves better, and she lies down and gets up better. On our tile floor she does have a bit of trouble getting up, so we do help her. She has at times moved on her belly to get to the carpet and gain more traction, the genius prodigal daughter she is!

The diarrhea has slowed, and her stool I saw last night and again this morning was formed her normal size stools, soft but not runny. :)

[labblab]

Thank you so much for these updates, and I am very glad to hear that Lulu is doing better with both her mobility and her stools. :) :)

Sometimes it can be so hard getting the stools straightened out. The same as with humans, sometimes the very same supplement can make GI issues either better or worse. It just takes experimentation to find out. We'll hope you've turned the corner now with Lulu!

Marianne

[LabDad]

Lulu continues to walk much better, her stools are more formed, and she is acting like she is hungry more, since she has lost 18 lbs, we figure that she needs to put a little back on, since some of that weight might be muscle mass.

I have noticed that the last two mornings that she is peeing about a half dozen times or more. I thought at first that it was territorial, and she has done this before. And she does tend to pee more often, especially the last 3 years or so. But I carry my trusty flashlight out in the morning, and I didn't notice that her urine had a lot of volume, and that perhaps it is just trickling out. I have had her on cranberry pills for over two years and I remember the vet saying she had a prolapsed (?) vagina. Could it be the antibiotic doing this? She will be done with that on Wednesday morning.

Anyway, Lulu looks good and alert otherwise!

[LabDad]

Lulu continues good progress. She had a mishap, yesterday when two neighbor dogs, including a girl friend of Lulu's, Bella with her big sis Daisy were trespassing. She galloped and she literally wore her hind legs tired. I even carried her a bit. But she recovered. Lulu adores Bella, so I was sorry to see this happen, and at least she got to meet her again. I will remember to keep my leash handy, because Lulu can be stubborn when she wants. :D:

I have decided since the slow urine drip isn't presently bothering her, to grab a sample later this morning and call the vet. That way if they want a sample I can drop it off as I am going into Romeo tomorrow and Lulu is due her 4th weekly adequan shot tomorrow.
:)

[LabDad]

Another antibiotic for Lulu, as she finishes her one for her diarrhea she started one for her concentrated urine. Dr. Booth prescribed Cephalexin capsules, 1000 mg in the morning and 1000 mg in the evening for two weeks. Here's hoping that works! Otherwise Lulu continues to improve, and she is much more demanding. I like a spunky dog! :)

[molly muffin]

Awwww Yay for you and LuLu! And still like that young Dr. Booth. Sorry to hear LuLu has ad diarrhea though. Poor thing but isn't it awesome to have her all spunky and playful again. :)

Sharlene

[LabDad]

Lulu continues to improve, her mobility is better, though she does have days where she feels like she's 70. Well don't we all! I still help her up on our slippery hard tiled floor. Her pee seems to be a bit better, though I would think her volume should be higher first thing in the morning. She doesn't complain, she just pees a lot of small pees. She has been like this, peeing more often probably for 3 years or so. So I guess I will keep an eye on her, and perhaps mention to the vet when we take her in for her monthly shot, as Dr. Wilson (or probably Dr. Booth) wants to see how the adequan is doing.

[molly muffin]

:) thanks for the update. Very happy to hear that LuLu continues to improve.
My molly is a frequent pee dog too. She'll go 5 or 6 times, rather than one long one. Unless it's raining, then 2 rather longer pees and a gallop back into the house.

Sharlene

[LabDad]

Lulu continues to have good mobility, though she still has some trouble getting up and occasionally lying down. She had a bit of constipation yesterday so my wife added some pumpkin. That seems to have done the trick, she had a normal bowel movement this morning.

She sees Dr. Booth this Wednesday since Dr. Wilson (owner and the one who did Lulu's ACL ligament surgery on her back legs in 2005) said he wanted to see her after a month without more adequan and then to get her monthly dose if it has improved.

I am wondering if I should have Dr. Wilson see her or let Dr. Booth see her walk. He's a very good vet, but the ACL surgery is only done by him. So will think on that today. I don't like to have multiple vets as a rule and like to give our pets consistency in who they see when possible.

[LabDad]

Well Lulu saw Dr. Booth yesterday and he thought she is doing well for a 12 year old. He prescribed a new antibiotic for her urinary tract infection, which they saw. He wants to do a re-test in the lab 2 or 3 days after she is finished in 2 weeks. I had her nails trimmed. She was antsy a bit during the night. I let her out about 4 am and waited for her. Then she was having a hard time lying down again. She splies her legs and it was difficult to get her to lay down. And of course she does have trouble getting up. I wonder if the adequan injection may have made her more sore. So she isn't having a great day. She did eat her food finally & I added two teaspoons of pumpkin to it as she was constipated yesterday and I think may still be. I am at work but my wife is home with her so I told her to make sure she gets up every once in a while. I will walk her outside when I get home as she walked a good distance this morning with me.

I AM thinking that maybe she needs more protein, and she loves ham or chicken. So I am wondering if maybe adding some hamburger to her meal would be good? Her weight is 67 lb, where she had been 84 lbs prior to treatment. She has been in the upper 60 lbs for the past month.

[addy]

Not sure if I have an opinion on the hamburger. Zoe was dropping weight, a bit too much for my liking. I had decreased her raw and added more of her Honest Kitchen fish and sweet potato. I wasnt sure if it was from that, muscle wasting, something else. Long story short, I increased her food, increased the raw a tad and increased the wet food and she went from 16.5 to 17 pounds in two months. ( She is a little dog). I usually go by how she feels more than her actual weight.

Sometimes, I think they have bad days, just like us with their arthritis. I hope today is better for Lulu. You are doing a great job advocating for her. Keep up the good work.

[Squirt's Mom]

Beef is typically higher in fats than chicken and fats can be a problem for our cush babies as they are prone to pancreatitis. If I were you, I would try to find lower fat foods to feed, increase carbs to add weight instead with things like rice, sweet potato, you could try white potatoes tho they may make the arthritis worse - just about any veggie we eat, they can eat. You can google and find good lists of foods to avoid with canines, too.

Glad Lulu is doing well and hope the weight issue improves soon.

Hugs,
Leslie and the gang

[Squirt's Mom]

Some recipes for Satin Balls, and other food ideas, designed to help pups gain weight -


Satin Balls - (Cat's recipe)

1 lb ground lamb, turkey or venison (or combination)

1 8 oz package of ricotta cheese

2 ounces almond butter

2 ounces coconut oil

4 ounces ground flaxseed

1 dozen egg yolks

2 cups rice cereal cooked

Other things to try include green tripe, sardines(canned in water and
drained) scrambled eggs, novelty meats like ostrich and rabbit, and certain
types of baby food. Baked treats can be good too, if the meat content is high
enough to get them interested. Don't OD on protein (as you know) with
Cushing's.

Kathy’s recipe
TO ADD WEIGHT - SATIN BALLS

20 pounds ground 70/30 beef or lamb
2 pounds beef or chicken livers pureed in the blender (gross I know)
12 eggs pureed in the blender
1-pound bag of cranberries pureed in the blender with the eggs
2 containers high fat ricotta cheese
2 cans jack mackerel or Salmon - drained
2 big cans spinach drained
1 box total cereal
1 jar wheat germ
1 big round box oatmeal
1 can of pumpkin
2 cups unsweetened applesauce
Bake at 350 like a meatloaf.

[Squirt's Mom]

I should have let you know that Satin Balls are pretty high in fat content, as I'm sure you can easily see, and should not be given very often. A sudden increase in fats can trigger pancreatits and a steady diet can lead to a chronic condition there as well as other problems we don't want to add to the mix. So if you decide to try the balls, use them sparingly. These recipes were designed for dogs who have difficulty maintaining weight but who are otherwise fairly healthy.

Hugs,
Leslie and the gang

[LabDad]

Thanks for the recipes. And yes I considered the fat part, but if pancreatitis is a problem will use sparingly. One of our two almost 10 year old sister cats, Nellie has pancreatitis and we have the cats on a prescription diet. She is doing much better and she was getting pretty sick. By the way Lulu is Nellie's dog, she cuddles up with her and this has been her tradition since she was just under a year in age! Molly the other cat is a bit shy and doesn't cuddle up, but they both respect each other. I have the latest adorable picture of the two of them, but I don't see a link to upload on this forum, I guess because of the server space.

Lulu came upstairs all on her own tonight, unusual so maybe her legs are getting stronger. This is such a tricky disease taking the likes of an Einstein Endocrinologist to figure out or someone who studies the stock market ups and downs, there are good, average and not as good days, it seems, though Lulu has seemed to improve.

[Squirt's Mom]

I have the latest adorable picture of the two of them, but I don't see a link to upload on this forum, I guess because of the server space.

There are albums you can make here under your profile. Go to User CP and look down the left hand bar. You will see an area for albums where you can upload pics of Lulu...and any others you wish to share. ;)

Hugs,
Leslie and the gang

[LabDad]

There are albums you can make here under your profile. Go to User CP and look down the left hand bar. You will see an area for albums where you can upload pics of Lulu...and any others you wish to share. ;)

Hugs,
Leslie and the gang

Thanks. I have started to upload pictures, but I am having a problem with the order of pictures. As I add new ones, they are being put at the front of the album. I am not seeing a way to move photos once they are posted, so I am going to wait before doing any more. I want to load chronologically, so I may have to put the most recent pix in first?

[Squirt's Mom]

Yeah, you do have to put them in backwards from the way you want them to be seen and they can't be moved around in the album once entered - or I've never been able to figure out to do that anyway. ;) So I end up spending some time entering, deleting, then re-entering....every time! :p You'd think I'd learn, huh? :D

Gotta go see what you've got so far!
Hugs,
Leslie and the gang

[LabDad]

Yeah, you do have to put them in backwards from the way you want them to be seen and they can't be moved around in the album once entered
Gotta go see what you've got so far!
Hugs,
Leslie and the gang

Thanks, well so far I have the beginning a bit. So I will start to enter the last ones. I reduced sizes and put in yearly folders. So I may have to play around with these. So there are just a couple right now, but will try to get more up. I will leave them up though until I resubmit them in the beginning.

[molly muffin]

Just sending you, LuLu and family a Happy Thanksgiving day wish.
I'll be watching for those pictures!

Sharlene and Molly Muffin

[LabDad]

Happy Thanksgiving, Molly Muffin, Squirt's Mom and others. I have finished the life story album of Lulu for now. It shows her 11 year plus history with us. Enjoy!

http://www.k9cushings.com/forum/album.php?albumid=561

[Squirt's Mom]

Those are great! You have some really beautiful shots there, Dad, and some precious memories for sure.

Hugs,
Leslie and the gang

[LabDad]

Thanks Squirt's mom on the pictures. I have not posted here in a while and just an update on Lulu. Her urinary tract infection is cleared up! Dr. Booth agreed with giving her adequan every three weeks. He also agreed that she can be tested anytime again for Trilostane levels. We will try to schedule this probably after the holidays, as that will be over three months. Lulu does get up better and still has a bit of trouble lying down. She is skinnier, but has kept her 68 lb. weight over the last month. I have increased her canned dog food in the morning at least, and she has been eating most of her food.

We keep a flashing red light on her, turn it on when we put her out at night. She has had this since she was a puppy and it still flashes. I will get two new hearing aid size batteries for it today I think. So if you have a Cushing's dog or any older dog, it's not a bad idea, because if your dog is like Lulu and likes to tromp in the weeds, sometimes they can get caught, and it just makes it easier to find them.

Our two cats are doing better. Both had urinary problems, one pancreatitis and one with urinary tract infection.

[labblab]

Thanks so much for the update, and I'm so glad that all three of your kids are doing better! I just looked at Lulu's album and Leslie is so right -- they are indeed beautiful shots and precious memories. Lulu sure hit the jackpot the day she appeared on your doorstep! What a lucky girl, but I know you feel so lucky, too. She is so special. :)

Keep up the good work, and please let us know how things develop with the January testing.

Best wishes!
Marianne

[LabDad]

Lulu is doing quite well, she is getting up on her own, most of the time. I have her getting adequan every three weeks, I think I notice an improvement. She did have a setback as her stools had clostridium bacteria and rods (bacteria infection). So she is back on antibiotics and the stools have formed. She had a couple of accidents in the kitchen, but she couldn't help it. And she does warn us, but it kept us busy! I will add a couple of pictures of her in the snow to her album.

[molly muffin]

I love LuLu's life album. :) It's good to hear that she is still doing well and enjoying the snow she loves.

Sharlene and Molly Muffin

[NoonelovesmelikeNorman]

Hello Dad of Lulu,

Happy you found a good Vet you trust and that you have found this site...I feel so fortunate for this site. So many days I spent hours on this site and found great support.
I love my Noman and no one loves me like him, but we also have a lab and have to say I beleive labs are the best dogs in the world....Our Raven (joe's) I beleive is precussioning as well and has lumps on her chest. Joe's finacial sitaution is worse than mine. Plus he just had a heart attack, 3 stents put in and has 3 more arteries to have opened. He will be off work for some time which might mean losing his home..more stress, but not going there....Joe is alive, and so are our puppies...feeling blessed for every moment.

All I know is that we love are animals and are more and more appreciative of them in every way, every day. The night Joe had his heart attack, Raven an excellent walker, kept stopping and wanting to turn around...like she knew something wasnt good with Joe. Best dog in the world she is. ; )

Wishing you the best with Lulu your beautiful lab!

Sharon and Norman

[LabDad]

Just a quick note, Lulu's diarrhea is gone, hopefully stays gone this time. She is going in for her Cushing's test today (4-8 hours). :)

[labblab]

Good luck with the testing, and we'll be really anxious to hear the results!

Marianne

[LabDad]

They did the two hour test, hardly had chance to get a cup of coffee and read on my Kindle. She is pooped today, I usually notice that her mood is a bit different. She has lost 2.5 lb since two and half weeks ago. So I went and bought some boneless chicken breasts. She was about 62 lb, where she had been at 65 lb.

Results should be back within a couple of days.

[molly muffin]

Crossing fingers for good results!!!!

Sharlene and Molly Muffin

[Harley PoMMom]

All fingers and paws crossed here too!

[LabDad]

Dr. Booth called with the results but I forgot to get the values and their computers didn't update tonight. But Dr. Booth said that probably because Lulu's weight has gone down, and she is 62 lb now, where when she started treatment she was about 86 lb, but a bit chubby.

He said that her values were off enough that he was concerned because her adrenals could be suppressed too much and didn't want her to go into Addison's Disease. So he is reducing her dosage of Trilostane to 75 mg from 100 mg. I won't get the new pills till Tuesday though.

Lulu seems pretty good tonight, more energy than yesterday!

[addy]

Hi,

Let us know when you get the results. If you are not getting the new dose until Tuesday, you arent giving the old dose until then are you? Just worried about that.:o:o:o:o You know me, Miss worrywart.:):);):rolleyes:

Give Lulu a happy pat from me.

[LabDad]

I asked about taking a bit of the powder out of the capsule, but Dr. Booth said it would be okay to give until I get the new dose. What else could I do? You know if I had a accurate scale I would be tempted to try to weigh out the difference.

I used to work in chemistry, but I don't have that accurate a scale. I looked at the capsules and I don't know how easy to remove part.

I just don't want to jeopardize her health! I am open to suggestions though!

[frijole]

The manufacturer specifically states NOT to open the capsules. Please don't even think about. They should put this in BIG letters on the bottle. We get asked this so often.

Lulu will be fine waiting a few days because if her cortisol is low to the point of being Addisonian that means she is really low and it will do her good to be off for a few days. That is perhaps why she seems better today.

Please do get those important test result numbers so we can take a look ok? Thank you! Kim

[LabDad]

Will do, too late now to get the results as they run the show this late as an emergency room. Will find out tomorrow.

But frijole are you suggesting that I stop her medication until I get the new pills?

Dr. Booth didn't say to do that. He wants to have her on the new medicine and then repeat the test in 30 days.

[frijole]

OK I want to make sure we are on the same page ... you are waiting for pills that are a smaller dose right? (because your vet is concerned she's addisonian) I am assuming that the pills you have on hand are the higher dose right? If so I would NOT give a full dose because then you are just ASKING to go Addisonian (lower cortisol even more).

If you are giving two pills a day you could give one vs two but you cannot use a portion of a capsule.

Please confirm that I have this right because I don't want to mislead you if I am wrong. Thanks! Kim

[LabDad]

I give Lulu one 100 mg. capsule every morning. I don't want to wait until Tue. or Wed. for the new pills to be in. Dr. Booth said she should be fine until then.

Correction. I don't want to just stop giving Lulu her pills until Tue or Wed. The vet didn't say she was in Addison's just that she is lower.

[frijole]

OK. You said:

He said that her values were off enough that he was concerned because her adrenals could be suppressed too much and didn't want her to go into Addison's Disease. So he is reducing her dosage of Trilostane to 75 mg from 100 mg. I won't get the new pills till Tuesday though.

If Lulu's values are low and she's had diarrhea then she could in fact be close to addisonian and giving her the higher dose four more days could send her even lower.

What I would do depends entirely on the test results. If the 2nd number on the test is between a 1.0 and a 2.0 then I would find a way to speak to the vet because frankly I would not risk her going any lower and going Addisonian. If her test result is higher than that then I'd chance the four more days at the higher dose but I would watch her like a hawk. That means going outside with her everytime so you can SEE her poop to make sure it isn't diarrhea. If it is - withhold the drug.

This is why the vet wants to lower the dose. (to avoid going low) Giving the higher dose scares me if her cortisol is already too low. That is why it is so important to get those numbers.

So call the vet in the a.m. and get the numbers from the test from the front desk. Tell them it is important and you need them right away. If they are low then try to get the vet on the phone so you can talk about skipping a couple days. I truly do not think it'll hurt anything. Her cortisol will go up a wee bit but frankly if she's low to the point you are changing the dose then it will probably HELP her not hurt her.

Does this make sense?

Thanks,
Kim

[milosmom]

just sending a thank you kim for keeping an eye and all that are here !!! patty (milo)meka xoxo

[frijole]

I give Lulu one 100 mg. capsule every morning. I don't want to wait until Tue. or Wed. for the new pills to be in. Dr. Booth said she should be fine until then.

Correction. I don't want to just stop giving Lulu her pills until Tue or Wed. The vet didn't say she was in Addison's just that she is lower.

I see your update. Just keep a close eye on those poops ok? also if she acts lethargic or vomits - cease and call the vet. We are worry warts! Kim

[frijole]

just sending a thank you kim for keeping an eye and all that are here !!! patty (milo)meka xoxo

No problem - I've been there and know it is scary. This forum saved my dog's life almost 8 yrs ago and I never left.

[LabDad]

I will call first thing in the morning. I can wait on giving her morning dose. I believe I forgot giving her a pill one morning a few months back, since I ended up having an extra day and I don't think the lab gave me any extras.

[LabDad]

She did have diarhea a bit ago and treated with antibiotics. Her poop today was a bit strained. I wouldn't call it diarhea, but she had a bit of problem going, from what I saw, doesn't mean she didn't go on her own. See you tomorrow. She's outside now, a slight rain and she's barking, she loves to bark at night.

[frijole]

Good luck. Glad she's out enjoying the rain and barking!! Good sign. :D Look forward to tomorrow's update.

[LabDad]

Okay, on the phone, the results are Pre: 1.2 and Post 0.8

Dr. Booth is at one of the satellite offices. The lady is faxing me a copy and the satellite office for Dr. Booth.

I am waiting giving Lulu a dose this morning and will call the satellite office when I'm sure the faxed results have been sent.

[frijole]

OK that is too low. Anything below 1.0 IS Addisonian. That doesn't mean it's permanent but continuation at the same level is just asking for that to happen.

How is Lulu acting? With those results we'd normally see extreme lethargy and inability to get up. Please do not give any more of the drug. A few days off will allow her cortisol to rise to levels that are acceptable.

I have to leave for work and am counting on others here to help you should you have more questions. Sending positive vibes your way. Kim

[frijole]

THe post number is the one that counts and it is below 1.0. The manufacturer would tell you to cease giving it fwiw.

[LabDad]

Well Lulu has up and down days. You know I think she has been a bit more not with it and of course down 3 lb. since 2 1/2 weeks ago. She is in good spirits and can get up, still has trouble lying down.

I think the last couple of days though she has been a bit more tired.

So you think that not having any trilostane until Wednesday, and then giving her the lower dose then won't shock her?

[addy]

Please do not give Lulu her Trilostane today.

Per Dechra:

< 1.45 Stop treatment. Re-start at a decreased dose
1.45 to 5.4 Continue on same dose
> 5.4 to 9.1 EITHER: Continue on current dose if clinical signs are well controlled
OR: Increase dose if clinical signs of hyperadrenocorticism are still evident*

> 9.1 Increase initial dose

As you can see, the manufacturer of Vetoryl clearly states any post under 1.45 stop treatment and restart at decreased dose. This would apply to compounded Trilostane as well.

[Squirt's Mom]

One thing I do like about Trilo (Vetoryl) is that it can be stopped and restarted easily with few, if any, adverse effects. It would be much worse on Lulu, and you, if her cortisol were to get too low...and there is always the possibility of permanently damaging the adrenals so that she becomes Addisonian. ;)

Much less risk associated with withhold the higher dose than giving it if she already getting too low...as it sounds she may be from the description of her behaviors.

Hugs,
Leslie and the gang

[LabDad]

Thanks, I will call the vet. I don't know if he will agree, but I think you all have the right info. The values for Vetoryl are the same then as trilostane?

[addy]

Yes, the values are the same. Vetoryl is just the brand name of Trilostane.

Perhaps your vet was just busy or miscommunicated somehow. My IMS has had to have a few refresher courses from me.;);)

[labblab]

Just wanted to pop in to tell you that I'm in agreement with the rest of the crew: if there's any doubt, it is better to withhold the medication than to administer it. I'm posting a link to the U.S. Product Insert for brandname Vetoryl:

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

You can read through their recommendations and warnings in conjunction with cortisol levels that have dropped too low. Perhaps Lulu's cortisol is not as low as we are fearing, and that is why your vet did not tell you to discontinue the dosing. But it is important to know for certain what that ACTH result was in order to know how to proceed.

Marianne

[LabDad]

Marianne, the pre I posted at 1.2 and the post at 0.8. I don't know the reference, but I haven't given Lulu her dose this morning.

Alternatively, I am going to ask Dr. Booth if he wants her on a reduced dose sooner, to see if I can get 3 or 4 pills from the local pharmacy we got them from in the beginning. They were more expensive than the Kentucky place, but I could run over there today if they could put together four pills.

[Squirt's Mom]

If those are the results of the most recent ACTH, she is toooo low and the med must be stopped and not restarted until signs are strong again and an ACTH shows the cortisol level is rising beyond the highest allowed for Trilo.

And no, the ranges for Lysodren and Trilostane (Vetoryl) are not the same, close but not the same.

Trilo (Vetoryl) =

http://www.dechra-us.com/files//dechraUSA/downloads/Client%20Literature/38965_Technical_Brochure.pdf

A positive response to therapy is regarded as an
improvement in clinical signs and a post-ACTH
serum cortisol concentration of between
1.45 μ/dL and 9.1 μ/dL (40-250 nmol/L). (The post of 9.1 u/dl is acceptable ONLY if ALL signs are well controlled.)

For Lysodren =

http://www.k9cushings.com/forum/showthread.php?t=181

The recommended target range for good control of the cortisol production is a result of 1-5 ug/dl for both the pre and post ACTH stimulation test numbers

Hope this helps...and again do not give any more Trilo of any dose if those numbers are from Lulu's most recent ACTH.

Hugs,
Leslie and the gang

PS. You might want to print this chart off and show it to your vet. ;)

[LabDad]

Dr. Booth called and he was convinced :) with you all, and I will wait until the new reduced dosage pills come in. Thank you all.

[labblab]

I'm sorry -- I missed seeing your earlier post with the test results. In this case, you really do need to stop the trilostane entirely for the moment. Here's the related portion of Dechra's dosing instructions:


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

So simply lowering the dose is not enough right now -- Lulu should first have a "break" from the medication in order to allow her adrenal reserves to regenerate. Also, if she continues to act "off," she really should have a blood sample drawn to check her "electrolytes" (the blood chemistries that relate to the ratio of potassium, sodium, etc.,) since steroid levels that are too low can throw off this balance.

Marianne

P.S. We were posting at the same time. I'm really glad that Dr. Booth has agreed to hold off on the trilostane for the time being.

[Squirt's Mom]

I want to be absolutely sure you understand -

DO NOT restart the lower dose Trilo when you get it. Lulu needs to be showing strong signs and have an ACTH that shows the cortisol is rising beyond the acceptable level BEFORE starting the new lower dose. ;)

Vets often approach Trilo (Vetoryl) thinking it is safe - it is NOT safe. It has the exact same potential risks as Lysodren and must be treated accordingly. Playing willy nilly with dosing and testing can lead to serious, permanent issues with both drugs. ;)

[Jenny & Judi in MN]

My Jenny went Addisonian from too much Lysodren. She hasn't had any Cushings meds since April 2012 and was on prednisone until August 2012.

Her cortisol is slowly increasing and her specialist said he doesn't want us to let it get out of control making her uncomfortable, but he wouldn't even consider giving her any cushings meds until her post #'s are over 2.0 (I'm thinking higher but we'll cross that bridge when we come to it)

glad your vet agreed to stop the trilo. I have to say it's been a nice mental break not worrying about the cushings meds for awhile.

[LabDad]

Thanks all. I have printed some of this. And I will print the PDF too on Vetoryl.

I am thinking of calling where Dr. Booth is today, since I could just swing by the satellite office with Lulu and have her electrolytes tested. But maybe it's best to just wait and see how she does. She is peeing okay, and her stool on this morning's walk was firm.

[frijole]

Whew... checked in to make sure all was ok... I had to run this am. Thanks everyone for helping out where I left off. I didn't have time to search for the Dechra acth recommendations. Good job.

Dad - you are doing great. Like Leslie said - it isn't just a matter of waiting 4 days. We need to wait until the cortisol has risen to a certain level and that will require another acth test and some time. Glad Lulu is doing well. Kim

[LabDad]

Well Lulu made it through the day. I took her with me, had to go the bank branch and then decided to go main branch, long story so will spare the details. Foggy, but went to where I completed a work project to get some money, and the owner asked if he could pay me part. I said okay as long as I could cash at his bank. Then he asked if I was going to tidy up the project like I said I could. I did for two hours, and went and walked Lulu after an hour. She peed a couple of times and went back in truck. I have water in the truck for her and stopped at convenience store to get some cheese nips for her to tide her over till home.

Now she is a bit hungrier this evening, seems more alive. She does get this way in the evenings though.

I don't know if they shipped the reduced dosage pills as they needed a new payment card and I hadn't given it to them. I might get it with a bill, but want to discuss with Dr. Booth what you all on the forum have suggested. It does make sense, I just don't want her to be ravenous again, but maybe that is her nature at times?

[molly muffin]

Whew! I am so glad the gang was here to help with LuLu's results yesterday and today. No idea How I missed yesterdays post but I swear I almost had heart failure :eek: while catching up on the goings on this evening! (we probably need a fanning yourself while swooning icon)

Worry warts indeed. :) Definitely have a chat with your vet, but I wouldn't start anything until you see that POST number come up a bit. It might even be that if she has more symptoms at night that you would consider going to a twice a day dosing, but that again, is something to talk with your vet about.

So glad that today was okay. (now no more near miss heart attacks on the forum. I'm getting older you know!) :eek: :D

Sharlene and Molly Muffin

[addy]

Let us know how things are going when you can:)

[LabDad]

Hi Addy and others. Lulu is doing fine today. She shows her hunger at the meal table. She has us trained. She is pretty good, but reminds us that she is allowed a bit of table food.

This has been day two without her trilostane. I don't know how long we should wait before she is retested, but we are taking this just one day at a time.

[Skye]

I am not certain of weather conditions in your area.....but i feel i need to at least mention couple of things that caught my attention......cheese nips contain quite alot of salt which can really throw things off balance and the other is leaving her in car unattended. For many reasons and all being for her safety.....including safety from other people. I so hope all is well, and she is doing okay.

[LabDad]

No worries, it wasn't hot. I came out after an hour and walked her around and then worked another hour. Could have stayed longer but didn't. The mixture a bit salty. She likes some salt, but she doesn't get an over abudance. I just didn't want her starving.

[LabDad]

I am going to put a call in today to Dr. Booth, not sure where he's at today. But I will tell him that the general (wise) consensus is to wait until her levels go above normal.

Is 30 days a good time period to wait for a retest?

[labblab]

If Lulu were my dog, I think I'd let her symptoms determine how soon you retest. If her Cushing's symptoms start really kicking in again quickly, I would want to go ahead and recheck her so that you can resume dosing if her cortisol is rising again rapidly. But on the other hand, I wouldn't rush to recheck if her symptoms seem to stay under control for a lengthy time period. This is one situation where I'd let her symptoms really "call the shots" in terms of testing/treating.

Marianne

[Jenny & Judi in MN]

I am going to put a call in today to Dr. Booth, not sure where he's at today. But I will tell him that the general (wise) consensus is to wait until her levels go above normal.

Is 30 days a good time period to wait for a retest?

when Jenny saw the specialist after becoming Addisonian, he recommended a few weeks at a minimum but like Marianne said, he was most concerned with her symptoms. He doesn't want her to have raging cushings again.

That was last April. I tested her in August and will be partially testing her tomorrow. She hasn't had any symptoms.

So yes, at least a month pending any symptoms.

[LabDad]

Thanks, Jenny, Judi & Marianne,

Sounds good. I will just monitor Lulu's symptoms.

[LabDad]

Just got the notice that the reduced 75 mg pills have been sent, though I hadn't authorized payment. I had to change credit cards, so the one they tried to charge was closed. But I told the Kentucky company to call me first telling them that I would have to give them another card.

I told them I might send the pills back, because they are 88 dollars. They said they would keep for a year, so I wonder if I should just hang on to them and if so keep them in the refrigerator or just room temperature. I am thinking that Lulu's cortisol levels will eventually go up?

[Jenny & Judi in MN]

you just don't know
in April 2012 Jenny's pre and post were .2 & .3
In August 2012 they were .8 & 1.0
Here it is January 2013 and she hasn't had any cushings meds for 9 months

But I don't think Belinda's Bo's levels ever came up. $88 is a lot of money. I'd cancel if I were you. You can always place an order later.

Judi

[frijole]

I agree... you don't know so I'd have them cancel the order if you still can. You can always order again. And the dose might be even lower... let the symptoms determine the next step. Kim

[addy]

Hi,

You sure are getting lots of good advice.:D:D I hope Lulu is ok so far. Have you talked to Dr. Booth at all? Just wondered. Sometimes the pups bounce back faster from going to low from Trilostane compared to Lysodren, but you just never know.

Give Lulu a big hug from me:D:D:D

[LabDad]

Hi all,

I greatly appreciate all the help. I told Dr. Booth I would see that he gets the website address, plus I know at least one other veterinarian that I am going to send this site too. You see many of the vets with high volume practices only see a handful of Cushing's cases. And the info is out there, but they can't possibly know it all. Dr. Booth seemed eager to get the site, he said give it to the office and they will put it in his notebook.

Yes, Dr. Booth agreed, and said let's check her in a couple of weeks. Another doc. we know suggested a month.

Lulu is doing well. For a bit she didn't seem interested in food about half an hour ago. But then she did eat a biscuit that was by her foot, and I gave her a small bit of chicken which she gladly ate.

She can be funny, and I have noticed that when dogs get older their personalities can change just like people. She seems to be doing well.

I want her to gain a bit of weight, though my wife likes her weight. You can feel her back with and the bone above her head with her skinnier physique. But I think some weight should come back if she is a bit hungrier. Now I did notice that she was pretty hungry late afternoon.

[LabDad]

Lulu seems to be not as hungry tonight. She did eat a treat and she doesn't turn down chicken or ham. She did try to get up the stairs by herself and fell back a step, so she might have hurt herself a bit. She has been able to get around, but I think she is tired tonight. Will keep an eye on her.

Will keep an eye on her through the night as I usually do. But she was pretty active this evening so it may just be that she wanted to go to bed early and occasionally will go up early. I don't usually help her up till close to 11, since she likes to be where the family is.

Going to get her a small piece of ham and then retire.

[LabDad]

Lulu doesn't feel as well today. She did fall on the steps going up to bed, early last night. I had to help her up. I think she may have slid down a couple of steps. They are carpeted.

This morning she did come down the stairs with my help, but she was bit hesitant. She went outside but after a while she lied down. She does this when she's tired. And she has a bit more trouble lying down, though she can get up.

I got her to eat only some soft food, like chicken, rice, ham and some canned dog food. She wouldn't touch her dry food, her treats or her pills. Now she did eat one meaty bone treat.

I think I will call the vet. I don't know if this would be a sign of Addison's or just that she hurt herself?

She was fairly active yesterday afternoon, and wanting food from us, which is typically normal for her.

So I thought I would post this. She does appear to be comfortable.

[Squirt's Mom]

Morning,

Yes, I would have her checked out asap. She may have hurt her legs in the fall and / or the cortisol may be too low still. Be sure they check her electrolytes, not just the cortisol. And do NOT let them tell you she needs back on the Trilo - with this behavior, the med would have been stopped for a bit anyway. ;)

Please let us know what you learn and remember that not everything that happens with a cush pup is related to Cushing's so don't let the vets get tunnel vision. ;)

Hugs,
Leslie and the gang

[LabDad]

We have decided to go to vet at about 3 pm, five hours from now, or earlier. Dr. Booth will be the ER doctor at 5:30 pm and they expect a couple hour wait then. So we figure we would get there at 4:30 pm and then just wait until he comes on staff.

Lulu is resting well, she can get up and did so when my wife, Linda (a.k.a. Moo) gave her some chicken and rice. She just perked up when Moo came down. So I think she will be okay and we can see the doctor of our choice, even though it will cost us 12 dollars more for the ER charge.

[gummysmurf]

I agree with Squirt's mom on this one. The lack of interest in food, overall tiredness, trouble with stairs - these are all things that happened to my dog when he was very very sick. He would perk up a bit and I'd think I was over reacting, but then he'd feel bad again. So now I'm of the opinion that it's better to be safe than sorry.

You know, I used to worry about Baxter's weight a lot with the cushings, but once he got cancer I was so grateful for the little bit of chub. And thank goodness for cushings that keep our doggies with a healthy appetite even when they are going through some rough times.

[LabDad]

Lulu seems to holding her own. I have her in the basement and going to use the treadmill, she loves the basement. She is alert and can get up and walk outside and pee. I think she did either pull a muscle or otherwise hurt her leg. She will be fine till we leave this afternoon. It has been hectic, as I mentioned bank before, we had a serious break-in and of course the other stressful things.

We will do a short bit of shopping, most for Lulu and stop at my contract job, for money they owe and to touch base.

Lulu comes first for us, but it's been a struggle and I think one of my quotes shows that I am up to it. At least I hope so.

So see you on the other side of the treadmill!

[addy]

Okay, I am glad she seems better. Let us know what happens with Dr. Booth. I wonder if you should have some prednisone on hand just in case. Some vets will give it to us, some refuse. Maybe ask to see what his feelings are about it.

[LabDad]

I am going to ask Dr. Booth about prednisone. I should have some. It saved my life 30 years ago.

Yes, Lulu ate my wife's rice, spinach and something else, a very yummy and low-calorie soup. She added some chicken for Lulu, Moo is a vegetarian. Great recipe

Lulu seems in better spirits, she sat outside while I treadmilled, and then I brought her in with me, and then we both walked out the basement door up the hill to the kitchen for lunch. Now I am back in the basement to shower and get ready to take her to the vet.

[molly muffin]

Checking in on Lulu, glad she had something to eat. Low cortisol just makes them feel rough around the edges and so I hope that is all it is, but just in case, stick with the chicken and low fat food, don't want to get her pancreas upset.

hugs,
Sharlene and Molly Muffin

[LabDad]

Lulu has regained some of her spunk. Dr. Booth thinks she just had a fall which caused her some stress. He ran some labs. The electrolytes are okay. Her AlkP is high, but that is typical with Cushings. But the number was pretty high. I had a very high value when I had Ulcerative Colitits years ago, but it has been normal since.

http://www.k9cushings.com/forum/album.php?albumid=596&pictureid=4519


Lulu is glad to be home and her appetite has improved.

[addy]

BIG SIGH OF RELIEF ICON:D:D:D:D:D

Sometimes we see that number in the thousands. Glad to hear Lulu has improved.

[molly muffin]

Very glad to hear that Lulu has regained some of her spunk. I wonder if the higher number on the AKLP might have something to do with the cortisol dropping low.

Sharlene and molly muffin

[LabDad]

Sharlene,

I am going to see if I can't get all of Lulu's lab results from the past years. Her liver enzymes have been up before, and I believe the first time was back in 2006 or 2007. This would have been after her ACL surgeries as I believe the Romeo Vet Clinic did the tests. We started using them more after the surgery because their lab costs were surprisingly cheaper than our closer Port Huron vet. Her liver enzyme values then came down. She may have had the start of Cushing's Disease then!

Since our Port Huron vet retired we have pretty much moved her care to them.

Lulu has been fine today. She walked a bit, but was reluctant to even meet her neighbor dog Bella, a cute Jack Russell Terrier. They became great friends over two years ago, when Bella was still under a year old. Those two would play tug-a-war. If I find the short videos I will post them. I do have a video of Lulu opening one of her Christmas gifts. I will post the link. I have uploaded the files so I will just have to create a webpage to point to them.

[addy]

Hi,
I was poking around DVM 360 and I came across an article which discussed low cortsiol concentrations with Trilostane. I thought I would post the link for you. I have always thought this to be a trustworthy source but if it is not I am hoping one of our administrators will tell us.

http://veterinarymedicine.dvm360.com/vetmed/article/articleDetail.jsp?id=491107&sk=&date=&pageID=3


If the cortisol concentration is below 0.7 μg/dl, withhold trilostane until signs of hyperadrenocorticism recur, and closely monitor the patient for signs of hypocortisolemia. If the post-ACTH stimulation cortisol concentration is 0.7 to 1.5 μg/dl, suspend therapy for 48 hours, and then restart it with a 50% dose reduction.

Perhaps Lulu will only need half of her 100mgs which would mean only 50mgs.

[LabDad]

Interesting study, Addy. Thanks. I am at the point now to wait and retest in the next couple of weeks or so. But to watch Lulu. Too bad it takes time to get the trilostane if it's mailed, since I try to keep the costs down too.

[labblab]

Just wanted to pop in with my two cents worth. Addy, I also rely on that publication -- DVM360 -- for lots of excellent resource info. And Dr. Audrey Cook is a distinguished veterinary endocrinologist who is a faculty member at Texas A & M and also a consultant to Dechra. She is the researcher who has been studying possible use of baseline cortisol as a monitoring tool for trilostane treatment.

Having said all that, my only reservation about this article is that it was printed in 2008. There has been a lot of water under the bridge, so to speak, during the intervening years re: trilostane dosing and monitoring. So even though the source of this info is highly credible, I'd want to see whether Dr. Cook has updated her recommendations in recent years. At the time of that article, I think the general initial dosing recommendations were higher and also there was less awareness of trilostane's potential for more lasting impact on adrenal function.

It may be the case that Dr. Cook is still making this same recommendation. To our frustration, it is definitely the case that different researchers and specialists have different preferences regarding trilostane treatment. But in terms of this specific recommendation, I'd feel more comfortable if I saw it in a more current publication.

Marianne

[LabDad]

Thanks Marianne.

I gave Dr. Booth the URL of this forum, too. I plan to give a Dr. Geiger this address, he is a country vet that we take our cats to. He was very interested in Lulu's Cushing. He said he is treating about 4 or 5 dogs now. His clients don't have a lot of money, so until recently I don't think people treated the disease in his area.

[addy]

Thanks Marianne, I did think about the date but then it also seemed to correspond to how Dr. Peterson handled Cindy's Penny when she went too low but perhaps my memory is faulty on that;)

I'm glad to know the site is valid. I have used it quite a bit over the years.

[labblab]

Addy, you may very well be right in your memory about Dr. Peterson. You know, since there do seem to be differing recommendations, it would be great if we could find the time to hunt up and consolidate everybody's advice in one spot. That wouldn't necessarily give us the "definitive" answer, but it would be interesting to see how the opinions overlap (or not). Maybe a good project for us to tackle at some point!

[Harley PoMMom]

This article is pretty new (12/10/2012) from Dr Peterson:
When using trilostane, it has become increasing clear that we do not want the cortisol values to drop too low, because that may indicate early or mild adrenal necrosis (1,11,12). In contrast to the protocol used in this reported study, I recommend stopping the drug in all dogs that develop a ACTH-stimulated cortisol values less than 2.0 μg/dl, and repeating the ACTH stimulation test in 1- to 2-weeks in those dogs. Some of these dogs will require that the drug be restarted at a lower dosage, but others will maintain low to normal serum cortisol concentrations for prolonged periods of time. And a subset of these dogs, presumably because of mild adrenal necrosis, will never need any further trilostane treatment to control the signs of Cushing's syndrome.

Low-Dose, Twice-Daily Trilostane Treatment for Dogs with Hyperadrenocorticism (http://endocrinevet.blogspot.com/2012/12/low-dose-twice-daily-trilostane.html)

[LabDad]

Pretty good information from Dr. Peterson. So Dr. Booth was right in saying to repeat the ACTH in a couple of weeks.

[addy]

makes you feel better,huh?:):):):):):):)

You know, we live and breathe one disease and we cant keep it all up to date so can you imagine, really, how hard it must be to stay up to date on all diseases and conditions as our vets must? My IMS totally forgot Dechra said post stims up to 9.2 ug/dl were ok if symtpoms were well controlled. I could not fault her for that and at least she listened to me and admitted that she forgot. Half the battle, ya know?;)

Hang in there, you are doing great!!!

P.S. GREAT FIND LORI :)

[LabDad]

Look at Lulu's new outfit! The handle work great for helping up stairs.

http://www.k9cushings.com/forum/album.php?albumid=561&pictureid=4534

[frijole]

:D:D:D I love that doggy smile. She knows she is looking good in that new shirt. Actually that looks like quite a good invention. I've never seen those before. Kim

[Jenny & Judi in MN]

what a very cool idea! Lulu looks great! Red suits her :)

[addy]

thats one happy looking little girl, very cool handle:):):)

[molly muffin]

Pretty spiffy outfit there Lulu!

Sharlene and Molly Muffin

[labblab]

Wow!!! That is a great shirt!! May I ask who makes it so that other readers who could use a "hand" :) with their dogs can track it down?

Marianne

[LabDad]

We got it as a gift. Ruffwear, www.ruffwear.com. We returned medium size, just a tad too tight. Went for the large size. Lulu weighs now about 63 lbs. It does cost 60 dollars, but is of pretty rugged construction.

[molly muffin]

Hi, just checking in real quick to see how Lulu is doing. :)

Sharlene and Molly Muffin

[LabDad]

Lulu is doing okay. She seems to be progressing but she is quiet at times then boisterous other times. We do try to take her coat off each day for a while. I don't want her to ue it as a crutch, but I do like the fact we can help her up stairs. On my Droid so will say more later.

[LabDad]

We took Lulu to the vet today. She has had a cough, as if she had something lodged, then I thought maybe she got kennel cough. And she hadn't had a booster shot in a while, probably a year and a half. So the doctor put her on Doxycycline capsules and cough tablets. She is resting pretty good.

Dr. Booth said her heart and lungs sound fine. Lulu was glad to leave as we had her soft bed and a favorite toy. She grabbed the stuffed toy from my hand as she got ready to leave, which tickled me!

I think she feels a bit better and is sleeping, so maybe the antibiotics are making her a big groggy.

Oh Lulu was up 2 1/2 lb, so that is good as we think she was a bit too skinny. And my wife noticed that where she had surgery on her abdomen a year and a half ago, that the fur is finally start to grow back again. It started to grow back after surgery and just stopped. We have attributed this perhaps to her Cushing Disease. We aren't sure if it is growing back because of her disease being more in remission?

[NoonelovesmelikeNorman]

Hi There! I just read over a bunch of Lulu's history. Happy she is doing better, boy, she has been through a lot. Happy she gained a couple of pounds after losing so much.

Wishing her continued progression of healthier days and weeks ahead.

Peace, Sharon and Norman

[molly muffin]

When the Post cortisol number is below 5, which with Lulu's it did go low, then once that cortisol isn't so high, the hair will go through regular growth cycles again. At least that seems to be the consensus of what might be happening. We've seen it many times on the forum.
Worrying about the cough. Glad the heart looks okay, that is good. So, hope she gets over this.
What about allergies?

Sharlene and Molly Muffin

[Simba's Mom]

Hoping Lulu feels better soon, cute story grabbing the toy saying lets go, aw our pups are so special. Take care!

[LabDad]

Thanks all on concern and insight. Sharlene, I guess it's possible that allergies could play a part. I don't know. We did get Lulu some compressed rawhides to chew on. But we supervise these. She chewed for a while and then stopped. I think the cough and the antibiotics had her tired last evening. She ate breakfast, but she wanted to go out first this morning. She usually is a bit hungrier. But she ate her food and then drank some water. I have gone back to powder Metamucil giving her a couple of teaspoons, one at breakfast.

[SoggyDoggy]

How cute, grabs the toy to urge you out the door. Sweetie! The antibiotics may have upset her tummy is she has only just gone off her food. If this might be the case, probiotics work, or even a good yoghurt with high acidophilus content - if she will eat it that is. Some dogs like yoghurt and it can sure help to ease the effect of the antibiotics on the GI tract.

[LabDad]

Thanks Naomi, I think we have some Greek yogurt in the refrigerator. She likes yogurt.

[SoggyDoggy]

It's worth the try at least. If the Anti-B's are upsetting her, it is a potential quick, easy and for a change, cheap solution. :D Good luck, hope it is something simple for once for you! Poor old girl, she has been through it for sure! I do love the vest you bought her though, very innovative!

[LabDad]

well she wouldn't touch the yogurt all afternoon. So she went and chewed on one of the rawhides we got her late this afternoon and lo and behold she lapped up the yogurt. She is feeling a bit better, and looks a bit more alert. And though she didn't walk as far, she was tired and when the neighbor dog, a ways off she wanted to see, they only got within 20 feet. But you know Dr. Booth said it might be a good idea to keep her from other dogs, if she has kennel cough, so I will have to remember that. She had a good pooh, though earlier she was straining, so the metamucil is working. :)

[molly muffin]

Well, a couple things are working then. Glad Naomi thought to recommend the yogurt! That should help with the tummy.
As long as they are interested in the rawhide, it's a good sign. :)

Sharlene

[LabDad]

Lulu obviously wasn't feeling well early this morning and prodded me to take her out early. I did, she came back in and slept very well. She wasn't real hungry this morning but ate most her food. She got her Tramadol, cough suppressant and two antibiotic capsules. Then she threw up about half hour later or so.

I did notice a bit of her rawhide and a slight bit of bone, as if it was chicken bone, not sure. We just give her chicken. Now my wife said maybe it was a part of the bone I took away from her six days ago. And we thought she might have swallowed a fragment. She is an agressive chewer, and I make sure she gets just the toughest things. But I slipped and she made a dent in the bone, and then I took away and any fragments I could get from her.

She had a slight bit of blood in the last part in mucus, something like you might have after a bad cough. But that is all.

So we are going to put her back on a bland diet today, chicken & rice. She seems a bit better after throwing up. I did notice that she still occasionally has a muffled cough, but it's infrequent.

I thought of giving her an extra antibiotic capsule, just in case she didn't get it all in her system. She has enough for 12 days. But I probably will wait until 5 pm and give her, her evening dose then.

[addy]

Hi,

Rawhides can cause loose stools and if Lulu chews like my Zoe, maybe the rawhides are not a good idea if she is breaking pieces off. The antibiotics can definitely bother their tummy. If she wont eat yogurt you could try a probiotic if she will take a pill. But you have to give the probiotic maybe 2-4 hours before or after the antibiotic, so maybe in the middle of the doses. I use Gentle Digest by Arc Naturals. You should be able to find it locally at a pet store.

Just another thought:):):):)

Hope Lulu feels better soon.

[LabDad]

Thanks Addy,

I will look for when I am out.

[molly muffin]

Keeping a watch on you guys. :) See if she does any better on the bland diet and keep her there for a few days. I wouldn't give her any more rawhides for right now. Just so that nothing that is hard on her digestive system is getting in there.

Sharlene and Molly Muffin

[LabDad]

Lulu doing much better this evening. Her appetite is good.

[addy]

Yippie, that is the kind of news we like to hear:D:D:D:D:D:D

[Harley PoMMom]

So very happy to hear this great news....Go Lulu!!!

[molly muffin]

Awesome! Keep it up Lulu

Sharlene and Molly Muffin

[SoggyDoggy]

Whew! That's excellent news! Well done Dad!

[LabDad]

Thanks all, this forum has been extremely helpful. Lulu ate her breakfast. She wasn't overly hungry acting but she cleaned out her bowl.

[molly muffin]

Yay! Just keep LuLu on that bland diet for awhile and nothing too harsh to her GI tract. It does sound like she is doing better. How are her energy levels?

Sharlene and Molly Muffin

[addy]

That's our girl!!!!!! Keep up the goood work, Dad:D:D:D:D:D

[LabDad]

Yes, Lulu's appetite is still there, especially protein like chicken, ham & hamburger. I still am concerned about her cough. Dr. Booth said her lungs and heart sounded good. I suspect a kennel cough and I think Dr. Booth thought it possible, and had us take her out of the lobby when we paid, as to not give any other dogs kennel cough.

She has had a bit more eye discharge I have noticed, and she has had this before. Occasionally she will have a drop on her nose, and I noticed both of these two symptoms this morning. The eye discharge I have noticed the last two or three days. So I am thinking that she has kennel cough. She got this two years ago when she was being treated for Cushings then. And I don't believe she has had Bordetella vaccine in at least a year now.

So her energy level has been lower the last three days. She usually gets a burst in the late afternoon and she did yesterday. Will watch today. She has the last few days liked to go outside and lie in the light snow. Her temperature was normal at the Vet's

I remember when she had kennel cough two years ago, it took a bit of time, and I think the vet then gave her some antibiotics too. So we are hoping that she gets more of her energy back soon.

[molly muffin]

Molly got kennel cough from a doggie day care once and it scared the bejeebes out of me. That hacking cough, labored breathing just had me in a panic for days before it became just a cough every now and then. I was really relieved that she got over that and I never took her near that place again. She has stayed over with them for a week I think it was, while we were out of the country, visiting family in the US. I know it can be very taxing on their systems.
Some dogs do like the cold. My golden retriever Loved it. The water, the cold, anything outside she was ready to go. Of course her down time she wanted to be inside snuggled up, preferably in your lap, but she'd settle for on the couch next to you or practically on your feet. (bit much to have a retriever on your lap after puppy stage has passed) Sounds like LuLu is a typical retriever in that she likes those same things. Every one I've known as been like that and snow seems to be a particularly fun playground for them in the winter. All kinds of activities can be had in the snow!! :)
You're doing awesome with Lulu, you and your wife are just super great with her. I'm looking forward to hearing that she is getting over this cough and back to our normal lulu once again. (and we are still keeping an eye on those cortisol levels too. :) ) don't think I'd forgotten that!!

Sharlene and Molly Muffin

[LabDad]

Hi all, well Lulu was a bit bloated in the abdomen last night, we unfastened her bottom harness for the night. She slept comfortably, with just a slight panting at about 4 this morning. I turned on a fan we keep near the window on low for her. That worked.

This morning I got her some rice & chicken to warm up but decided to wait to see if she was very hungry. I put her antibiotics out, but wanted to wait on those to.

So I brought Lulu down and she wanted by the door. I was ready with flashlight. She poohed, nicely, and that is all she wanted to do. So I think she knew she needed to go. She is inside comfortable, and I took her harness off for now and put her collar back on. I may need to adjust it slightly so it isn't too tense.

I am happy that she has poohed twice, and much normal. So I figure she will need to go again and I will feed her shortly. I think maybe we gave her too many small meals yesterday and her energy level is definitively down, due to her cough.

She hasn't coughed alot, though I did hear her after I helped her down the stairs.

[SoggyDoggy]

Both my boys had a strain of kennel cough a few weeks ago. It was actually the normal strain that goes around as they are both vaccinated, but there is somethign really potent going around here at the moment. Apparently the vets have been inundated - I took them in 2x in 3 days :o. Anyway, it really knocked them flat for a good week or so, both on metacam and Fraser on anti-biotics too. Fraser didn't cough at all with it, just hurked a bit of phlegm and he was really congested (hence the anti-b's). But he got through it and so will Lulu. With some good rest, she will let you know when she is feeling better. It is a worry though when they don't feel right, you just want to make them better!

[LabDad]

I posted a couple of x-rays of Lulu. http://www.k9cushings.com/forum/album.php?do=editpictures&albumid=596&pictureids What a day. I did have a good job interview on my end today and another one on Friday.

Lulu had a bit of a hard time walking with her front left leg. Finally carried her in. We didn't know if she had injured it or could it have been a stroke. Dr. Booth said it doesn't appear neurological as she was able to put her foot back when he moved it. She does seem to be able to walk okay at first, it just seems to bother her and cause her to limp after being on it a while. Will be with her tomorrow both of us to watch her. My wife tried to get her up the ramp and Lulu slipped. I got out to help, though I just had my treadmill shorts on. We don't think she injured her leg, and the vet, x-rayed her and said it looked fine. But we have to take her out to go pee and not exert herself. He gave her stronger antibiotics, some Azithromycin 250 mg tablet twice a day. He x-rayed her lungs and said it is not as dark as normal, which could be what is termed 'old dog lung' . Now he showed us her heart and said it was slightly enlarged. But he thought that the antibiotics might clear up the cough, and see him in two weeks if it did, earlier if not. We took her to Dr. Booth's closer place since he was at a satellite office and that was 10 miles closer for us.

We will just have to wait and see. He said that if necessary can do an EKG, and that costs more.

She is resting fairly well, so I am hoping the new antibiotics will work. Never a dull moment. One thing I did notice is that she does seem to be shedding with her fur more, something she hasn't done in almost a couple of years. Boy it's complicated with the Cushing's and then this.

[Jenny & Judi in MN]

my dogs got kennel cough last year from the nasal vaccine. ugh. It took Jenny about 6 weeks to get over it. We had her on antibiotics but I think that was just to keep both dogs from reinfecting each other. I read somewhere or someone here told me that it just takes time.

so don't be discouraged if it takes longer than 2 weeks. and I would suggest never getting the nasal vaccine for kennel cough!

[LabDad]

Hi Jenny we are hoping for a resolution of Lulu's cough. I just brought her down, actually she didn't want to leave her upstairs bed. I put the coffee on and bundled up and got her down, actually carried her carefully down and then let her walk outside. She did not want to pee. So I brought her in. I gave her a small helping of rice and hamburg and she gladly ate it all. So I gave her a bit more and she ate. She didn't want any water.

Lulu is calm and alert. So I am hoping the front left leg is a mild sprain. She will get a dose of antibiotics in a little over an hour from now.

[addy]

I hope Lulu is feeling better today and good luck with fingers crossed for happy news from your interview.

Zoe was limping around back in October, turned out she sprained a toe and I have no idea how she did it. :rolleyes::rolleyes: I am hoping it is a mild sprain or maybe just a twisted muscle that will get better quickly.

[LabDad]

Well noon report on Lulu, is she threw up. I did give her some food at lunch, not much, but she apparantly didn't tolerate it as she hadn't peed or poohed in 18 hours. So she started to pooh. I got her outside and she did squat and poohed good, though loose, but I would expect that.

She still hasn't peed, and I am trying to get her to do that. She is pretty sick with the effects of the cough, though I haven't heard much cough, but she is tired. I help her walk with the harness by raising up so she doesn't have to put much weight on her legs. But it's not the same, I don't think she likes to pee when I hold her, so I also put her on a small leash.

Now I may try to use the longer leash instead of the foot long one for peeing, as that may give her more initiative. She anticipates everything, that is she thinks to much. I think she prefers the basement as it is easier to go outside, no steps because the sliding basement door is at ground level.

I have some Acepromizine 10 mg, but not giving her, just was wondering if that might help relieve any anxiety. But that drug is pretty potent, as I usually would give her half a pill when a storm came by, and she would be pretty lethargic for the next 8 hours.

I will be monitoring, have to go to the bank and possibly library but that will be just half an hour and my wife will be around. I may at that time try to get her to go upstairs from outside.

[LabDad]

I haven't given Lulu a Duramax, her half-pill that she can have once a day. She had one yesterday, so I don't like to give every day, but it might ease any pain she has. I did put some ice on her front left paw, as my wife said it looked like it might be swollen. She didn't seem to mind the ice as she left it on for about 10 or 15 minutes.

[LabDad]

Got some self-adhering bandage and a plastic bag for Lulu. She walked on the light snow which I think was bothering her front left paw. She peed! :) she came back and chose to go to the basement. I may stay with her tonight there. Already napped a bit on the couch! Tnx on the good luck for interview, I am going to work on the informal interview for Friday.

[molly muffin]

Hi! Good luck from me on the interview too!

My Tasha (golden retriever also)got to where she only wanted to be in the basement because it has the slider door to right outside and no stairs. She hated it though if we were upstairs, she wanted to be with us, but she just couldn't do all the stairs. Poor Lulu, she'll like it better if someone is with her down there, or you'll have to carry her up and down the stairs, which is liable to be hard on your back and knees too. :(

Hang in there. Hopefully this too shall pass.

Sharlene and Molly Muffin

[LabDad]

Thanks on the interview. Lulu slept well last night. She did have me take her out to pee in the middle of the night. She peed again this morning, drank some water, took her meds which I wrapped in a piece of ham. She isn't hungry this morning, is quiet, did give me her paw when I asked for it once. So other than the eating breakfast she would appear to be a bit improved. I don't hear a cough as of yet, just quiet and you can tell she doesn't feel her perky self as of yet.

Well I am going to have my breakfast, I slept surprisingly well on the couch in the basement. http://www.k9cushings.com/forum/album.php?albumid=596&pictureid=4598

[addy]

I'm glad she is urinating and the cough has lessened. Hope the basement sofa didnt kill your back!!!! Poor Dad.

Here is to hopes for a better day today!

[LabDad]

Just an update before lunch-time. Lulu still hasn't eaten, other than a very small bit with her meds. I gave her half a Duramax, though I had to put it in ham, and she ate the ham, so I just had to make her take it.

I am hoping with her cough, (she's only coughed two or three times) that she is tired and she appears calm. I had her upstairs via outdoors for a while, but when I just took her out, she just wanted to come back to the basement. So there she will be, and I will continue my cleanup in the basement which I have been doing, it really got to be a mess after my dad passed away over a year ago, and I had to get all his things out.

I am thinking that Lulu should surprise me and start to eat this afternoon, she has done this before. But will watch. Maybe the new antibiotics are causing the extra tiredness or just the cold itself. I think if she stays the same this afternoon, that I would put a call into Dr. Booth this afternoon.

I have noticed that Lulu's fur is softer and a definite growing from her Cushing's Treatment. I used the furminator and was getting a lot of fur. The last time she shed was almost two years ago, and she had been treated for Cushing's then and had been on Lysodren for about a week and then taken off, because the vet then, said she could go into Addison's. The shedding Lulu did was on the day after our anniversary at a friend's home in northern Michigan. And she was excited with the dog our friend was babysitting and fur was in the air.

Anyway, back to my cleaning and lunch. Will update this afternoon.

[NoonelovesmelikeNorman]

Hello Lulu's Dad!
I too am I'm happy Lulu is urinating and the cough has lessened, now to just get her to eat...baby steps...praying she will begin eating and heal up. You're a great dad for staying with her in the basement and keeping a close eye on her...both you and your wife are doing a great job!
p.s. I hope your interview went well.

Thinking of you and Lulu...

Sharon and Norman