Jake - 11 1/2 y/o Cocker (Trilostane) [Archive] - Canine Cushing's Information and Support Forums

lvasilio

01-12-2012, 06:59 PM

My dog, Jake, was just diagnosed with cushings. I have just spent the last 5 hours reading posts in many of the threads on this site. While I have learned so much I am so afraid of what we are about to face. Jake is my first dog. He is an 11 1/2 year old, 32 lb cocker spaniel. My vet seems capable and has requested compounding to start him on 10mg. He has already informed me of the followup ACTH needed.
I just want to thank ALL OF YOU for your remarkable dedication and sharing your vast first hand knowledge. I don't feel alone now. And you will be happy to know I called the vet this afternoon and requested copies of the tests they have run so far so that I have them if needed.
I know we are just starting this journey but I know I have someone to turn to who really understands
Thanks
Lesley and Jake

Altira

01-12-2012, 09:22 PM

Hello Lesley,

No you won't ever be alone here. I'm sure the "cush angels" (with all the brains and insight) will be floating thru here soon to start asking questions. Hold tight we got you!

StarDeb55

01-12-2012, 09:38 PM

Leslie, welcome to you & Jake! I'm certainly sorry that both of you are faced with Cushing's, but I'm glad you found us. I'm glad that you have requested copies of all of Jake's tests from your vet. When you get them, we would like to see all of the results from the Cushing's diagnostics that were done. This may include an ACTH, low dose dex test, or even a high dose dex test. I would assume that Jake had some general bloodwork done such as a senior wellness panel or super chemistry panel. If so, please post only the abnormals, along with reporting units & normal ranges. If a urinalysis was done, we would like to see those results, most important one is the specific gravity. Sorry to bombard you with all of this, but there are common abnormalities on general bloodwork in all of our pups that may point a vet toward Cushing's. The most common abnormalities are usually found in liver function tests.

Could you tell us a little bit more about Jake? What symptoms were bothering him that led you to go to the vet? Did the vet rule out diabetes & thyroid? I ask about these 2 problems as their symptoms can overlap with Cushing's.

I am not a trilo parent, but can give you some general information. The trilo parents will be along to offer you more specific feedback. It does sound like your vet knows what's going on when treating Cushing's. Verbal recommendations that we have had previously from Dechra, the manufacturer, list a starting dose of 1 mg./lb. body weight. I know this sounds like Jakes's dose may be on the low side, but we have seen repeatedly in this group that it's much better to start low with trilo & work up, then start high, the pup gets into trouble, then you really have to start making major dosage changes. Please make sure that your vet has explained to you the followup testing schedule for ACTH testing to monitor the medication as this is crucial until you get Jake stabilized.

Now, for the good news, with treatment, Jake should be able to reach his full lifespan with a good quality of life. My 1st boy, Barkley, was successfully treated with lysodren for nearly 8 years, crossing the bridge at 15. My 2nd boy, Harley, who was diagnosed at 13 1/2, had been doing well on lysodren for 2 years when he crossed the bridge from causes unrelated to his Cushing's. Yes, I've been lucky enough to deal with Cushing's twice as have several other members.

Again, welcome to both of you! We are here to help in any way we can.

Debbie

Harley PoMMom

01-12-2012, 09:46 PM

Hi Lesley and Jake!

Welcome to both of you to our forum, so glad you found us and we will help in any way we can.

Getting copies of all tests and posting the results here would be great and will really help us to provide you with meaningful feedback.

Is your vet prescribing Vetoryl/Trilostane? If so, 10mg for Jake's weight of 32lb sounds like a very good starting dose. Here's a handy link with info about Vetoryl/Trilostane: Trilostane/Vetoryl Information and Resources. (http://www.k9cushings.com/forum/showthread.php?t=185
)

What symptoms does Jake display? Is he on any other herbs/supplements/medicines? Any other health issues?

Cushing's is not a death sentence, it is a treatable disease. With proper medical management, close monitoring and owner observation, most Cushingoid pets can live to their full life expectancy, with complete or partial resolution of clinical signs, and good quality of life!

Please know you are definitely not alone on this journey and feel free to ask any and all questions.

Looking forward to hearing more about your sweet boy, Jake.

Love and hugs,
Lori

addy

01-12-2012, 09:58 PM

Hi and Welcome,

You most certainly are not alone any more. My Zoe started on a low dose of Trilostane last June. We started low because she also has colitis/IBD. I think your vet is very smart to start low.

Zoe has tolerated the Trilostane pretty well. We are currently having some issues with winter allergies but now that the snow arrived I am hoping they abate.

Boy, was I nervous giving her that first dose but it all worked itself out:D

We are always here for you. I am glad you found us.

Hugs,
addy

Squirt's Mom

01-13-2012, 10:23 AM

Hi Lesley and welcome to you and Jake! :)

Ok, it is going to be difficult to spell your name right....mine is Leslie. :p So I apologize from the very beginning. :o:D

We are a Lysodren house - my Squirt has Atypical Cushing's. And, boy!, can I relate to your fears. :eek: The first time I heard the word "Cushing's", I had no idea what it meant but I knew by the look on our vet's face, it could be better....and my world caved in. My Sweet Bebe, Squirt, is the light of my world and I could not, and cannot, bear the thought of a day without her in it. Sooooo, for weeks after hearing that word I was a bit out there....well, ok, I was WAAYYY gone! :o:eek:

By the time I found this group, I was a complete basket case. It's a true wonder someone didn't send the men in white coats to take me away to a nice soft room. :p But I knew almost immediately, this was home for us. Here I found understanding, compassion, and unending support...on TOP of exceptional knowledge and first hand experience. They took my sweaty, shaking hands and led me along, teaching me with every step, wiping my tears, making me laugh...but mostly teaching me how to help my baby girl.

After nearly four years, I would like to tell you that I am once again sane. But since I never started from that point, returning is a bit unrealistic. :p I can tell you that I no longer fear Cushing's or it's treatments. I understand that there are much, much worse conditions I could be dealing with; that Cushing's is NOT a death sentence; that my Sweet Bebe can live out her full life and beyond - and find pleasure and joy in that life. In looking back over these last few years, I can also see the gifts we have been given as a result of this disease. Friends who truly understand and care, friends located all over the world, friends I can call any time of the day or nite, friends who will remain a part of my world from now on. I have learned more than I ever dreamed possible not only about Cushing's but about many other canine conditions and related issues. That horrible word, "Cushing's", has brought some wonderful things along with it as well as that initial gut-ripping fear.

So you just hang in there, Mom. You are NOT alone. While I am so sorry you have a need to be here, I am so very glad you found us.

Hugs,
Leslie and the gang

lvasilio

01-13-2012, 03:50 PM

OMG you guys are a lifeline! I was on the verge of tears yesterday reading how caring and knowledgeable you folks are. I feel like I know all of you because I sat here yesterday and read many threads for hours.
Jake and and a precocious Basset Hound named Paisley share my home and keep me sane. Sadly I lost Ramsey, Jake's wonderful brother, last year after a heroic battle with cancer. I am so lucky to have Angel Medical Center within an hours drive and that's where we went weekly for a year for his treatments. It finally took him over the bridge last year and I miss him terribly. Cushings was suspected in Jake after I had a wellness panel done as part of his regular checkup. As my vet, Steve, explained it's always good to do this for JUST this reason. When he called to talk about some mildly elevated readings he suggested we do the ACTH stimulation test. And of course that didn't come back definitive, as so often happens. Then we did the urine, which didn't rule it out and finally the LDDS, which confirmed the diagnosis. I am so glad Steve was there when i went into to pick up the 60mg Veteroyl the other vet had ordered. Steve nixed that and after some consulting with another vet in the practice who has some knowledge they decided to start him on 10mg. to begin. I will certainly post all the results from all of these as soon as I pick up the files. As I said I stopped reading yesterday to call the vet to order the copies. I found you wonderful folks from a sheet he gave me with some support info on it.
I had noticed he had this little pot belly going and after having Ramsey on massive doses of pred for a terrible skin problem I found the belly concerning but noted it to talk to the vet when I took him for his yearly exam. I had also noticed his thirst was unusually voracious and he was never a beggar but had become one. Plus I was getting up nightly to let him out. A lot of this I chalked up to older age. The two things I don't see are any muscle wasting and coat issues. We play ball in a very big back yard daily and I think this may have helped to keep up his tone. I have also been giving my dogs 1400 mgs of fish oil daily for a year and a half and presume this might be why he has no skin issues. I put capsules in a mug with a little water, heat them in the mic for 30 seconds and then drop them on their food with the hot water and the oil squishes out and they love it. I have not seen any negative effects, only positive. Paisley has a lovely coat as well.
What i have noticed with Jake over the last couple of months is he occasionally has a very grumbly stomach and gas. Not all the time, however. I wrote down all the recommendations for food and plan to hit Pet Smart tomorrow. Better food for both pups can only help them. I have had Jake and Paisley on Lamaderm, a dry food for dogs with sensitive skin, basically because that's what I fed Ramsey for his skin issues and they all seemed to like it. The dermatologist and nutritionist at Angel had no problems with formula. I do mix a dollop of moist food into it to make it more interesting.
I took someone's advice and made a video of Jake last night and took a lot of pictures so I have a baseline.
I pick up the compounded med tomorrow but I won't start him until Monday so as to have access to the vet if I need it. I also thought it might be a good idea to get a fresh prescription of prednisone and some pedialyte to have on hand. This is all stuff I learned from you wonderful people. Thank you SO MUCH for being there for us!

addy

01-13-2012, 04:08 PM

Hi and Welcome,

I am glad you found your way here but sorry for the cause.
The main thing to know is you will no longer be alone in the journey.:)

Just wondering, about the prednisone for the skin condition: when was the last time your pup had prednisone?

Also wondering, is it possible to post Jake's test results? It helps us get an idea of what is happening.

Hang in there, others will be along soon if they are not already here;)

hugs,
addy

apollo6

01-13-2012, 04:32 PM

Dear Lesley and Jake
Welcome, you are not alone. As you will read my Apollo is on Trilostane also. He is now 13.33 years old and is on 10mg. weighs 10lbs. Get copies of all the reports for future references, ask all the questions you don't under stand about the reports with your vet.
The stomach gurgling is not that uncommon with Cushing's. In my case Apollo has had pancreatitis on and off. I would run it by your vet. Remember you know Jake more than any one else. If you notice a change don't ignore it. Apollo is my first dog also. YOU are doing the best you can for Jake read up on Cushing's , find out which kind Jake has- Pituitary or adrenal, or atypical.
Hugs Sonja and Apollo
p.s. JAKE is cute.

lvasilio

01-13-2012, 04:32 PM

I will certainly post all the results when I pick them up from the vet next week.
The prednisone was actually something i used for his brother, Ramsey. Jake hasn't had pred for well over a year.

lvasilio

01-13-2012, 04:34 PM

Oh and Jake has the pituitary Cushings.

lvasilio

01-13-2012, 05:06 PM

In all the many posts I read yesterday I remember reading about the cortisyn (sp?) vial can actually be used more than once thereby holding down the cost of the necessary retesting. I cannot find the info I THOUGHT I copied. I would like to make sure my vet is aware of this as I realize this is a business for them and they may not be forthcoming with this info. Can someone either send me the link or copy the info again. So sorry. I have so much saved in files but cannot find this one thing.

lulusmom

01-13-2012, 05:32 PM

Hi Lesley and welcome to the forum.

Here is a link to the information you want on cortrosyn.

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

You are correct. Your vet may not be forthcoming about his/her saving money and not passing that savings on to you.

Glynda

lvasilio

01-14-2012, 08:13 PM

Thanks for info. This is a real balancing act.
Spent the last 4 hours catching up on other pups posts. Skye's story is really gut wrenching. I so hope things will get better. It truly is day to day with our sick little ones. I think Jake is having a little issue with pancreas tonight. Seems somewhat uncomfortable. I need to get him on a better diet- low fat- and have to get to Pet Smart tomorrow and start reading labels. I remember reading someone suggesting pepcid for these grunblies. He is not in pain or groaning etc but it is upset. Is this something I can give him? Does anyone know if this is okay? I am boiling chicken for him and have brown rice for tomorrow morning meal. Am picking up his compounded trilo Monday. Wanted to start on a weekday just in case.

Harley PoMMom

01-14-2012, 09:45 PM

My boy, Harley, had pancreatitis and that darn pancreas sure is a fickle organ!

Has Jake had a spec PL test done to confirm the pancreatitis?

With pancreatitis, feeding a very low-fat, high carb, and mod protein is usually suggested. Also keeping the dog well hydrated and feeding several small meals are recommended.

I used to give Harley pepcid ac but found that it made him nauseous so I switched to slippery elm. Handy link with info about SE: http://www.littlebigcat.com/health/slippery-elm/

Boiled skinless chicken breasts with rice is an ideal bland diet when the pancreas is flaring up.

Hope Jake is feeling better soon.

Love and hugs,
Lori

lvasilio

01-16-2012, 11:47 AM

Was a really busy weekend. Sorry for not replying. That's exactly what I started him on Saturday night. Thank you again to whoever posted that in the past. And thank you for you tips about pepcid and slippery elm. Will check out the link. His stomach has been good since then. I spoke with the vet this morning and had a long discussion about all the questions I found to ask from reading these posts tirelessly all weekend. He was able to answer all but the question about the first followup ACTH timing/food/no food, but got back to me right away with this response. They want Jake to have had his breakfast but they will test 4 hours after the pill/food has been given. Does this sound right?
I am picking up all his records today and will post all later.

Harley PoMMom

01-16-2012, 11:59 AM

Trilostane/Vetoryl absorption is enhanced by administration with food, so fasting for an ACTH test is not recommended. If a dog has an issue with lipemia, which is the presence of elevated or abnormal levels of lipids/fat in the blood, then a low-fat meal should be given with the dose of Trilostane before the ACTH test.

lvasilio

01-16-2012, 12:55 PM

Good to know. Is the four hour wait period typical? Seems like most of what I read is two hours. What's your opinion?

lulusmom

01-16-2012, 01:17 PM

The manufacturer of Vetoryl (Trilostane) recommends that the acth stimulation test be done within 4 to 6 hours of the morning dose. As I recall, UC Davis, who has done their own studies, instruct pet owners to have their dogs in for the acth stim test within two the three hours after dosing. When my dogs were treating with Trilostane, I would feed and dose them at 6:00 am and have them to the vet by 10:00 am.

addy

01-16-2012, 01:25 PM

I will chime in as well. Try to have all your ACTH tests done at about the same time. So if this first ACTH test has the initial draw about 4 hours after dosing, when it is time for your next ACTH (in 30 days maybe) test at that same time rather than 6 hours for example.

Good luck. Hope everything works out with Jake. My non Cush pup is part Cocker Spaniel. I always tell people that is why he is so sweet and loving. Cockers are such nice dogs.

hugs,
addy

Cyn719

01-16-2012, 01:58 PM

Lesley

Welcome neighbor--I am right around the corner here in Rhode Island! I just had a few minutes to read about Jake - but I will go back and reread it later today - just wanted you to know I am here for you--

Sending lots of support - strength - prayers - love and hugs!!!!!!

xoxo

lvasilio

01-16-2012, 09:44 PM

Dear Cindy and Penny,
I followed your story from the very beginning on Saturday. You and Penny are some strong girls! I couldn't read fast enough to get the whole story. I hope she is doing better and tolerating the new medication now.
I picked up the trilo from the compounding pharmacy today and will start it tomorrow morning. Very nervous. I am home all week so it's the perfect time to start.

Cyn719

01-16-2012, 11:58 PM

Perfect time to start while you are home - Im glad they decided to start him on 10mg - the lower the better - we started Penny on 60 then 120 and it was way to much for her - I know you are nervous but you will be there to watch him - which is good - we will all be here for you whatever you need! Cush Angels are he Best!!!! As you know they were there for me and Penny in our crisis and and still are there when needed:) I said I left a message with my IMS and she called back tonight - she said if I want to try the Previcox she needs to be off the Rimadyl for 2 weeks - ugg that scares me but I would like to try it -- we will see

love and hugs!!!!!!!!

lvasilio

01-17-2012, 11:39 AM

Hi Cindy,
When I picked up my compounded trilo yesterday they gave me a pamphlet about the various things they can do. They mentioned they can make topical ointments from meds that may be less harsh on stomachs. I'm just wondering whether they can compound an arthritis med that might be better for Penny's stomach. Novice at this stuff so maybe not.
The vet decided on 15 mgs twice a day. The pharmacist stressed the importance of picking a time to start that would be both convenient morning and night. Since he won't eat (remarkable I know for a cush dog) in the early morning I chose 9am/pm, as I work and occasionally have to do things at night, and I live alone. Does anyone know how critical it is to be EXACTLY 12 hours. I am afraid some nights I will run late. Can i give it a bit early if I have to?

lulusmom

01-17-2012, 12:26 PM

Since he won't eat (remarkable I know for a cush dog) in the early morning I chose 9am/pm, as I work and occasionally have to do things at night, and I live alone. Does anyone know how critical it is to be EXACTLY 12 hours. I am afraid some nights I will run late. Can i give it a bit early if I have to?

Yes, it is very uncommon for a cushdog to not have a voracious appetite and it is even more uncommon for a cushdog to not eat at all. Was Jake having stomach issues at the time the LDDS test was performed? I ask because your vet did an acth stimulation test that was negative prior to the LDDS which was positive. The acth stim test is less likely to yield a false positive in the face of a non adrenal illness or severe stress. It is, however, more likely to yield a false negative if a dog has an adrenal tumor. Does Jake have pituitary or adrenal dependent cushing's? Was an abdominal ultrasound done to validate the LDDS or differentiate between pituitary and adrenal disease? Did the urinalysis show dilute urine with low specific gravity? What specific symptoms does Jake have today?

Sorry for all of the questions but if a dog is not eating, you should not give them Trilostane and if a dog doesn't have elevated cortisol, you most certainly should not give them Trilostane. I could have overlooked something in scanning your thread but it looks like your vet confirmed a cushing's diagnosis based solely on an LDDS test and that makes me more than a little nervous, especially in a dog who is not eating.

With respect to twice daily dosing, you should try to give the doses every 12 hours. I did exactly that with one of my cushdogs but there were a few times when I got held up at work and couldn't give the evening dose on time. If it was more than two hours late, I would skip the evening dose and resume normal dosing the next day. The reason for that is that there is an overlap in the two doses and if given too close together, the combination could drop cortisol too low.

Harley PoMMom

01-17-2012, 12:42 PM

In an ideal world, a dog that is being treated BID, should have their medication 12 hours apart but we do not live in an ideal world and life does get in the way!! ;):)

I do not believe if you give Jake's Trilostane a bit early or late that it will be harmful.

Dechra does recommend that an ACTH stimulation test be done 4-6 hours after the dose of Trilostane is given, I do think that the timing of the tests is very important. By this I mean if Jake's first monitoring test was done 4 hours after his Trilostane then all of his following ACTH stimulation tests should be done 4 hours after his dose of Trilostane, this way one can compare apples to apples, so to speak.

Hope this helps.

Love and hugs,
Lori

lvasilio

01-17-2012, 04:24 PM

Okay, I apologize in advance for this long post. These are the results from the ACTH, the urine and the LDDS- only the abnormal values.
To clarify, Jake has never been hungry in the morning- ever. He is not ill, while his stomach does get upset at times I think changing to a low fat diet will help this. He is always voracious after he has finally awakened in the morning. Just not a morning dog. He drinks tons of water, pants excessively, has a belly bulge, sparse hair on his belly but no wasting of muscles- the only one he doesn't have.
No ultrasound but they determined it was pituitary

ACTH 12/7/11
TEST RESULT REF RANGE
ALK PHOSPHATASE- 568 10-150 U/L
POTASSIUM 5.9 4.0-5.6 mEg/l
NA/RATIO 25 27-40
HGB 20.0 12-18 g/dl
HCT 55.6 37-55 %
EOSINOPHIL 1 2-10%
ABSOLUTE EIOSINOPHIL 80 100-1250 /uL

PRE- ACTH CORTISOL 5.8
POST ACTH CORTISOL 11.7
2ND POST ACTH 10.0

Vet said this was not conclusive so we did a urine to rule it out

URINE 12/20/11
URINE CORTISOL 14.9
URINE CREATININE 103.4
URINE CORT/CREAT RATIO 45
Seems anything over 34 suggests cushings. No flags were indicated in the rest of the levels.

LDDS 1/6/12
PRE DEX 8.7 1.0-5.0 ug/dL
POST 4 HR 5.6 less than 1.5 ug/dL
POST 8 HR 5.4 less than 1.5 ug/dL
Results all say this is consistent with pituitary dependent hyperadrenocorticism.

I hope this has filled in the blanks.

lulusmom

01-17-2012, 04:26 PM

Yep, that fills in the blanks. Thanks!

Rebelsmom

01-17-2012, 04:43 PM

Hi Lesley, late welcome I know.. I wanted to drop in and say hi I have been keeping up on your thread and everyone has been giving you some great advice. I don't have much more to add but would like to tell you that my pup Rebel has been treated with trilo successfully for almost 2 years, he just had his 9th birthday back in October. He has had some stomach problems recently and he takes 1 pepcid (10mg) in the evening 1 hour before dinner. I have also started giving him a late night snack before bed and leaving him extra food out during the day so his stomach doesn't get empty. You seem to be well on top of things and I don't think you will have any problems, but if you do know we are all here to help anyway we can.

Love and hugs from us.

lvasilio

01-17-2012, 04:59 PM

Thank you. It's nice to know some of the pups tolerate this. I'm wondering about the "with food" aspect. How much food should they have for maximum absorbency? I am pilling him twice a day at 9am/pm and I am planning on splitting the two meals into three smaller ones feeding last at 9pm. Obviously as late as that is, I'd like to not have a full meal on his stomach when we go to bed to hopefully alleviate a wake up in the middle of the night. Do you know if I can give him just a snack and have the absorbency still be maxed. Ah... so many questions!

Rebelsmom

01-18-2012, 10:07 AM

Rebel, gets his Trilo twice a day also at 7 & 7. He gets his with his meals and he gets a late night snack of a dog biscuit before bed. At one point I was dividing his evening meal up and feeding him right before bed also. This didn't really work for him, I'm guessing because he wasn't hungry yet when we went to bed so he wouldn't eat.

At what time in the evening does he get fed? That might play a roll in how much food is still in his belly at the 9pm dosing.

Cyn719

01-18-2012, 11:09 AM

Penny is having stomach issues from something but when she was on trilo she never had a problem eating - we tried to do 12 hrs like 6 and 6 - 7 and 7 but some days it was 7 am and 5 pm or some mornings (very few ) she didnt want to eat early so she ate 1000 and then agan at 630pm so I was always off a few hours - Its just how it worked out for her - its just if you feed him at 9pm at night wont he get up in the middle of the night to go out?? Maybe feed by 7 the latest if possible?

hugsssss xoxo

lvasilio

01-18-2012, 11:41 AM

Gave this some thought and went ahead and fed dinner at regular time- 5pm. Then gave him his pill in a snack of reduced fat cream cheese and a couple of small pieces chicken and two large Blue Buffalo dog biscuits. Hope that was enough food. Not sure hoe to gauge that. Thought i might have the problem you mentioned. I didn't because he didn't have a full meal.
I am very vigilant to Jake's routine. I swear he had a more restful night last night. He has been a twitcher since this began and I noticed he had a more peaceful night. I am hoping we will not keep dropping to the point he is lethargic and unhappy. Will watch for that.
Hope Penny is better today.

lvasilio

01-20-2012, 10:14 AM

Friday morning and Jake has had his 2 doses of 15mg each since Monday morning. So far no adverse reactions but no changes whatsoever either. Still drinking and wanting to eat everything. Am slowly changing diet to Blue Buffalo.. need to check this out more... and seems to be tolerating it. Stomach does seem better. Talked to the vet about pancreas issue a possibility and he assured me upset stomach doesn't always mean pancreas issue and he has not been vomiting or have loose stool.
Posted abnormal results a few days ago. If anyone sees anything amiss can you shoot me a quick note so I can bring it up to the vet.
Hope all the other cush pups out there have a peaceful and happy weekend.

Harley PoMMom

01-20-2012, 12:15 PM

Talked to the vet about pancreas issue a possibility and he assured me upset stomach doesn't always mean pancreas issue and he has not been vomiting or have loose stool.
Posted abnormal results a few days ago. If anyone sees anything amiss can you shoot me a quick note so I can bring it up to the vet.
Hope all the other cush pups out there have a peaceful and happy weekend.

Some dogs, like my boy Harley did, have pancreatitis but display no symptoms. The only way to confirm pancreatitis is with the spec PL test.

Jake's potassium is elevated and this would concern me, what are the values given for his creatinine, BUN, and calcium? Some medications such as enalapril and Trilostane can cause the potassium to be higher. Is Jake on any other medicines?

lvasilio

01-20-2012, 03:00 PM

RESULTS / RANGE OF NORMAL

CREATININE- 1.0 (range of normal- 0.4-1.8 MG/DL)

BUN 22 (range of normal- 7-27 MG/DL)

CALCIUM 10.8 (range of normal- 8.2-12.4 MG/DL)

He isn't on any other medication. Been a pretty healthy boy up until now.

lulusmom

01-20-2012, 03:51 PM

I think a slight elevation in potassium can be caused by the blood draw itself. Debbie can confirm this but I think hemolysis can cause elevated potassium. I also just read that in a human, leakage of potassium from the muscle into the blood by the donor clinching their fists or from a tight tourniquet, can cause elevated potassium.

lvasilio

01-23-2012, 12:15 PM

Well it's been a full week and Jake still seems to be tolerating well but i am seeing little effect from the 15 mg twice a day. I think he water consumption has slowed somewhat but he is still ravenous and panting when he gets excited, which is what has been happening. i made his appointment for his first check next week but am wondering if it might be skewed because the first ACTH was performed with the gel and this one will be with the cortrosyn? Does anyone know if this will make a difference.
The meal thing seems to be working. His dinner is at 5PM but he gets his nightly pill at 9PM with a light snack of pill in a little light cream cheese, couple bites of cooked chicken and a biscuit. Figured I've covered all the food groups.

lulusmom

01-23-2012, 02:35 PM

Most vets prefer Cortrosyn over gel for its accuracy; however, I've read studies that say the difference, if any, is negligible. It's more important that the vet stick with one of the stimulating agent for all tests. If your vet will be using cortrosyn exclusively, it's not a problem at all. Just make sure Jake has his morning dose with food and get him to the vet's within 3 to 4 hours after that. I hope this helps.

Glynda

lvasilio

02-01-2012, 05:08 PM

Jake had his first follow up ACTH test today and level went from 11 to 5 roughly. I haven't picked up the actual copy of the test but this is a good direction. I told his vet that since this is the first two week check I want him to stay on the relatively low dose for another two weeks to see if there is further movement down. i don't want to push because he has seemed to tolerate 15mgs/ twice daily and absolutely don't want any kind of induced crash. Can't say there has been a huge change in his actions. Were up in the middle of the night last night. Seems like it's 4 out of 7 nights we're still up. Seems to have found food that doesn't upset his stomach and aggravate his poultry allergy. Not easy. Blue Buffalo.
I feel so badly that so many of the pups are having issues right now. Ever wonder if they suffer like us older folks from barometric changes and arthritis?

addy

02-01-2012, 07:10 PM

I think wait and hold is a good idea so I'm on board. Some pups are a bit slower to resolve. You still have time.

Hang in there, give Jake a belly rub for me.

hugs,
addy

Harley PoMMom

02-01-2012, 07:43 PM

I totally agree with you and Addy. We have seen members dog's cortisol go lower on the same dose.

Is another ACTH stim scheduled?

Love and hugs,
Lori

lvasilio

02-02-2012, 12:18 PM

Yes we are doing another one in two weeks. That is the correct spacing I think?
Tiny positive changes everyday. Keep hoping it stays that way

Harley PoMMom

02-02-2012, 12:55 PM

According to Dechra's US product insert an ACTH stimulation test should be performed 10-14 days after the start of treatment, also the electrolytes should be checked.

After any dose adjustment an ACTH stimulation test should be done between 10-14 days also. When a therapeutic range is found with treatment an ACTH stimulation test should be conducted in 30 days then 90 days, and every 3 months.

Of course if issues arise that warrant an ACTH test sooner, one should be performed.

Here's a handy link to Dechra's product insert: Dechra's U.S. Product Insert. (http://www.dechra-us.com/files/dechraUSA/downloads/Product%20inserts/Vetoryl.pdf)

You're doing a great job!!!

Love and hugs,
Lori

Cyn719

02-02-2012, 01:07 PM

Give Jake a kiss from me and Penny. Yup these dogs age like we do:eek:

Hugsssss xoxo

lvasilio

02-08-2012, 05:49 PM

Sorry to be so dense but can anyone clarify since Jake is on the same dose he was when they did the first ACTH test at 14 days, do I need to get one done 14 days after the first test, even if the dose was not adjusted, or should i wait until a full 30 days after the first ACTH test was done? Just do want to have to pay for something he doesn't need until 30 days after his first ACTH while on the drug.

mytil

02-08-2012, 09:06 PM

Hey, no you are not dense :) According to the manufacturer's instructions after the initial ACTH test is done at the beginning the long-term monitoring is recommended as follows.

Once an optimum dose of VETORYL Capsules has been reached, re-examine the dog at 30 days, 90 days and every 3 months thereafter.

Terry

PS, that is unless something changes in symptoms then retesting (ACTH) is performed at that point. Also if there are any increased in symptoms or your dog is just not feeling well, electrolytes are checked in conjunction.

labblab

02-09-2012, 07:01 AM

I totally agree with Terry -- you are not dense at all, because over the years I have been confused about that, too, when the first 14-day ACTH is not yet within the desired therapeutic range (not yet "optimum") but you are seeing improvement and the dose has not been changed. I don't know if it's what Dechra intends, but my own inclination would be to go ahead and wait for 30 more days after the first ACTH test in order to give your dog a really good chance to stabilize on that dose. Unless, as Terry says, Jake seems unwell or if you are not seeing any improvement in symptoms. In either of those cases, you wouldn't want to wait so long before make a dosing adjustment.

Marianne

lvasilio

02-09-2012, 02:16 PM

Thanks so much for the input. Jake is doing much better on the 15 mgs twice a day but not at the optimum level from the first post ACTH. It was my inclination to wait 30 days at the same dose before we see if we need an adjustment.

lvasilio

02-19-2012, 01:50 PM

Well, happy to report Jake's test on Tuesday showed his level at 3.7, normal. We will keep him on the 15 mgs twice daily and hope all stays well.
I am a little apprehensive that I have to travel for 7 days next week leaving both my "kids" in the hands of my dog sitter. She is a nurse and I feel comfortable with her but it doesn't lessen my concern. She says the 12 hours in-between dosing schedule is not a problem for her but it is a concern of mine. Guess I'll just have to have some faith.
I am so happy I found all you wonderful folks who helped me understand this disease and get the answers to all the questions. I feel my vet is so much more responsive to me because he knows I am informed. I am following the progress of so many good people struggling with so many problems with their pups. My heart goes out to them and I will share what knowledge I have. If it is lymphoma (God forbid) or acute skin conditions, I am your "man" so to speak. I have VAST knowledge on bot of those!
Thanks again to all my Cush friends and let's think good thoughts for all the Cush babies out there!
Lesley and a happy Jake

Harley PoMMom

02-19-2012, 03:12 PM

That's a great post number!!! YOU are doing a fantastic job at advocating for Jake!!!

Love and hugs,
Lori

labblab

02-19-2012, 03:35 PM

"Ditto" from me, too!! That's a great test result, and I hope you travel safely next week!

Marianne

lulusmom

02-19-2012, 07:58 PM

Good Job Leslie and Jake!

Cyn719

02-19-2012, 08:14 PM

Lesley

So happy you got good news about Jake:D:D:D:D

I know it must be so hard to be away for a week.....and it's sounds like you have a good sitter...but us moms always worry.....be safe on your travels

Love and hugs xoxo

lvasilio

03-19-2012, 12:29 PM

Harley PoMMom

03-19-2012, 12:44 PM

How are Jake's symptoms?

lvasilio

03-19-2012, 12:51 PM

Well, I still am seeing some symptoms. Very mild but I noticed those hard itchy bumps they get on their skin seem to be more prevalent, and he still seems to get very ramped up when he is excited. His appetite is normal, water drinking seems normal and I waited him out last night and he came back to bed rather than getting me up at 2am as he has been doing nightly again. That leads me to believe that maybe he was "training" me. I just don't think he is completely maintained, on the other hand he has tolerated 15mgs daily so well I hate to take the chance of going to 20 and having issues. He also has allergies kicking up now so i wonder if this could be the "itchy" issue. So hard to know when they just won't talk to you!

labblab

03-20-2012, 07:02 AM

So had a frantic week away, but all was well upon my return. Now another question.
Jake went for his 30 ACTH test and it went from 15 day- 3.9 to 30 day 5.5, just barely normal. Has this happened to others. He is on the same dose twice, 15 mgs. daily, but it rose. Any thoughts?

It is not uncommon for dogs to require dosing changes when treated with trilostane. But the increase in ACTH results from 3.9 to 5.5 is not huge, and maybe Jake was just more stressed at the time of the second testing which might account for the difference. If you consistently see increasing symptoms (or lack of desired symptom resolution) from this time onward, however, I would consider discussing a small dosing increase with your vet.

Marianne