T.C. (12 y.o. lab X) -- Lysodren (RIP dear T.C.)

[glfprncs]

Hello everyone!

I'm the mom of a very wonderful lab X named T.C. whom I have had the privilege of being mom to for the past 6 years. I'm pretty certain that T.C.'s symptoms have been in evidence over the past few years, but it wasn't until his water intake and excessive urination really became obvious that we had an issue. T.C. has always been a bit of a camel at the water bowl, and he's always been STARVING for food every moment of every day...it's just that in the last 6 months, he's become REALLY thirsty, will pee for minutes at a time and became quite loud and demanding for food.

We originally (late November of 2011) diagnosed T.C. as diabetes insipidus (his bloodwork values that 'prescreen' for cushings are within normal limits), and he responded really well to the desmopressin acetate for about 5 weeks. Then, the water drinking and urination came back with a vengeance.

In talking with the internist at UGA, discussing his appetite and his increased nervousness in the past 2 months, we ran a low dose dex test this past week. We are a positive for pituitary dependent cushings.

Meds will be in next week and we'll be starting him on Vetoryl.

My biggest concern is that I worry his cortisol levels are masking any arthritic signs. TC used to take glucosamine/chondroiton supplements about 2 years ago, but took him off after a year as he no longer was showing any issues with creakiness in his hind end. Alas...it was probably the rising cortisol levels beginning to mask it way back then.

Any thoughts on where you go should we find we have some pain/arthritis issues once we start on the Vetoryl?

Also...any suggestions you have for a new cushings mom, I'd greatly appreciate it.

[glfprncs]

A few things to add....

When we originally started testing T.C., I had a feeling in the back of my mind that I was dealing with cushings. However, we started with bloodwork and urinalysis so that we could have a trail of 'evidence' of sorts so that we could rule out what we weren't dealing with as well.

Original bloodwork all came back within normal limits. T.C.'s Alk Phosphatase numbers were in the high end of normal (I want to say upper 300s), but nowhere near what my vet would see in a dog that was typical cushings. Kidney & liver function normal, no issues with diabetes mellitus, white blood cell count normal. The only thing that raised a red flat was that the specific gravity of his urine was 1.001.

So, vet asked to withhold water for 10 hours and get another urine sample. I did with the exact same results (1.001). After consult with the internist at UGA, vet determined diabetes insipidus (pituitary no longer producing anti-diuretic hormone) was the issue. We started on a low dose of Desmopressin Acetate, a synthetic ADH. We had great results...within 48 hours, overall water intake dropped by about 8-10 cups per day. Stayed that way for about 3 weeks, then we'd have good days and not so good days. We played with the dosage, but after 5 weeks, we were back to the same water guzzling came as before.

We ran more bloodwork, and based on those findings (sorry, I don't have those numbers) as well as increased anxiety seen in the dog, his ravenous appetite, his response and then lack thereof to the Desmopressin Acetate (apparently, many Cushings dogs will respond to the D.A. at first, and then the results will diminish), it was recommended that we run the low dose dex suppression test.

I'll need to look at the lab report (I just got the results tonight) when I get to the vet's on Monday, but the 8 hour results were 2.1.

[Harley PoMMom]

Hi and welcome!

I copied this post from another thread:
Hi and welcome to you and Rio!

According to this abstract: The desmopressin stimulation test in dogs with Cushing's syndrome. (http://www.domesticanimalendo.com/article/S0739-7240%2807%2900101-4/abstract) Desmopressin significantly stimulated cortisol release in dogs with PDH. Since the majority of dogs with Cushings are diagnosed with PDH and since Rio's ultrasound did not find a tumor on any of his adrenal glands, I would assume if Rio does have Cushing's the diagnosis would be PDH, so before any Cushing testing is done, IMO, the desmopressin drops have to be stopped too.

Cushing's is one of the most difficult diseases to get a confirmed diagnosis because not one Cushing test is 100% accurate so it usually takes multiple tests for a proper diagnosis. Strong symptoms are a huge part of the diagnosis and a Cushing savvy vet will not initiate any treatment without strong symptoms and a proper diagnosis.

Please know we are here to help you in any way we can so do not hesitate to ask any questions.

Love and hugs,
Lori

Sorry I only have a moment to post...was the Desmopressin stopped before the Cushing's test/s?

[Cyn719]

Hi and welcome to you and T.C. So sorry for the reasons you are here.....but you came to the right place for support and advice. I can tell you that the members here are fantastic and so knowledgeable!! A lot of questions will be asked but this is to get the whole picture and to give you the best advice. Other members will be along to help. Hang in there it's a lot....but we will be here for you always!

We started penny's treatment at 11. Before that she had arthritis but wasn't bad because of the higher cortisol level...so when she did start vetoryl she did feel it more....she did ok but then needed meds. Every dog is different though. Penny is on dasaquin....which is what you are using.....adequan shots......fish oil.......rimadyl........tramadol at bed time for pain. There are meds but TC. May not need them....but if so there are things out there to help.

Hugs and support xoxo

[glfprncs]

Hi and welcome!

I copied this post from another thread:

Sorry I only have a moment to post...was the Desmopressin stopped before the Cushing's test/s?

Thank you for copying that for me. The desmopressin drops had been stopped, but only 48 hours prior to the Cushings test. That said, they tend to be effective for D.I. for about 8 hours, yet I wonder if any residual effects of the medication could still linger. Good information for me to remind the vet about when we talk on Monday.

[glfprncs]

Just curious...with regards to starting Vetoryl. What sort of changes should I expect to see once we starts meds and approximately how long will it take for us to see those changes?

Also, are there any serious side effects that I should be aware of when starting Vetoryl?

[Harley PoMMom]

Usually a decrease in the ravenous appetite, excessive thirst and urination are seen in 2 weeks after starting Vetoryl. If there is any hair coat issues, this could take a lot longer to see an improvement.

The adverse reactions of Vetoryl are but limited to: vomiting, diarrhea, lethargy, or the dog just not acting like him/herself.

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

Hope this helps.

Love and hugs,
Lori

[glfprncs]

Picked up TC's Vetoryl this afternoon...will start him on his dose first thing tomorrow morning since we have to do ACTH stim testing in 2 weeks 4-6 hours post meds...mornings seemed best although I'm antsy to get him started on meds as soon as possible.

With regards to Vetoryl...for those of you with Cushings dogs on Vetoryl, how difficult was it to find a maintenance dose? TC is 60 pounds and based on his weight, is starting at a dose of 120 mg. Vet said that finding the dosage with Vetoryl has proven to be much easier than older meds that were used to treat Pituitary based cushings.

Also...once you find the correct dosage, how often do you need to test cortisol levels via ACTH stim test? Am I confused as to how the vet is going to use the values from the test (it is to verify that the meds are working properly and that the intended response is as desired, yes?)?

[labblab]

Welcome from me (another Lab-Lover!), and I can imagine how anxious you are to finally get started with treatment. I do have a couple of cautionary thoughts to share with you, though. Even though 120 mg. is the starting dose that is listed on Dechra's published dosing chart for a dog of T.C.'s weight, a number of specialists are now recommending that dogs begin on a lower dose in order to minimize the risks of unwanted side effects or a cortisol level that drops too low too quickly. Dechra's written commentary that accompanies the dosing chart suggests an intial range of 1-3 mg. per pound, but elsewhere they themselves recommend beginning at the lowest end of the range: at 1 mg. per pound. Since T.C. will be starting off at a higher dose, I encourage you to watch him very closely for any indications that his cortisol is dropping too low: for example lethargy, vomiting, diarrhea. Really, if he looks unwell to you in any way, you will want to withhold the Vetoryl and consult with your vet.

Also, it is great that your vet has apparently seen such dosing consistency with his patients. But our experience here is that many dogs do take a fair amount of "tweaking" in order to arrive at their ideal trilostane dose. And their dosing needs can change over time. For that reason, I encourage folks to initially ask their vets to prescribe capsules in smaller dosage units so that you have flexibility to move up or down, especially during those first weeks when you are trying to arrive at an ideal dose. If you have only been given 120 mg. capsules, you are really limited as to any dosing changes that you can make in the event that they are warranted. So just keep that in mind with any future Rx refills.

And yes, the purpose of the monitoring ACTH tests is to make sure that T.C.'s cortisol level is being maintained within a therapeutic range -- neither too high (which can leave symptoms unresoloved) nor too low (which can precipitate very serious problems). Coupled with symptom resolution, it will be the ACTH results that permit your vet to decide upon appropriate dosing adjustments. Once an optimal dose has been arrived at, Dechra recommends continuing to test every 3 months in order to insure that there have been no significant changes in cortisol level over time.

Good luck with the Vetoryl, and please do keep us updated.
Marianne

[glfprncs]

Marianne...thank you for the information regarding the dosages. My vet did tell me point blank that if TC shows any of the symptoms you also shared that I was to stop meds immediately and contact him (even on the weekend). What I didn't realize, though, is that those effects weren't necessarily a side effect of the drug, but in reality, are the effects of too low cortisol levels (I have that right, yes?).

Will keep a close eye on my old man, hope for the best, and make adjustments as needed based on his response.

Thanks to you all!

[Harley PoMMom]

What I didn't realize, though, is that those effects weren't necessarily a side effect of the drug, but in reality, are the effects of too low cortisol levels (I have that right, yes?).

Will keep a close eye on my old man, hope for the best, and make adjustments as needed based on his response.

Thanks to you all!

The adverse side effects can be seen with too low cortisol and what is called cortisol withdrawal syndrome. Corticosteroid withdrawal syndrome is usually seen within 10 days of starting treatment. Only an ACTH test will be able to distinguish between the two.

[glfprncs]

Day 2 of Vetoryl today...keeping a close eye on T.C.

The good news is that I volunteer at a local no-kill animal shelter, and one of my fellow volunteers has a lab X who also takes Vetoryl. She's able to have the shelter order her meds directly from the company at half the cost (she pays $100 for 2 30 dose boxes of 60 mg Vetoryl, I just paid $90 for one box), and she pays the invoice directly. So, once we have the dosing regulated, I'm pleased to learn that I can add my order onto hers and save a bit of money along the way.

[Squirt's Mom]

Oh, how nice that you will be able to order via the shelter and save a bit! Finding a way to save money with this condition is always a boon. I know you are watching TC like a hawk and am sure you will both do just fine.

Bless you for the work you do. It can be tough even in a no-kill shelter, I know, but those days when things work out make it all worthwhile. There was a black Pit/Lab female in our shelter a year or so ago who was so depressed. She would come out and walk with you and was sweet, but you could tell she was just so, so sad. One Sat. morning, a little boy who also looked sad came to find a cat but he and the Pitty X met eyes and it was like they had both come home at last. She stood up, wagged her tail; he left the porch of the cat house and walked to the row of cages outside where she was. There were two fences between them so they just stood, staring at each other, grinning in their own ways. Next thing we knew, they we playing ball and chase, rolling on the ground playing...and she went home with him that day. She had just been waiting for "her boy."

Keep up the good work - all the way around!
Hugs,
Leslie and the gang

[glfprncs]

Thanks Squirt's Mom...there are days when I want to beat my head against a wall with regards to volunteering at the shelter. To make it even more fun, I'm an adoption counselor, so I get to meet all kinds of 'interesting' people. That said, I also get to help find some wonderful dogs fantastic homes with great people. In the end, that's why I do it. The shelter where I volunteer was the home to 2 of our boys before they became a part of our family, so I feel I 'owe them' my volunteer time since they took such good care of TC's brothers (Louie and James) before we could find them.

Day 4 of the Vetoryl today. No signs of any negative issues regarding the dosage and dramatic dropping of cortisol levels (which is good), but also no real changes in T.C.'s Cushings's type behaviors (which I realize not an issue as he's only been on meds for 4 days). We had a lovely romp this morning in the neighborhood (the weather and my flu bug has kept us from our regular walks this week). T.C. is quite pleased that his ability to pee so often and at such great length allows him to mark LOTS of trees and shrubs in the non-residential area of our neighborhood (basically, the place where all the dogs go pee so that they know who was in the neighborhood of late).

[addy]

Glad to hear Day 4 is going well. Each day gets easier. Every dog is different in how long symptoms will take to resolve.

I know it is hard to wait, we want them better right away!!!:D

your doing great,
hugs,
addy

[marie adams]

Welcome to you and T.C.,

It looks like you are getting the help and information you need to help T.C..

You mentioned the arthritis and stopping the meds. I noticed when my Maddie's cortisol levels were lowered that I started to see more evidence she did have arthritis, but she also had the hind leg muscle atrophy. I continued to use the glucosamine/chondroiton supplements along with fish oil, vit c, and then flaxseed oil for her skin and coat.

You are doing great so keep up the good spirits and work!:)

Take care!!!

[glfprncs]

Day 8 of the Vetoryl...first real change I've seen since starting the meds is that rather than impersonate a camel at the water bowl after eating breakfast this morning (T.C. would generally drink an entire bowl of water every morning), he lapped up about 1/4 of the bowl and walked away.

Here's hoping we're on the right track.

[Squirt's Mom]

Oh! That sounds very positive! :D I hope you start seeing more and more changes as the days pass and soon your T.C. is dragging you out for more and more romps!

Hugs,
Leslie and the gang

[glfprncs]

4 more days until we head back to the vet's office for our first ACTH test. Paws X'd!!

[glfprncs]

ACTH test was today...should have labs back tomorrow. Here's hoping we're on the right track.

[addy]

I hope you have good results, crossing paws with you. I am waiting for my results from Friday for Zoe's stim. We can wait together.
hugs,
addy

[glfprncs]

Played phone tag with the vet yesterday (though he said the results of the ACTH stim. test on Tuesday show we're moving in the right direction with the Vetoryl). Played phone tag with him again today, but got his results from the tech.

3/6/12
Blood sample #1 (pre ACTH) 0.8
Blood sample #2 (post ACTH) 3.1


T.C. is on 120 mg of Vetoryl once per day with his breakfast. At the time of this ACTH testHe's always been pretty perky, and continues to be eager to go for walkies, is ALWAYS happy to eat anywhere and anytime you ask. His water intake is up and down...there are days when he continues to impersonate a camel, and other days when he seems to drink less. I'm going to start measuring water intake although it's difficult with 3 dogs (but doable). His urine seems to have a bit more color, but we haven't done a urinalysis since December, so I don't know if the specific gravity is higher post meds.

We're going to continue on this dose for another 30 days (unless he seems to be heading for an Addisons type crash) and do another ACTH stim the first week of April.

Thoughts? Suggestions?

[Harley PoMMom]

Even though those are really good stim results I am a bit worried because T.C. cortisol dropped significantly in just ten days and with him weighing 60 pounds and taking a dose of 120 mg I am very concerned his cortisol will drop even lower which would cause an Addison's crisis.

[lulusmom]

I share Lori's concerns, especially with a baseline cortisol of only .8. If T.C.'s pre and post numbers were higher, I wouldn't be as concerned about waiting another 30 days for a stim test but with the large dose, low numbers relative to time and the probability that cortisol will continue to drop, I highly recommend that you follow monitoring protocol and do another acth stimulation test at the 30 day mark. Regardless, please keep a very close eye on T.C.

[glfprncs]

I most certainly will...when I first posted his dosage, everyone's concerns were taken quite seriously and have been in the front of my mind every day. I keep a close eye on my old man, looking for ANY signs that his cortisol levels are dropping too low or too quickly.

At this point in time, I honestly haven't seen any changes from his perky, water loving, treat demanding, walk loving self.

[glfprncs]

Hey everyone! Just wanted to stop by for a quick update.

T.C. goes back this Thursday for his next ACTH stim (will be 30 days after his previous test and 45 days after starting Vetoryl).

It appears that his water intake has dropped some (his need to urinate definitely seems less urgent that before meds), but with the increase in temperatures, the water intake that I've been measuring fluctuates a lot depending on how much exercise he gets, the temperature, etc.

I am not seeing any other changes that are signs that his cortisol is dropping too quickly or has dropped to a dangerously low level. He's perky, alert, chases his baby 'brother' (who is 2 1/2 years old) like a youngster, goes for a daily walk, skin and coat are sleek and shiny, poops are solid. He's still quite ravenous (though he's been hungry every moment of every day we've had him over the past 7 years) and still urinates far more than the other 2 dogs, but less than 6 weeks ago. He does seem to show a bit more 'creakiness' of late. Of course, if the cortisol has dropped to more normal levels, the arthritis signs that he was showing 3 years ago may no longer be masked by the excessive cortisol being produced by his body. He's not lame, limping or in pain (that I can tell)...just takes a little more time to push himself up or lie down and get comfortable.

So, we'll see what the bloodwork shares from the ACTH test and move forward from there.

[Harley PoMMom]

Thanks for the update and so happy to hear that T.C. is not having any adverse reactions. Will be anxiously waiting with you for the results of the ACTH stim test...fingers and paws crossed for good numbers!

Love and hugs,
Lori

[glfprncs]

45 day ACTH stim results came in this morning.

30 days ago, pre ACTH was 0.8, post was 3.1

Yesterday's, pre was 0.7, post was 1.9

Vet is concerned, as many of you have expressed, that his cortisol levels dropped considerably in the first 14 days of treatment and dropped considerably again in the last 30 days. While it's the 'low end of normal,' he doesn't want to continue on the same dose.

However, vet recommended giving the dosage every other day, rather than daily. Wouldn't it make more sense to give 60 mg each day rather than 120 every other day? Just curious...I'm not sure of the 'lifespan' of the drug in the dog's system.

I'd like to run this past my vet first, unfortunately, when he called this morning I was out walking the dogs and missed his call. He's out of the office until Monday. He is planning on having conference call with me, himself and the internist at University of Georgia (who has been in on the diagnosis and treatment plan for T.C.), so I'm sure we'll move forward from there.

[Squirt's Mom]

I will let others who are experienced with Trilo comment further, but if it were me, I would stop the Trilo for now. It may be that the dose is too high and if his level continues to drop, he may go into crisis with the cortisol too low. So until you can work out a lower dose with the vet(s), I would err on the side of caution and stop the Trilo for now. This is one of the good things about this drug - it can be easily stopped and restarted without losing ground. Trilo is active in the body for only 2-12 hours, typically somewhere around the 8-10 mark.

Do you have prednisone just in case? Stopping the Trilo should stop the cortisol from going any lower but we always like to tell folks to have some pred on hand anyway...we just never know how a pup may react. ;) If you stop the Trilo and still see signs like vomiting, diarrhea, lethargy, or loss of appetite, this is when you would need a dose of pred. But with Trilo, usually stopping for a short period then readjusting the dose works just fine.

Let us know how T.C. is doing, 'k?
Hugs,
Leslie and the gang

[labblab]

Yes, in my opinion it would make considerably more sense to lower the daily dose rather than switch to every-other-day dosing. On average, trilostane only stays active in the body for approx. 12 hours. Perhaps your vet is trying to save you money if all you have on hand are 120 mg. capsules. But in the long run, I do not believe it will be a money-saver if you shift to an unconventional dosing protocol that does not keep your dog's cortisol under more consistent control.

Also, I don't believe I would cut the daily dose clear down to half. I think I'd discontinue the Vetoryl entirely for a couple of days, and then restart it again at a 90 mg. dose to begin with, because you don't want to go in the opposite direction and have the cortisol elevate to an extent that will reintroduce symptoms. But if you stick with brandname Vetoryl, a 90 mg. dose will involve combining capsules of two different strengths. So that does become more expensive. I'll be very interested to see what the UGA specialist recommends.

Marianne

[glfprncs]

I don't have a problem combining dosages at all...In fact, I'd prefer to give a 30 and a 60 daily rather than an every other day dosage because it's easier to remember to give the meds if I give it every morning. Plus, T.C. would be horrified if he didn't get his blob of peanut butter (containing his meds) every single morning. I've set a peanut butter presidence! : )

Thanks for your thoughts everyone. I'll let you know what transpires on Monday. T.C. and I just got in from our daily walk (I'm on spring break, so I've been able to spend a lot of time with my boys this week) and he was quite happy being out and about.

[glfprncs]

After speaking with the internist at UGA, we've decided to restart TC on a daily dose of 60 mg. He doesn't want to suppress his adrenals any further, so would like to err on the side of caution.

We'll do another ACTH stim in 3 weeks and adjust from there.

I've definitely noticed, though, that TC has been off meds since Friday morning.

[labblab]

Sounds like a plan! I'm so glad the UGA specialist advised remaining with once daily dosing. Please let us know how T.C. does on this decreased dose.

Marianne

[glfprncs]

After 5 days of no meds, we start back tomorrow morning at the new dose. What I thought was interesting is that now that he's been off the Vetoryl, I'm realizing that he definitely was drinking and urinating a LOT less. Goodness, I just came home from work and he peed for 3-4 minutes straight, moved a couple feet and peed again for 2-3 minutes, meandered in the yard for a few minutes and then peed again. Poor guy.

Also, last night, I noticed the anxiety which has been gone since he's been on the Vetoryl.

It's interesting how you don't notice the symptoms going away as much as when they return. It's been very insightful thus far.

[addy]

I hope the 60mgs work out. Finding the riight dose can be a bit of work sometimes.

Hang in there, you are doing so great!!!!!!


It's been very insightful thus far. It's interesting how you don't notice the symptoms going away as much as when they return. It's been very insightful thus far.

maybe because we are so anxious for the symptoms to go away!!! I'm glad you posted that observation though, it is a good reminder for us all:D:D:D

hugs,
addy

[glfprncs]

Here we are again...5 days away from T.C.'s next ACTH stim. I have a feeling we will be upping to 90 mg after the results come in. Water intake is through the roof, poor guy pees forever, hind end shakiness, but through it all, he's still one really happy old man! Love my T.C.

[glfprncs]

Should be getting test results back this afternoon, so we'll know our next step. One thing I've noticed is an increased shakiness in T.C.'s hind end. In addition, I went back and checked his paperwork from when we started testing, and T.C. has dropped 5 pounds since mid-February. He generally is in the 55ish pound range (he was a bit plump over the winter at 59, now down to 54), but that's a 10% drop in body weight. Don't know if it's an effect of the meds.

His appetite is unchanged...he wants to eat. All. The. Time. It's quite possible that his weight loss has coincided with the fact that my husband (who is a tour caddie and is also a softie for giving out too many biscuits to the dogs while I'm at work), started a new golf season in February, thus is away for weeks at a time. Less biscuits could equate to a leaner physique. Alas, I did mention it to the vet.

[addy]

I know how hard it is waiting for the test results. I just went through it too. I also noticed Zoe's hind legs having more trembling again and she came in controlled.

We will all wait with you :)

hugs,
addy

[glfprncs]

Took our middle dog to the vet today and while there got T.C.'s labs back. The ACTH stim from Tuesday, May 8 after 25 days on the new dose of 60 mg:

Blood sample #1--1.1
Blood sample #2--4.4

So...it appears we may have the dosage close, but the drinking and urination is as bad as it's ever been. Cushings stinks. :confused:

[lulusmom]

Those results look very good. If T.C. is on once a day dosing, cortisol may not be controlled throughout the day which may be why you aren't seeing complete resolution of symptoms. It's possible that T.C. is part of a small percentage of dogs who may ultimately need twice daily dosing. Have you discussed these results with the internist at UGA and let him/her know that T.C. is still drinking and peeing buckets? Are there any other symptoms that you are seeing at the moment?

[glfprncs]

No...our next chat with the internist is on Monday. Good suggestion, though, so I'll bring that up when we talk.

With regards to other symptoms....coat is looking a little funky right now, but I'm not sure if it's due to the winter/spring/summer 'molt,' his age, a recent change in dog food (I got caught in the latest Diamond recall and switched to a new grain-free food), or a combination of all of those.

There's been a more pronounced shakiness in the hind end as well.

Otherwise, he's still a really happy-go-lucky guy. We just got back from our regular walk and he trucked along like he always does...happy to be out and about.

I wouldn't be so concerned about the water/urination issues if I was certain that he wasn't really uncomfortable by the time I get home from work. He looks like he has a baby in his belly!

Some observations with regards to his water consumption....he tends to do his camel impersonation first thing in the morning and again in the late afternoon and into the evening. He'll drink an entire bowl of water right after he gets his morning breakfast, but the water bowls stay relatively unchanged from morning until I get home from work. They will be dry several times later in the evening, though. That sort of suggests that his main drinking time is when the Vetoryl wouldn't be active in his system, doesn't it?

[addy]

hmmmmmm, my Zoe does not touch the water bowl when we are not home, only when we are home, also never in the middle of the night.

so I am wondering if your pup drinks differently on the weekends when you are home durring the day?

Just a thought. We are dealing with the continued drinking and peeing too:)

hang in there,
addy

[glfprncs]

Chatted with the vet yesterday morning...our next line of thinking is to go ahead and get an ultrasound done (we haven't done one to this point since T.C.'s tests and symptoms did lean towards a pretty definitive Cushings diagnosis--alas, you all know the trials and tribulations of testing). There's a great internist about 2 hours away who WANTS the pet owner in on the ultrasound so that she can point out what she's seeing during the ultrasound (and then also copies the whole thing to a CD). I like that hands-on aspect, and she comes VERY well recommended by several dog and cat friends.

I just want to know if there might be something else that might be going on alongside the cushings.

[glfprncs]

Appt. with the internist for ultrasound, urinalysis and a looksie at all of T.C.'s labs the morning of May 29th. Will let you know what transpires!

[lulusmom]

We'll be anxiously awaiting your next update.

[glfprncs]

Just got back from our visit with Dr. Corrie Barker at Woodlands Veterinary Referral (near Athens, GA). Let me start off by saying she is EXCELLENT! I loved the fact that I was expected to be a part of the exam, the ultrasound, everything. She spent my entire appt. time (10:45-12:00) with me and T.C., talked aloud with her findings during the ultrasound, pointed things out and send me home with her written notes.

My vet hadn't sent all of the records that she needed, so she'll review those once she has them in their entirety. Note to self...next time, take the copies I have with me.

Here were her notes:
Kidneys: Symmetrical. No pyelectasia. No stones. Mild renal pelvic mineralization.

Gall bladder: filled with echogenic debris--mildly consolidated. Suspect early mucocele.

Liver--normal size and normal margins

CBD--N (no idea what this refers to!)

Adrenals: (she pointed out that both were enlarged (which is normal with Cushings dogs) but that they still retained their peanut shape, so no tumors)
Left--10.5 (cr. pole), 9.5 (cand pole) + 23 mmL
Right--11X31
Consistent with PDH

Prostate: Normal

Urinary bladder--distended (he had to PEE!!)--they took urine (a cysto UA) for urinalysis and culture to rule out some infection that would cause him to be still drinking and peeing so much

Her Plan:

Review all previous tests to ensure that nothing was missed.
Increase trilostane to 60 mg in the a.m. and 30 mg in the p.m. (she feels that TC's symptoms are treated during the day, but because he must metabolize the meds in that 10-12 hour window, that he may need a 2nd dose for the 2nd 12-hour period of the day)
Wait 3 weeks--if no improvement in symptoms, increase p.m. dosage to 60 mg.

She shared that in her experience with Cushings dogs that are on trilostane, that the ACTH stims need to be between 1.5-3.5 (T.C.'s last stim was at 4.4) to truly be effective in controlling the symptoms. She felt that being closer to 2 was even more beneficial.

She also said that for his age, TC is aging well. :)

So...I feel good about the experience (though my wallet does not! :eek:), glad to see that there's nothing obvious that could be causing the issues.

[lulusmom]

Sounds like you found a great vet who knows her stuff and better yet, you really click with her. In my very unprofessional opinion, I think her plan of action sounds like a good one. I'll be very interested to hear how T.C. does on the additional pm dose. Fingers and paws crossed that this will be the change T.C. needs to get stabilized and you can finally get a much needed break. I remember when my two were finally at a place that I could relax and not have to worry for at least 90 days.

[glfprncs]

I really did like her. She came as a recommendation from one of the volunteers at the animal shelter where I also volunteer. I received her typed notes yesterday afternoon (the ones that she sent to my own vet). From what I understand, she's VERY accessible to other vet's that are the 'primary' vet in the case. That makes me :)

Here are her final notes:

"I do believe that the diagnosis of Cushings is correct based on the results of the LDDS test, clinical signs and the abdominal ultrasound results (adrenomegally). The continued presence of increased drinking and urination frequency despite appropriate medical therapy could be one of the following:
-A urinary tract infection--which the urine culture should rule out
-Trilostate is required twice daily in some patients because of the short half life of the drug. He does appear to be more symtomatic in the late afternoon and early evening, about 10-12 hours after his morning dosing.
-Some patients with Cushings also have concurrent atypical Cushings (secretion of additional hormones from the adrenal glands) and some hormones are not suppressed by trilostane therapy
-There could be another current problem to cause continued PU/PD such as concurrent diabetes insipidus, psychogenic polydipsia, partial DI, etc. The fact that the urine is hypothenuric (less than 1.008) rules out renal insufficiency as the cause. He should not be able to concentrate or dilute his urine with renal failure.

I would like to get the urine culture results back first. I should have these results by Monday (June 4). If there is no bacterial growth, I would recommend that the trilostane dosage be changed to 60 mg in the morning and 30 mg at night. I find that it typically takes 2-3 weeks after a change in trilostane dosage to see clinical improvement. Therefore, I would wait this length of time before another dosage adjustment.

If the 60 mg in the morning and 30 mg at night dosage does not result in any clinical improvement, I would recommend that the evening dosage be increased to 60 mg (i.e. 60 mg twice per day). One month after the dosage increased to twice a day, I would recommend an ACTH stimulation test be done to evaluate his post cortisol hormone 4-6 hours post a.m. pilling. Ideally, my goal would be to keep his post stim cortisol between 1.5 and 3.5.

If he stops eating, begins vomiting, develops diarrhea, or has an abrupt decrease in water intake, his stimulation test should be repeated sooner than planned.

If twice daily therapy still does not control his excessive water consumption, we would have one of the following options at that time:
-Restart the desmopressin to see if that results in some clinical improvement in case there is concurrent partial DI. It is possible that with the control of the cushings as well as desmopressin therapy, he may have a better response.
-Send out an ACTH stimulation test to University of Tennessee to verify if other hormones are excessively secreted
-Change to lysodren therapy as this may result in better clinical control

We can talk more about these options when we see how he responds."

[glfprncs]

Just received the results from T.C.'s urine culture. Came back negative for any bacterial growth, so we've ruled out that urinary infection is causing the cushings symptoms.

Next step is to begin the evening dose of Trilostane at 30 mg. I'm to call Dr. Barker in 2 weeks as a follow up regarding his physical symptoms.

[glfprncs]

We are on day #9 on the twice per trilostane dose (60 mg in the a.m., 30 mg p.m.). Started noticing some changes on Friday (day #7) in that T.C.'s urine looked darker in color (it's usually almost clear like water). Noticed the same thing yesterday and this morning, T.C. didn't do his typical 'camel at the water bowl' drink fest. He is still drinking water, but more in the fashion of my other 2 dogs, not gulping down 16+ oz. at a time.

His appetite is good, poops look good, energy level good...so here's hoping that we're on the right track with twice per day medication.

[lulusmom]

It sounds like T.C. has turned the corner and his symptoms are resolving with the twice daily dosing. Sometimes that's what it takes. Good job!

[glfprncs]

I spoke too soon...we were back to the water guzzling first thing the next morning. Sigh...

I have a chat scheduled with the internist on Friday (she wanted an update 2 weeks after starting the p.m. dose of trilostane). Will update if we have a new game plan.

[glfprncs]

Chatted with Dr. Barker on Monday. Based on my monitoring of water intake for all 3 dogs (not the most scientific method, but as good as I can do), she doesn't feel that the water intake is abnormally high. So, today I'm to get 4 urine samples, take them to my local vet tomorrow and get a specific gravity as his day progresses. Got one already...3 to go. I will admit, as he urinates, his urine looks SO clear compared to my other 2 dogs...but in the rubbermaid container, it does have decent color.

Perhaps I feel he drinks an excessive amount of water because of the way he guzzles. Rather than going to the bowl and drinking a bit here and there as the day progresses, he tends to gulp massive amounts at differing times of the day (generally morning and evening). He drinks so much, oftentimes, that he regurgitates a bit of it or gags as he's drinking. That said, he produces an incredible amount of urine (peeing in 3 or 4 different places (and producing a solid stream for 20-30 seconds) each time he goes out to the bathroom).

[glfprncs]

Specific gravity on the urine samples came back:


8:00 a.m. (first urine of the day) 1.010
12:30 p.m. 1.005
5:00 p.m. 1.007
9:30 p.m. 1.010

Dr. Barker feels that it's because of poor regulation of his Cushings. She had hoped that the 30mg dose in the evening would help.

So...the plan is to up the p.m. dose to 60 mg (if you recall, he was on 120 mg once daily earlier this year, but he had a stim that came back low, so we changed the dose). So, 60 mg in the a.m., 60 mg in the p.m. ACTH stim in 10 days and if he stims okay, see if we get any changes in 3-4 weeks with regards to the water intake and excessive urination.

After that, put him back on the desmopressin in the even that he has concurrent Cushings and diabetes insipidus (we treated him initially for D.I. and had good results for 3 weeks, but them the symptoms came back, which is when we then pursued the Cushings testing).

If that doesn't work...no meds for 10 days and switch to Lysodren.

[mytil]

I have just a sec but wanted to make sure you and your vet know there is an approx. 30 washout period before switching meds.

[glfprncs]

We're not there yet (switching drugs), but I appreciate the feedback regarding switching. If we do make the switch from trilostane to lysodren, I'll be certain that we're all in the know. I hope I don't have to switch...even with the possible side effects that exist with the trilostane, the lysodren scares the living #*(@ out of me.

[frijole]

:D I can appreciate your fear of lysodren but it is truly a remarkable drug that i used for close to 5 years and it saved Haley's life. Each drug has its pros and cons.

If you don't have to switch - don't. But what Terri said is true - there is a 30 to 45 day wash out period when switching. To me that waiting and the resulting increase in symptoms is worse than tweeking the dose ... so good luck! Kim

[Squirt's Mom]

If it helps, Lysodren is poses no more risk than Trilostane. What makes Trilo seem safer is the short life in the body. Trilo is out of the system within hours while Lyso stays in the system for days, continuing to work. Both have the exact same risk factors - the key is always your vets experience plus your knowledge and diligence. I am sure you have your part down pat! ;)

Hope things settle down and you don't have to make the switch. It's always nice to be able to stay with what we start with. We are a Lyso household. When I first started this journey with Squirt, I wanted to use the Trilo but am very glad we didn't. I am the oddball here - Trilo scares me more than Lyso does. :D

Hugs,
Leslie and the gang

[glfprncs]

Back at the vet's office for another ACTH stim after being on the 60mg a.m./60 mg p.m. trilostane dosage for just shy of 2 weeks.

I have a feeling that his cortisol will be within the limits that Dr. Barker wants, but he's still symptomatic.

I'll know more tomorrow...

[glfprncs]

Even with the problems getting T.C.'s Cushings symptoms under control, he's still the best dog in the world. Here's our daily ritual post walk...he can't WAIT to get into the yard:

https://www.facebook.com/video/video.php?v=3634666859312&saved

[glfprncs]

Just got T.C.'s latest ACTH stimulation test results back after being on the 60 mg a.m./60 mg p.m. Trilostane dosage

First blood sample 1.1
Second blood sample 2.9

Dr. Barker feels this is exactly where he needs to be in order to truly control his cortisol with the trilostane. She wants to give this 4 more weeks and recheck again with another ACTH stim to make sure we're not dropping too low. That said, his main symptoms (excessive water intake, urination and ravenous appetite) are still unchanged. She feels that oftentimes the dog needs to be on the dosage for 3-4 weeks until the symptoms resolve.

So...for the time being, we wait for another month, recheck and go from there. The next step will be to add the desmopressin acetate back in in the event that he has diabetes insipidus in addition to Cushings.

[glfprncs]

Just curious...does anyone else have a dog who, when gulping down water at the water bowl, puke or gag on a regular basis?

This has been going on with T.C. for several years and is worse now that his Cushings symptoms aren't really going away with treatment. I'm sure he's puking and gagging simply because he drinks so much so fast. He doesn't throw up his entire stomach contents, but I'll hear him lapping up water, walk into the kitchen and see a pool of water on the floor (it's also usually very thick like it's mixed with gel). Othertimes, he'll gag up a small amount of water.

I failed to mention it to the internist when I was there in May...I assume there's a correlation, but didn't know.

Your thoughts?

[glfprncs]

I chatted with Dr. Barker this past week regarding T.C.'s gagging...she seems to think it is esophageal reflux. So, we're trying Pepcid AC for a few weeks to see if it makes any difference.

We're in Ohio visiting my parents for the next 12 days...he LOVES being on the farm.

[labblab]

I hope T.C.'s great vacation on the farm is continuing!

Thanks so much for your updates, and I'm sorry that nobody has checked in with you about your questions re: gagging up the water. But it is not a symptom typically associated with Cushing's, so I'm guessing that people don't feel as though they have much info to offer in that regard. :o

I will tell you that when she was younger, one of my non-Cushpups had issues with regurgitating food shortly after mealtime. We tried a couple different things, including feeding her smaller meals at intervals (rather than one or two big meals daily), and also giving her some Pepcid, too. We also suspected that reflux might be the culprit. Fortunately, she ultimatedly stopped doing it. I've slacked off on the Pepcid in recent years, but still do divide her meals.

Anyway, I hope the Pepcid will turn out to be helpful to you. And as you say, if T.C.'s voluminous water intake starts to decrease, that may be helpful as well. Hope you both enjoy the rest of your vacation, and please continue to keep us updated.

Marianne

[glfprncs]

It seems as though the Pepcid AC is providing some sort of benefit, as TC's gagging, which was a regular thing over the past few weeks (and throughout the day), is minimal at best this week.

On another note, as I posted earlier, we're on vacation in Ohio visiting my parents. We've been here for a week, and TC's water consumption has changed considerably. I almost wonder if the water intake at home is almost habitual. At home, he would hit the water bowl and consume anywhere between 24-36 oz. of water as soon as he finished his breakfast. Here, he doesn't even amble over to the water bowl after eating, and when he does go drink, he's not consuming voluminous amounts like he does at home.

Don't know if it's a conincidence, a change in venue, thus a change in drinking habits, or the trilostane.

We're having a wonderful time...T.C. is the only one of my 3 boys that I trust off leash, so when we go for walks, he's in HEAVEN (I can't really let him off leash at home as we live in a subdivision with traffic, whereas my parents have 90 acres...we just go hike). He's bright eyed, lots of energy (though when he crashes, he's down for the count), and has my dad wrapped around his paw. :D

[molly muffin]

Sounds like heaven for TC and for you! Enjoy your vacation. So glad that TC is improving.

hugs,
Sharlene

[Steph n' Ella]

Hopefully your "vacations" in Ohio are like my vacations in Ohio...lots of sitting and talking! :) Sometimes a trip to Kings Island. I'm in Cinci mostly and we usually fly into the airports in Dayton or Columbus. Of course we go across the whole darn state if we drive...

Do you have any images of T.C.'s abdomen on x-ray? Or have ultrasounds shown very enlarged liver? My Ella's stomach is actully pushed out at quite an angle due to her enlarged liver. I tried increasing the volume of her food recently and found she just doesn't have the room for one large meal a day. So I am splitting in to two feedings. Coughing and gagging has decreased with smaller meal size.

[glfprncs]

Liver was normal on the ultrasound...I don't have images, but in Dr. Barker's notes she wrote liver normal sized with normal margins.

He gets two meals per day...he doesn't gag his food, only when he drinks water.

[molly muffin]

A normal liver is a good thing!! Yipeee! No enlargement.

Hugs,
Sharlene

[glfprncs]

Tomorrow is our next ACTH stimulation test (it'll be 6 weeks post twice dosing of trilostane at 60 mg in a.m. and p.m.). If the cortisol levels look good, we'll go to 4 month stims (which will be heaven on my pocketbook!).

[molly muffin]

Hoping for the very best possible results tomorrow!! Hugs, Sharlene

[lulusmom]

We'll be keeping fingers and paws crossed that the acth stim test results are awesome and that you get that much needed financial break and that T.C. gets a break from the needle for four months.

Glynda

[molly muffin]

My wallet just has molly's name written all over it these days. Not mine that's for sure. ROFL!
We all know that feeling around here it seems like! Please, oh please, be well T.C. and momma needs a new pair of shoes. *wink (just teasing)

Hugs,
Sharlene

[glfprncs]

T.C.'s ACTH stim came back from Tuesday.

His ACTH stim from 7/1 (he had been on his current dose of 60 mg a.m./60 mg p.m.--upped from 60 mg a.m./30 mg p.m.--2 weeks prior to the 7/1 test)

1st sample--1.1
2nd sample--2.9

His ACTH stim from 7/31 (so after being on the 60a.m./60 p.m. dose for 6 weeks total):

1st sample--1.2
2nd sample--1.3

I feel that we're a little close for comfort, though Dr. Barker, his internist considered his cortisol "very tightly controlled." I feel a bit better that his pre-cortisol was where it was, though. When we had himo n the 120 mg once per day dose, his 1st sample was < 0.7 and his post was 1.9.

Anyhow, my vet is out of town, so I'm having an e-mail conversation with Dr. Barker. While his thirst and urination are still far above normal (in my opinion) and his hunger ravenous, there does seem to be some small decrease in the symptoms, though they're still strong. She wants to get a morning urine sample to check his specific gravity again (which, to the naked eye, still looks very dilute), and we move forward from there.

We're thinking that he may also have diabetes insipidus, so if the specific gravity remains low, although the cortisol is clearly controlled, we'll add the desmopressin acetate in and see if we get some changes. I'm wondering, too, if we may lower his evening dose back to 30 mg, as his current cortisol levels make me a bit nervous.

I assure you, I'll be keeping a VERY close eyes for changes in appetite, poo consistency (he just took a big poop in the back yard and it was perfect grain free dog food consistency--nothing even close to diarrhea), water intake, and apathy.

[lulusmom]

Wow, I'd say T.C.'s cortisol is under tight control. Those numbers are a bit low for my comfort and I am baffled as to why his symptoms have not resolved. Dr. Edward Feldman of UC Davis mentioned that a small percentage of dogs they treated with Trilostane never saw a resolution of PU/PD (excessive drinking and peeing). It's possible that T.C. is in that minority. Unfortunately, Dr. Feldman didn't elaborate on whether or not Trilostane was deemed ineffective in those dogs and switched to Lysodren or if they tried desmopressin as a last ditch effort.

Glynda

[glfprncs]

Glynda,

Dr. Barker did mention that T.C. might just be part of that population that doesn't respond to trilostane. I'm truly trying to be objective regarding his water intake/output. It's difficult to truly measure it because I have 3 dogs drinking out of the same water bowl, so a lot of it is my subjective view. He's always been a 'big drinker and pee'er,' so is big drinking and peeing just normal for him? I don't know. In comparison to my other two dogs (who are similar in size and weight), he drinks far more and pees volumes compared to them. That said, is it better than 9 months ago when we first started this process...absolutely.

I'll know more when I can get the urine sample to the vet to check another specific gravity. If it's close to normal, well enough...if not....first we try desmopressin, then we do a washout period and start lysodren. That said, if his cortisol is managed, and his symptoms are manageable (even if they haven't 'disappeared'), then we manage them the best we can without any other changes or additions of any other meds.

[glfprncs]

Here's the new plan....

1. Get a urine sample first thing tomorrow to check specific gravity. If T.C.'s urine is still not concentrating, then we....

a. Decrease dosing of trilostane from twice/day dosing at 60 mg. each dose to once/day dosing at 60 mg since the symptoms are relatively unchanged when comparing the once/day vs. twice/day dosing
b. Consider that T.C. has concurrent diabetes insipidus and begin desmopressin acetate drops twice/day.

If the urine is concentrating, then I'm a complete nutball with regards to the symptoms I'm seeing and we keep a VERY close eye on his cortisol, perhaps tweaking his trilostane a bit and backing off on the dose.

[lulusmom]

I think checking the USG is a great place to start and if it turns out that you are a complete nutball, welcome to the club. :D

[glfprncs]

Well...I'm sad to say that T.C.'s specific gravity of today's urine sample (which was first thing and he sleeps in the bedroom with no water access at night, so his urine really SHOULD be concentrated) was 1.006.

Clearly, even though T.C.'s cortisol is under such tight control, there's something else going on that's not allowing his symptoms to go away.

So...we're going to stop the p.m. dose of trilostane because his symptoms were the same when he was on a once/day dose of 60 mg. versus the twice per day dose of 60 mg both a.m. and p.m., allow his cortisol to rise a bit (his stim from the once/day 60 mg dose was 4.9 post, I believe), so his cortisol is still controlled, and we're going to add the desmopressin acetate in thinking that he has concurrent diabetes insipidus and Cushing's.

Will keep you all posted. I never thought this was going to be such a roller coaster. The good thing is that my boy still has a gleam in his eye, a spring in his step, a wag in his tail, and lots of love to give every day. : )

[glfprncs]

T.C. was pretty demanding at 7:30 this evening, his evening trilostane time. I usually give it with a blob of peanut butter....

Of course, I relented...no trilostane, but he had his peanut butter. : )

[frijole]

That is so cute! Kim

[glfprncs]

Finally got T.C.'s new meds on board...had his first dose of demopressin this afternoon. We'll see how treating both Cushing's and diabetes insipidus goes. I'm hopeful.

[molly muffin]

Oh good! Crossing gingers and toes for you! Let us know how it goes!

Hugs,
Sharlene

[Squirt's Mom]

How are things going with TC's new meds? I hope you see improvements very soon!

Hugs,
Leslie and the gang

[glfprncs]

He's had 3 doses of the meds since yesterday afternoon/evening, and I can already see a definite change in his water intake.

However, we had the same immediate results the last time he was on the desmopressin, but we only had positive results for about 4 weeks and then the water intake and urination increased dramatically again. He wasn't diagnosed with the Cushing's at that time, though, so we're hoping that since his cortisol is now controlled, that if he does have Central diabetes insipidus, too (and the only real way to know is to just give the meds and see if they respond), we'll finally get the symptoms managed.

[molly muffin]

I hope for a really long time of good results!
Glad that you are seeing some improvment now. Every good day counts. :)

hugs,
Sharlene

[glfprncs]

Just thinking towards the future...

We have yet to have an adrenal panel done at U of T. In the event that T.C. doesn't have a long term response to the desmopressin (like he did prior to treating his Cushing's), our next step would be to send an ACTH stim to U of T to see if he's secreting other hormones (I assume this would be an Atypical type of Cushing's).

If that's the case, I've heard two differing things...that the dogs have to be off trilostane in order to do this and that you simply send your most recent stim done 4 hours post morning trilostane therapy. Any idea which it is? Also...the washout for trilostane is 30-45 days...would this be done at the end of that washout period?

[glfprncs]

T.C. has been on the desmopressin for just short of two weeks. Water consumption has decreased, on average, about 30-35%.

What's unusual, though, is that he drinks the majority of his water first thing in the morning. In fact, just this morning he ambled to the water bowl after breakfast and lapped up about 48 ounces. His drinking patterns are just so odd (and so entirely different from my other two dogs) that I, of course, still worry that we haven't gotten this right.

I'll continue with the treatment, though, because we are seeing the results we want at this point in time.

[Squirt's Mom]

Recessed camel genes, perhaps? :p

[glfprncs]

We've always called his morning water bowl soiree his "camel impersonation." Truly, I've never seen a dog drink so much in one appearance at the water bowl.

[molly muffin]

Wow, camel indeed. Just make sure he gets a good long time outside after That kind of water. ROFL!

hugs,
Sharlene

[glfprncs]

So...I'm starting to get excited because we're 3 weeks post medication changes with T.C. and he's doing FANTASTIC!!

With regards to his energy and behavior, it's almost like the old T.C. is back. He's playful, energetic, silly, sweet...he's just more like "him" again. Clearly, he's a much happier boy with the lower trilostane dose.

He's been on the desmopressin (for suspected Central Diabetes Insipidus alongside his Cushing's disease) for 3 weeks, and in the past week, I've been able to drop the dose from one drop twice/day to one drop once/day and maintain the same results. Water intake has dropped approximately 50-60 ounces per day, and we're holding steady with more normal drinking patterns (though he still does the majority of his drinking first thing in the morning). His bladder is no longer distended and no longer looks like a balloon bulging and ready to pop.

I'll get a urine sample in the next week and check specific gravity, but visibly, it looks much darker and more concentrated. He's not due for another ACTH stim until November, but I'm hopeful that we've finally managed to figure out what's going on.

[Squirt's Mom]

WOOHOO!! :D That is wonderful news...and a long time coming, huh? ;) I know you and TC are relieved and enjoying the days much more!

Hugs,
Leslie and the gang

[glfprncs]

5 weeks post start of desmopressin...water intake has increased a bit (by about 16 oz. per day). Took in a urine sample yesterday for a specific gravity check, and sadly, he's still not concentrating his urine as I'd like (it was 1.012).

Waiting for the word from the internist on Monday as to what our next step will be. I think it'll be to send an ACTH stim to the U of T to see if his other hormones are in excess (either because of the Cushing's disease or because the trilostane can oftentimes cause it as well).

[glfprncs]

T.C. will be going in at the end of this month (he's due for vaccinations, rabies, etc, so I figured get it all done in one visit) for an ACTH stimulation test. He's not scheduled for one until November, but we'll be sending this one off to the U of T to see if he's oversecreting any other hormones. If this is the case, we will, more than likely, take him off all meds for a washout period (approx. 4-5 weeks) and then load him on lysodren. I'll let you know what we learn...

[labblab]

Just want to warn you that it seems likely that ANY dog with elevated cortisol will also exhibit some elevation in intermediate hormones as well. And as you say, trilostane can enhance that effect. So I'm not sure how valuable the UTK testing will be in terms of telling you something that you would not already know. Since T.C.'s water intake is trending upwards again, Lysodren may still end up being an option for you to try, but I'm not sure that you'll get a lot of value out of the UTK testing at this stage...

Marianne

[glfprncs]

Just wanted to pop in for a really quick T.C. update. After talking with my regular vet, we decided to hold off on the ACTH stim and the U of T adrenal panel at this time. T.C.'s water intake remains within normal amounts (and it has remained within a more normal intake for just shy of 3 months), he's urinating less, he's got great energy, his coat looks good, and while he's still ALWAYS hungry (he's a lab, they're always hungry!), I can say his name while he eats and he'll pause and look at me. His urine, while still not a 'normal concentration,' continues to be the only red flag we see with regards to his Cushing's disease and diabetes insipidus.

So, I measure water daily, I give lots of belly and eat scratches, we go for walks, he plays hard with his 3 year old brother, and I monitor. He'll go for a 6 month ACTH stim in December just to make sure his cortisol isn't creeping up (or down).

[molly muffin]

What absolutely great news to hear about T.C. So glad that he is doing better and most importantly that he is playing with his brother and having a great time. You can always tell how they feel by their attitude towards play I think.

Sharlene

[Squirt's Mom]

What a wonderful update! :) I hope things continue on this trend for a long, long time to come!

Hugs,
Leslie and the gang

[glfprncs]

Here we are just prior to Thanksgiving and I'm thankful that my T.C. is still doing well on his 60 mg. dose of trilostane and 1-2 drops of desmopressin for his diabetes insipidus.

Great energy, loves to play with his 3 y.o. brother, loves walks, and now that it's getting colder, appreciates when we light up the gas fireplace!

We go in the next few weeks for an ACTH stim just to check that his daily dose of trilo is keeping his cortisol within appropriate levels.

[Squirt's Mom]

YAY! Another good report on sweet TC! :cool::cool::cool: Hope it continues for a long time to come.

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

[molly muffin]

Happy Thanksgiving! Yay for T.C.! It is always nice to read the good news posts!

hugs,
Sharlene and Molly Muffin

[glfprncs]

Well...T.C. had his latest ACTH stim on 12/27/12 and I was honestly really surprised at the results. They're quite low.

His pre cortisol was <0.7 and his post was 1.3.

I received his results on Friday and had to wait until Monday to hear back from the internist. He was off meds for 2 days (Saturday and Sunday) and by Sunday night, his symptoms (which were completely managed on the 60 mg once/day dose and the 1 drop of desmopressin) were back in full force. Water intake increased dramatically, he seemed nervous, shaking, panting, etc.

So...he clearly needs to be on the trilostane, but now we've got to mess around with the dose AGAIN. I'm frustrated...guess I'll need to start saving pennies again for all the ACTH stims we'll be having over the next few months.

The good news is that even with the low cortisol, T.C. has been feeling fantastic. He's got great energy, his coat shines, he loves going for walks/playing with his doggy brothers, has a great appetite, has solid poop...all is grand in his labby world.

[glfprncs]

Hi all! It's been quite awhile since I've posted an update with regards to T.C., but everything is going VERY well.

A brief history: T.C. was diagnosed with PDH Cushing's (and possibly diabetes insipidus) in February of 2012. We spent about 15 months treating with Vetoryl with varying results. We were never able to get him to concentrate his urine, and while his water intake decreased, he was still drinking far more than normal. Under the advice of his internist, we tried varying doses of Vetoryl during the 15 months, ranging from twice daily dosing of 60 mg to being on a mere 10 mg dose at the end of this time period. His ACTH stims were generally always too low (even on the 10 mg dose), and by July of 2013, his water intake was increasing more and he was developing horrible anxiety.

He had the U of T adrenal panel in August and all 2ndary hormones were elevated. We did a 6 week washout off the trilostane (which was not a fun experience--daily accidents, horrid anxiety, etc.), ran an ACTH stim to make sure his cortisol truly was high, and then loaded on lysodren.

Lysodren loading went MUCH faster than expected (5 days), we had him overcontrolled at first (based on that ACTH stim he was pre <0.7, post 0.8), but went off lysodren for 2 weeks, did a follow up ACTH stim (pre 1.2, post 2.3) and started maintenance. His last ACTH stim (after the maintenance dose for 3 weeks) was pre 2.1, post 3.9). Will keep an eye on water intake (as I always do) and any other symptoms, but for now we'll recheck him in 3 months.

The best news is that his water intake is normal, his urine is concentrated, he's not searching everywhere in the house for food, and the anxiety is GONE. It's like I have a totally different dog than what I had in July.

[Squirt's Mom]

Oh, it is soooo good to hear from you and TC again and especially to know he has improved so much! I've wondered about ya'll but when it's been so long since we've heard anything it's a bit scary to ask, if you know what I mean. ;) So seeing this post today is a real boon! :cool::):cool:

And I am very glad you shared your experiences with Vetoryl (Trilostane) and Lysodren! I hope others who may be having the same issues that TC did and are using Trilo will make note. Some pups just do better with one drug over the other and for TC, it is Lyso over Trilo. As one of the very few here who will always choose Lyso as the first treatment approach, I like hearing these stories! :p I'm just about always the odd man out in any situation, tho! :D:p:D

Don't be a stranger! Next time, I just might brave hunting you down! :p
Hugs,
Leslie and the gang

[glfprncs]

I'm SO sorry for not updating more often. I didn't even think about what others might be thinking. That said, thank you for thinking about us over the past 10 months!!

I'm finding the more 'experience' I'm getting with Cushing's, that T.C. has been a bit of an odd case. He's had the vets at UGA scratching their heads more than once. I'm glad I pushed the issue with the UofT adrenal panel. I'd been reading that, oftentimes, larger dogs start needing a lower and lower dose of trilostane to keep the cortisol lower, but then the symptoms continue. That's what was going on with T.C., and then he started these REALLY weird hiding/anxiety symptoms. I couldn't unload the dishwasher without him cringing and running into the other room. I'd find him shaking and hiding in the corner. He also started climbing onto the shelf underneath the coffee table and hiding there as well. So, when we ran the full adrenal panel, and his other 2ndary hormones were sky high, we realized that he was probably exhibiting the symtoms due to a possible atypical Cushing's that is actually caused by trilostane use (there are documented cases where trilostane use in larger dogs actually causes the adrenals to oversecrete the 2ndary hormones even though the cortisol is completely controlled).

My vet has been VERY open to listening to me, and he's concurred that he's learned a considerable deal by being T.C.'s 'primary' during the time and consulting with the internist as needed.

I'm just relieved to have a more 'normal' T.C. back again. He's lost a considerable amount of hind end musculature in the last year, and his weakness is evident. He actually fell in the kitchen when we were in that 6 week period where he was on no meds. It was awful...he literally couldn't stand on his own for about 5 minutes. I'd envisioned the worst. Amazing that 5 weeks later, he's doing so well. We actually just got back in from a mile walk, and he's now sound asleep in the foyer in the sunny spot coming through the door. He's a happy chappy.

[Squirt's Mom]

Oh, btw....I changed the title of TC's thread to reflect the treatment change. ;)

[frijole]

Wonderful news. Appreciate you sharing this because trilostane isn't the solution for all dogs and your story is a perfect example of when lysodren does work better. All dogs are different. sorry you went thru so much to get there but there is a lesson to be learned for others.

Thanks for coming back with the great update and don't be a stranger! Kim

[molly muffin]

I second what Leslie and Kim have said. Trilostane/vetroyl is not for every dog and Lysodren can truly be a life saver.

So glad to hear the good news that TC is doing so well! You've had a heck of a journey, so glad you have the regular TC back.

hugs,
Sharlene and Molly Muffin

[glfprncs]

Hi and Happy Holidays to everyone at K9 Cushings!

Just wanted to pop in and give a happy update about my boy, T.C., who is now the ripe age of 15 and well-controlled on Lysodren for the past 14 months (he is almost 3 years post Cushing's initial diagnosis).

Here's a link to his "Christmas Photo" this year if you're interested: https://www.facebook.com/photo.php?fbid=10204096634070131&set=a.1872956897664.2096389.1053400816&type=1&theater

T.C. is still fairly active and adores his daily walk (he does sleep a lot more during the day now) and still adores food. The best news, of late, though, is that he finally has concentrated urine. After years of urinalysis that showed a concentration of 1.008-1.010, his is normal (his last ACTH test looked great, too).

So while he's slowed down and he's definitely looking and acting a bit like an "old" dog, he's still quite the happy chappy and I adore him to pieces.

[Squirt's Mom]

MODERATOR NOTE: I have merged your update into TC’s original thread. We normally like to keep all posts about each pup in a single thread as it makes it easier for members to refer back to the pup's history when needed. If it's been a while since you've been here, you will probably have to scroll back a few pages. Thanks!

[molly muffin]

Oh how wonderful to hear that TC is doing so well still. Lysodren was definitely the drug of choice for him. What a love. He is just adorable in his christmas hat.

[Squirt's Mom]

Howdy stranger! :D

I am so happy to hear than T.C. is doing so well! He looks great, too, by the way! A very handsome frosted face fellow indeed! You are doing a superb job, Mom!

Wishing you and yours a very Merry Christmas!

Hugs,
Leslie and the gang

[glfprncs]

Good morning my cush pup friends,

It's with a heavy heart that I'm here today. Late Friday night, I had to say goodbye to my boy, T.C.

He'd been getting along great on lysodren. It was easily managed, all of his ACTH stim tests came back looking good, but just prior to Christmas he became VERY ill. After lots of bloodwork, X-rays and then a follow up to the internist for an abdominal ultrasound, it was revealed that he'd had an acute pancreatitis attack. He spent the weekend receiving supportive IV care, and bounced back great. In typical cushing's form, he even loved his very low-fat dog food.

The only problem is that he didn't receive his lysodren dose during this time, and subsequently lost his lysodren "load." We did another ACTH stim this month, and his post cortisol was quite high (30.7), so we began reloading him on his lysodren.

I got him loaded on Thursday. When I got home from work on Friday, the house was a disaster and I couldn't find TC. He'd had diarrhea and vomited during the day, but I could also see where he'd wandered into areas of the house (where the dogs never go), seemed to have gotten stuck, and I found him underneath my computer desk (a sort of cave-like area). He didn't want to get up, but with my urging he did. I immediately gave him prednisone, thinking we were in an Addison's crisis and contacted my vet who agreed. We thought he'd perk up over the next few hours.

He was resting comfortably, but an hour later got up, vomited, staggered around discombobulated, ran into the walls, got stuck behind a chair and collapsed onto the floor. I rushed him to the ER vet.

We still thought we were in an Addison's crisis, but his bloodwork revealed a resting cortisol of 6.7 and all of his electrolytes were smack dab in the middle of normal.

His temperature was high (106.3) and his blood glucose was low (39.8). We ran more and more bloodwork, but everything was so inconclusive.

I sat there on the floor of the ER vet's office with my dog, watching him struggle, unable to stand, defecating on himself, and I just couldn't put him through anymore. I made the decision that night to say goodbye.

In hindsight, it's quite probably that TC had a stroke while at the house. The ER vet was thinking we were possibly looking at insulinoma, but who knows.

In the end, T.C. lived to be 16 1/2 years. Together we hiked in the Rocky Mountains, waded in the Colorado River, camped in Colorado, West Virginia, North Carolina, and Maryland. He's chased prairie dogs in Colorado. He's been to the nation's capital, paddled in the Atlantic Ocean off the coast of Georgia, and buried his entire head into a snow drift in Ohio. He had two brothers that he could herd around the house like cats, but who loved him dearly. He loved going for walkies.

RIP my dear boy.

[labblab]

I am so very sorry to read this news, but also so very grateful that you've returned to let us know. T.C. has now been added to our special memorial list of honor, amidst our other beloved ones.

http://www.k9cushings.com/forum/showthread.php?t=7676

What a wonderful life you shared! We know you will miss him dearly, but we hope the memories you made together will continue to fill your heart and remind you of his shining spirit.

Do take care and please return at any time, to share stories or memories or just to tell us how you are doing.

Always in loving memory of you sweet boy. RIP, indeed.
Marianne

[molly muffin]

I am so sorry to hear this about TC. :( He did really wonderful for a long time.
I just want to extend my sincerest condolences to you and your family on the loss of a beloved family member.

[Joan2517]

I am new to this site and so very sorry for your loss.

Joan