Our 9 year old Shih Tzu has diagnosis of Cushings

[Jamie]

Our sweetheart, Jessy, has just been diagnosed with Cushing's disease. We are trying to educate ourselves on Jessy's condition and have found this forum to be a great resource. The information is sometimes confusing and often frightening but we are doing our best to become better informed and would greatly appreciate information, feedback, and recommendations from the members of this forum.


Jessy is a spayed 9-yr old Shih Tzu weighing about 10 lb. She was was diagnosed for adult onset demodectic mange in March 2011 and treated with Ivermectin for 4 months. The demodecosis cleared up but reoccurred last Dec. (2011) and the treatment with Ivermectin was resumed. She was also treated for a urinary tract infection (UTI/hemoturia) in Dec. 2011 and was treated with 250/mg day cephalexin for two weeks. The UTI reoccurred in 3-5 days and the treatment was repeated for two weeks. It reoccurred again and a urine culture/sensitivity test was completed and she was treated with clavamox for 10 days. The UTI came back in 3-4 days and she was referred to the Veterinary Clinic at Mississippi State.

Jessy has some minor hair loss but doesn't exhibit many of the normal signs for Cushing's disease including elevated liver enzymes, bloated stomach, high water consumption, urination problems, or excessive appetite. MS State Vets examined her and did blood work, abdominal radiographs, ultrasound and a SNAP 4Dx test. No bladder stones, polyps, or tumors were observed. The ultrasound showed enlarged adrenals and slight rounding of the liver lobes. All serum chemistry parameters were within normal ranges with a slight but non-significant elevation in ALT.
They conducted an ACTH stimulation test. The results were strongly positive (about 50 ug/dL). They were surprised that she tested so
strongly positive on the ACTH stimulation test (>22 is consistent with pituitary-dependent Cushing's) and felt she definitely has Cushing's. An endogenous ACTH test was conducted several days later and her levels were elevated (90 pg/ml). She was then diagnosed with pituitary-dependent Cushing's. They feel that treatment is indicated because the demodectic mange and reoccurring UTIs are likely secondary impacts due to a suppression of her immune system by the excessive cortisol levels. The veterinarians at MS State have prescribed Trilostane at a single-day dosing of 1 mg/lb (10 mg/day) with followup ACTH-stimulation testing in 2 weeks . We live about 150 miles from the Veterinary Clinic at MS State and our local, gp veterinarian will be conducting the followup tests and conferring with the veterinarians at MS State on the appropriate course of treatment, monitoring schedule, and recommended adjustments in dosage based on the results of the ACTH-stimulation monitoring tests. The MS State DVMs also prescribed treatment with 125/mg clavamox every 12 hr for 4 weeks for the UTI and to continue treatment with 0.19 ml/day ivermectin for the demodectic mange. The Trilostane is on its way and we are worried about starting another med. Hope we are on the right track.

Thanks for providing such a supportive site. We look forward to hearing from you.
Jamie and Ken

[labblab]

Dear Jamie,

Welcome to you, Ken and little Jessy. Well, by consulting the specialists at Mississippi State, you've done exactly what I would have recommended in a situation where the symptom pattern and lab results are not clear-cut. But since other illnesses have been ruled out and Jessy is suffering from persistent problems that can be worsened by the immunosuppression associated with Cushing's, it will be very interesting to see whether the problems resolve with trilostane treatment.

The vets are right on the mark as far as the intial starting dose that is currently recommended by Dechra (manufacturer of brandname Vetoryl), and also the ACTH monitoring schedule. But since Jessy does not exhibit the outward symptoms that are so common with Cushing's (excessive appetite, thirst and urination), you will not be able to gauge the effectiveness of the trilostane on the basis of a lessening of those symptoms. Instead, you will need to watch carefully to make sure that you don't see unwanted medication side effects emerging that could signal a dose that is too high (like vomiting, diarrhea, lethargy). I'm guessing the university vets have already given you information in this regard. But in addition, here's a link to Dechra's U.S. Product Insert. It contains a lot of helpful treatment and monitoring info:

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

I'm really glad you've found us, and we will be very anxious to know how Jessy (and mom and dad!) are doing as treatment progresses.

Marianne

[trippyjanet]

Welcome! I unfortunately do not have any information to share because I just also found this board myself recently, but what I can tell you is that this board is full of wonderfully knowledgable and caring people who will provide their knowldge, lend a shoulder and be a unbiased third party when tough decision come up! I hope you find it as great here as I have so far!

[lauraperla]

Welcome Jamie and Jessie,
I'm new here too but wanted to say hello and welcome. This is an excellent site, I have learned so much already from the fabulous people here.
We started our Cushings journey with a 4 month phase of 'it's a UTI' from our vet, followed by 3 months of 'it's thyroid' from the second vet we went to, so I know how frustrating those early times can be.
Hoping that Jessie is soon feeling much better!

Laura and Saoirse xx

[Jamie]

We just received the trilostane medication for Jessy. Mississsippi State dispensed 14, 10-mg capsules (1 mg/lb) at a cost of about $43.00. How does this cost compare to other sources?

Miss. State recommended doing the ACTH-stimulation test in 10-14 days. Is there an optimal time period? We're thinking it may be best to test in 10 days so we'll still have four days supply while waiting on the test results and possible dosage modifications. On the other hand, if the longer period of 14 days gives more accurate results on her long-term response then we would opt to wait and obtain some more capsules while waiting on the lab results.

Jessy's water and food intake are not excessive (asymptomatic) so we will be watching closely for other adverse reactions. How soon after starting the meds would we expect to see problems if the dose is too high or she can't otherwise tolerate the trilostane?

We are scared to death about starting this but feel we have to treat. Trying to keep our emotions under control so we can learn and do the very best for Jessy. It is nice to communicate with folks that understand how much these fur babies mean to us. Thanks so much.

[Harley PoMMom]

Many members use a compounding pharmacy for the Trilostane because it is cheaper.

The ACTH stimulation test has to be done 4-6 hours after the dose of Trilostane. Also, the Trilostane has to be given with food for proper absorption.

We have seen many dogs here have their cortisol drop lower on a dose that was being given over a period of time, so IMO, I would recommend no dose change until the 30 day mark. When there is a dose change an ACTH stimulation test should be done within 10-14 days, the electrolytes should be checked too.

Love and hugs,
Lori

[Squirt's Mom]

If Jessy doesn't have Cushing's or if the dose is too high, you can see adverse effects with the first dose. Since the signs used to monitor treatment (peeing, drinking and appetite) are not present, it is going to be especially critical that you watch her like a hawk and at the very first sign of problems (loose stool, loss of appetite, weakness, lethargy, nausea/vomiting), stop the Trilo, call your vet for an ACTH and electrolyte check asap. Trilostane has the exact same potential side effects that Lysodren does. ;) The only thing that makes it seem safer is the short life in the body. Trilo is out in 2-12 hours while Lyso can last for days. So don't be lulled into thinking you are using a "safe" drug and be on your toes as I know you always are. :)

We will be here anytime you need to chat!
Hugs,
Leslie and the gang

[jmac]

Hi there,
I just want to welcome you and Jessy to the forum. She sure is a cutie! I am a huge dog lover in general, but I have a special place in my heart for Shih Tzus. :) I wanted to tell you that you are doing a wonderful job of figuring things out for your girl. Good work going to the specialist to get all of the testing done. It sounds like you have the right mindset and like you're getting good advice from the vet. I am glad to hear you can take care of the monitoring at your regular vet. That will be nice!

Getting the Cushing's diagnosis can be very scary and overwhelming, but many, many dogs do very well on treatment. I hope Jessy will get some relief from these other conditions as well.

You have found a wonderful site with very knowledgeable, helpful, and caring people. We will be with you every step of the way on this journey!

Julie & Hannah

[Jamie]

We just wish she was off these other two meds before starting the Trilo but that does not seem possible. We will get prednisone to have on hand, but we are trying to decide when to start her first dose. Timing when to start so we can test and get back results in time to order more Trilo and not run out is a factor. If we start tomorrow the vets will be in the office for 3 and 1/2 days so we can run her to them in case of an emergency.
If we start her on next Monday then we will have 5 and 1/2 days that the vet office is open. Then we could test 10 days after starting. Do we need to plan for the max days the vet office is open to watch side effects?

With so much going on with her, it really scares us about starting the Trilo but she has tolerated all the other meds just fine. It was highly recommend by the head vet at MS State for Jessy based on her test results and lack of other usual symptoms.

Thanks for your input. It really helps.

[labblab]

Hi again, Jamie. I'll bet Jessy does just fine with the trilostane. In answer to your question about pricing, there are internet sources from whom you can purchase 30 days of brandname Vetoryl for the same price as Mississippi State charged for the 14 days. If you Google "Vetoryl 10 mgs.," you'll see what I mean. "Drs. Foster and Smith" was one of the first sites that popped up for me, and they charge $1.55 per 10 mg. capsule, regardless of the number that are prescribed.

It does make it somewhat awkward that you've only been given 14 days worth of capsules. I agree with Lori that Dechra (manufacturer of brandname Vetoryl) generally recommends that the initial dose remains unchanged for the first 30 days unless there is evidence of overdosing requiring a decrease. This is because the cortisol level tends to continue to drift downward during the first month of treatment. Therefore, it is generally preferred to hold off on increases until you know where the cortisol will "bottom out" on the initial dose. With that in mind, you may want to go ahead and have at least a full month's worth of 10 mg. capsules on hand so that you won't be scrambling at the point of the 10-14 day testing. If you do end up needing to decrease the dose, hopefully you can find a compounding pharmacy in your area that could "repackage" those 10 mg. capsules into a smaller amount so that none of the drug is wasted. Here's a link to a "Treatment and Monitoring" brochure prepared by Dechra that I think you'll find helpful:

http://www.dechra-us.com/files//dechraUSA/downloads/Client%20Literature/47902_VETORYL_10mg_Treatment_and_Monitoring_Brochu re_Update_3_2_ps.pdf

As far as the timing of starting the trilostane and the 10-14 day testing -- truly, I'd pick the timeframe that is the most convenient for you. Check with your vet as to where you should take Jessy in the event of any emergency after-hours or on weekends. It's always good to be armed with that information. But the odds are slim that Jessy would need emergency attention, especially since you have prednisone on hand. As Leslie has said above, trilostane generally exits the system after approx. 12 hours. So if a dog seems unwell while taking the drug, the general recommendation is to withhold dosing so as to allow the cortisol to rebound to a higher level, and to additionally administer prednisone if the dog's discomfort warrants it.

Good luck, and definitely keep us updated, OK?
Marianne

[Jamie]

Thanks for everyone's help in getting Jessy started on her Trilo this morning. We gave it to her 3 and 1/2 hours ago and you would not know that she has taken anything. I know it is too early to really tell but giving that first pill is hard. Fortunately we are retired so we can watch her like a hawk.
I have been looking online for Vetoryl and there are several sites that have good prices. Has anyone used California Pet Pharmacy, VetDepot or Foster/Smith? There is a great local pharmacist that can compound for us.
We will keep you posted. It's a beautiful spring day here in Alabama so all of us will get out and enjoy it.

[Squirt's Mom]

Hi Jamie,

I use Foster/Smith for Squirt's Lysodren and have not had any problems with service. I can get it cheaper other places but I don't us credit cards. ;)

Glad things are going well! That first dose is a bit disconcerting, huh? But when we see our babies acting better and happier, it is all worth it.

Hugs,
Leslie and the gang

[lulusmom]

Hi Jaimie and a belated welcome to you and Jessy.

I think you've already gotten some very good feedback from others but I just wanted to tell you that I had a little black and white Shih Tzu shelter dog whose story sounds identical to Jessy's. We suspected that she was 9 or 10 when pulled from the shelter and she already had a bad case of ringworm and then horrific demodex. Sheets of her skin and hair would peel off when bathing her. She was on clavamox and ivermectin for many, many months. Like Jessy, she really didn't have many symptoms associated with cushing's but was ultimately tested and diagnosed by a derm vet. As I recall, she was getting 15mg once daily and I don't believe any adjustments were necessary.

Good luck and we'll be anxiously awaiting the results of Jessy's first stim test.

Glynda

[Jamie]

Glyna,
Good to hear from someone that has dealt with a Shih Tzu like Jessy. Did the dermodex clear up after starting the Trilo? Jessy has only lost a little fur from her tail. Our gp said she is the first he has treated with no primary symptoms and both he and the vets at MS State stated that she does not look like a Cushings dog. They were really surprised when her numbers were so high.
We have noticed that she quit jumping up on the sofa several months ago but our vet never heard of that being a symptom.
She is still doing fine on her first dose of Trilo and it has been over 5 hours. Like Julie we have a very special place in our heart for Shih Tzus and she is our first. Hoping for more time with her:)

[lauraperla]

Hi Jamie,
Our german pointer exhibited the reluctance to jump, where previously she had no problems. I have seen it listed as a Cushings symptom, I think it's probably the first very early manifestation of the muscle weakness / wasting a cushdog with full blown symptoms often has.
Hoping that Jessy settles well on to the Vetoryl. I know you'll be keeping a close eye on your baby, Leslie has given you excellent advice on what to watch out for.

Laura and Saoirse xx

[lulusmom]

Hi Jamie,

It's been a while since Mabel was my foster but as I recall, we got the demodex and underlying bacteria infection under control before we tested for cushing's.

Glynda

[Jamie]

It is day 6 and Jessy is doing fine on the Trilostane. Her Stim test is on the 27th. I will post the results.
Our weather here in Alabama has turned into summer and everything is coming to life so we need to start treating for fleas and ticks. We use Frontline Plus on Jessy but wondered about putting it on her while since she is a Cushpup on Trilostane. Is there any problem giving it to her? She is taking Clavamox and Ivomec, also.
Thanks again for all the support and information on this forum. You guys are the best.
Jamie

[jmac]

Hi again,

I would love to hear the response you get because in MN we are also entering summer (we seem to have temporarily skipped spring!) and I also need to get my dogs started on Heart worm and flea/tick preventative. Hannah did fine all last year (Cushing's was diagnosed last March) and I need to get them on something since that can be an issue, but I am worried about everything. We have our appointment on Wed. I'll be stopping back to see what people say. Hannah is not being treated with anything right now.

I'm so glad Jessy is doing well on the Trilo!

Julie & Hannah

[labblab]

Hi Jamie,

According to Dechra (manufacturer of brandname Vetoryl), during clinical trials of the drug, dogs were also given other commonly used meds without seeing unwanted drug interactions:


VETORYL Capsules were administered concurrently with a variety of medications that are commonly dispensed to middle-aged and geriatric dogs. The most commonly dispensed concurrent medications include heartworm prophylaxis, flea and tick treatments, routine vaccinations, antimicrobials, levothyroxine, non-steroidal anti-inflammatories, and joint supplements.

This quote is taken from Dechra's Technical Brochure:

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

If it was me, I would evaluate the use of heartworm/flea/tick preventatives on the basis of individual product safety, in general, for use with any dog. I don't think you would want to suspend any and all treatment just because your dog has Cushing's.

Marianne

[lvasilio]

Good to see the discussion and info regarding tick meds. I am having the same questions about Jake and Frontline Plus. My vet said it should be fine and judging from the Decra info it looks okay

[Jamie]

Went ahead and used the Frontline Plus and Jessy is fine. She is taking so many meds we wanted to make sure before using another medication.
She had her ACTH-stim test yesterday, day 14 on Vetoryl, and we got her results this morning. Her pre-ACTH level was 0.7 ug/dL and her post-ACTH level was 7.4 ug/dL. Waiting to hear from the vet at MS State but think the results are good. She is showing signs of improvement - more energetic, playful and is running and jumped on the couch for the first time in a long time. She never has been a heavy water drinker.
Maybe she can get off the other 2 meds soon. She has been on antibiotic since 12/21/11.
Any feedback on her results will be appreciated. Hope we are off to a good start?

[Harley PoMMom]

They conducted an ACTH stimulation test. The results were strongly positive (about 50 ug/dL).
Jamie and Ken



She had her ACTH-stim test yesterday, day 14 on Vetoryl, and we got her results this morning. Her pre-ACTH level was 0.7 ug/dL and her post-ACTH level was 7.4 ug/dL.

With such a significant decrease in cortisol (from 50 ug/dl to 7.4 ug/dl) on 10 mg once a day in 14 days just really keep an eye out for any adverse symptoms, although I am a worry-wart! But these are good numbers and I am happy for you.

When is her next ACTH stim test scheduled for?

[Jamie]

Not sure but we read that it should be done in 14 more days-day 30. Waiting to hear from the vet at Mississippi State. Our vet suggested 30 days from now. We are watching her very closely.
Thanks.

[Jamie]

Vet at MS State said to wait 4 weeks to retest but we are going out of town around that time so we will retest at 3 weeks. He was pleased with her numbers. She will stay on the Calvamox for 2 more weeks then we will take her off and do a urine culture and keep our fingers crossed that the UTI is gone then do a skin scrape to check on the demodex.
We travel in a motor home about 6 months a year and I am very nervous about being on the road with her. This year we have plans to go to Glacier National Park for the first time but worry since it is such a remote area. Any one know of some good vets in the area. Or any tips on traveling with a Cushpup.
thanks

[Squirt's Mom]

Hi Jamie,

The best tip I can offer is to make sure you have copies of all her testing with you as you travel. That way, if you do need a vet on the road they will have all her info in hand right off the bat.

Enjoy your travels! Sounds like so much fun!

Hugs,
Leslie and the gang

[Jamie]

We are in the process of trying to get her papers. MS State would not fax them to us unless we would pay a high price for them but would fax them to our vet for free. But getting them from him has been slow but we are still trying.
Any more feedback on her recent Stim test would be appreciated. All of this is new to us so we worry.
Best wishes to all of you out there dealing with this disease. It is tough.

[labblab]

She had her ACTH-stim test yesterday, day 14 on Vetoryl, and we got her results this morning. Her pre-ACTH level was 0.7 ug/dL and her post-ACTH level was 7.4 ug/dL. Waiting to hear from the vet at MS State but think the results are good. She is showing signs of improvement - more energetic, playful and is running and jumped on the couch for the first time in a long time. She never has been a heavy water drinker.

Any feedback on her results will be appreciated. Hope we are off to a good start?

Jamie, I'm so glad that Jessy is showing improvement. That is wonderful! And in conjunction with her clinical improvement, I think her post-ACTH result of 7.4 ug/dl is great at this stage of the game. The only other observation I'd make, however, is that the pre-ACTH level of .7 ug/dl is pretty low. Usually the pre-ACTH reading is not a factor in dosing decisions -- it's the post-ACTH level that directs the treatment. But since Jersey's pre-ACTH falls well below the norm, I'm wondering if this could be a "pre-signal" that this dosing level may turn out to be a bit higher than will be optimal for her.

It doesn't sound as though the Mississippi State vets are concerned about this and maybe I'm worrying unnecessarily, too. But if it were me, I'd just ask them about it the next time I spoke with them. Otherwise, I'm so glad that she's doing better!

Marianne

[Jamie]

Thanks so much for the feedback. We are also concerned with the low pre-test number and did talk to the vet at Mississippi state about her results. We asked if he felt the low pre-stim results were a cause for concern. He said he was not concerned as the cortisol levels vary considerably during the day and the response is the critical result. He went on to say that if the suppression was too great, causing a low pre-stim level, the adrenals wouldn't respond to the ACTH stimulation. He recommended waiting 30 days to retest but we're thinking about doing the test closer in 2 or 3 of weeks as this seems to be the normal protocol. What do you think?

[labblab]

I'm glad to hear the vet's explanation re: the pre-ACTH result. That makes me feel much better, too! As far as re-testing, this is just my own personal opinion. But as long as Jessy continues to look and behave well -- playful and energetic -- I think I'd be inclined to wait the 30 days as the vet suggests. ACTH testing is so expensive, and also you don't want to make a dosing change prematurely. The month should give Jessy plenty of time to really settle in at this dosing level so as to give you greater confidence if there then appears to be a need for a dosing increase.

Of course, if she starts acting poorly, then all bets are off and you will want to test sooner in order to make sure that her cortisol hasn't fallen too low.

Marianne

[jmac]

Hi-
I am glad to hear Jessy is doing well! Your trip sounds like so much fun, but I imagine it could be a bit more stressful traveling with a Cushing's pup. I think it's great that you are going to take her records with you. Hopefully being so prepared will mean nothing will happen! :D

Julie & Hannah

[Jamie]

Thanks for the feedback. We have thought about postponing our trip to Glacier until next year to give us time to adjust to all of this. We made plans before Cushings came into our lives. However, if she it still doing good in July we may just go for it. Most campgrounds are helpful in finding vets/docs etc.

Our son in in the Air Force and will be in Biloxi this month for training and we are scheduled to go there mid month so we will go ahead and have Jessy tested in 3 weeks so we can keep our reservations but will change if needed.

We really have high hopes that she will do well on the Trilo since we had to put down our Ladi (14 year old Chocolate Lab) last week and our hearts are broken. The old girl gave us so much but her body just wore out. She was our first Lab and we think everyone should experience a Lab at least once in life. Miss miss miss her. Jessy has got to hold us up for awhile and as our vet said you can't beat a Shih Tzu.

[Jamie]

Update:

Jessy had a urine culture on Friday and finally no more infection. However, her skin scraping showed dead mites so we will continue to treat the demodex. She has her second Stem. test yesterday with the results: pre-stim=3.4 post-stim=14.4 ug/dl. We are waiting to hear from her vet at Miss. State but are concerned with the result being higher than optimal range (1.5 to 9.1). What do you think? Thanks for everyone's opinion.
Jamie

[labblab]

How is Jessy doing behaviorally? My guess is that the vets will want to go ahead and increase her dose since her ACTH result nearly doubled since the last testing. 14.4 ug/dl really is too high, especially if she is still having issues with the mites.

Marianne

[Jamie]

Her energy level is not has good as it was before the first test but not as low as before the Trilo. Actually, she seems to feel good and she has never drank lots water.. Saturday she did not seem to feel good but the next day and since back to the same. We watch her like a hawk and may read too much into her every moment. We are still adjusting to all of this and especially worry after having just lost our Lab.
Still waiting to her from the MS vets.
Thanks

[Jamie]

The vet said to keep her on the same dose for now. She did have a clean urine culture so they seem to feel we have an improvement in her condition because the UTI is gone for now. If it reoccurs or she has other signs of Cushings then they will up her dose. He did not mention the mites. We communicate through email with MS so sometimes you just can not get all your questions answered.
Guess we just keep watching and hoping for the best.

[labblab]

Hmmm...I am really puzzled as to why they don't want to increase the dose when Jessy is now significantly above the therapeutic range, especially given the fact that she is no longer as energetic and continues to have the issue with the mites. Of course it's up to you, but I'd email back and ask about those issues, and ask why they are feeling "OK" for her cortisol to be above therapeutic range. I mean, why wait for her to develop another UTI and have to go through treatment again?? That just doesn't make sense to me...

Marianne

[Jamie]

Marianne,
Does not make sense to us either. Hate that she still has mites even if they are dead. We have called and emailed and are waiting to hear something for MS. Our vet seems to follow their lead. We just want the best for her and will keep asking questions. Still new to us.
Thanks, Jamie

[Jamie]

Marianne,
The vet explained why they will not change her dose now as being because she is still below the Cushings level. In other words, she is in a normal cortisol range. We will keep watching and hope the mites clear soon and the UTI does not return. Jessy seems to be doing good for now.
Thanks for you input.

[labblab]

Oh dear. I am really confused now, and apologize in advance for creating more "question marks" for you, too. But the "normal" range for a dog without Cushing's is different from the desired cortisol range for a Cushpup being treated with trilostane. Do you feel certain that this is really what the MS specialist has advised, as opposed to what your local vet has decided to do?

I am really glad that Jessy is doing well. So far be it from me to upset the apple cart :o. But I am just fearful that she may have a return of problems with a cortisol level this high.

Marianne

[Jamie]

Never apologize. Welcome your comment. MS state never would get back with us so we talked with our local vet. That was his explanation. MS State emailed us to keep her on the same dose for now and did not response to our calls or emails after that.

Let us be more detailed:

Here is the response taken directly from the email from the MS vet:
"Was the sample drawn 4-6 hours after giving the Trilostane? How is
Jessy doing otherwise? Has she had any other clinical signs (increased water intake or urination, lethargy, weight gain, increased appetite, panting)?
As long as she is doing well otherwise and her blood was drawn at the appropriate time, I would not change her dose at all. This result is
certainly higher than we like to see with trilostane treatment,
however, we are not seeing any of the other clinical signs that we
would normally use to monitor response to therapy. At this point her
primary sign that made us suspicious for Cushing's (urinary tract
infections) has resolved. Should she show additional signs referable
to Cushing's, or another urinary tract infection, then at that time we
may need to consider increasing her dose."

When I talked to our local vet and told him what the MS vet said, he said that while the stim-test result of 14.4 is above the optimal or desired range for a cushing's dog on Trilostane (1.45 - 9.1ug/dl) it is not above the normal or reference stim-test range for a non-cushings canine (reference range of 8-17 with results >20 ug/dl being consistent with Cushing's). And because she is not showing the typical clinical signs, he agreed with the MS vets recommendation to keep her on the current dose and retest in a few weeks.

Does this make sense because this is all new to us and can be very confusing? We appreciate your concern for our sweet girl.
Thanks Jamie and Ken

[labblab]

Yes, this definitely makes more sense! :)

Thanks so much for providing the entire explanation, because given this context, I now understand the vets' reasoning. Remembering that Jessy has not been exhibiting typical Cushing's symptoms, it actually did cross my mind earlier as to whether that somehow was factoring into the equation. And now I know that is indeed the case.

So carry on, and please do keep us updated!

[Jamie]

Good. We will keep the updates coming and hope for the best. Day at a time.

[Jamie]

UPDATE:
Took Jessy in for a skin scraping and the mites are finally gone so no more Ivomec. We just returned from a 6 week motor home trip and Jessy did great. She looks good and up to this point no signs of the UTI returning (been 6 weeks). We will keep her on the 10mg of Trilostane and continue to watch her like a hawk. Thrilled to be able to update with good news.
Wishing everyone a wonderful summer.

[Harley PoMMom]

What a wonderful update! We are so happy for you and Jessy! :)