Sunshine, 14 yr old Min Pin

[sunshinehoman]

Hi everybody,
we are new to cushings and this forum...Sunshine was just diagnosed today, she actually had a bladder infection and when her tests came back her urine was diluted. We questioned the diluted urine and went ahead with blood tests. I don't have copies of all the blood work (will get from vet) but they started her on Lysodren (Mitotane).. This vet opted not to do the initial dose and actually went right to a 2x week maintance.
Now that she has been diagnosed I feel really bad that I did not notice any symptoms!!! I have her with me all the time and did not notice, well I did notice increase drinking of water, but it has been so hot here I just figured it was the heat. She has nighttime incontinence for about 4 years now, but they did blood tests back then and no elevated liver enzymes at that time, so they put her on PPA and she has done wonderful with that! She also has weakness in her hind legs, but she had leg perthes when she was a puppy and her knee joint has arthritis so another one I missed! She sometimes plays with her food or guards if from our other dog, and is slowing down, but other than that there really are not other symptoms.

We have both our dogs on Nutro Senior formula and are highly considering switching to Instinct Raw Boost Grain Free Chicken, as we feel that the dogs would benefit from this food. We will be switching slowly as to not cause gastrointestinal problems. Any thoughts?

I have been reading a lot on food trying to decide what would be best for both dogs, it looks like actually making/cooking their food is not as good as giving them an actual good dog food that has all the vitamins, minerals, etc..they need?

This is all very overwhelming and I need sleep! Hopefully we are doing all the right things for our baby!

Any suggestions or thoughts would be appreciated, as I know my brain is going to burst from all the Internet reading!!!

[molly muffin]

Hello and welcome. Yes, sleep is a definite must!

I haven't started mine on the meds yet, we're still doing some testing, but we've just received the diagnosis of cushings a few weeks ago ourselves.

Some of the others who have lots of experience with Lysodren, will poke their heads in and be able to tell you what to watch for, and good ideas about food. It is amazing how much knowledge is contained in this forum.

Check back in and opt to get the instant email notifications so you'll know when someone posts. Life saver that little item is.

Hugs,
Sharlene and molly muffin

[frijole]

Hi and welcome! I found this group over 7 yrs ago and was in your shoes... felt bad cuz I know my dog had it for years and we accidentally discovered it. Good news is - that happens to almost everyone and there is absolutely no need to rush into treatment of cushings.

What is more important is to make sure that the dog in fact has cushings. Having read here for 7 years + I can't tell you how many times dogs are misdiagnosed.... so for this reason we ask a bunch of questions just to be sure that the diagnosis is right and if already on drugs, that the dosage is right for the dog based on weight.

Please tell us all you can about your baby. I know you said you don't have the test results but please do get copies of them all and post them as soon as you can. Do you know how much testing was done to diagnose? One test, two tests?

There is the acth test which takes a couple hours. There is an 8 hr test called the low dose dex suppression LDDS test. Did you have an ultrasound done?

What symptoms does your dog have?

I saw where you have started on lysodren. Please tell us your dogs weight and the amount you are giving (I think you said you are giving it twice a week?)

OK - I am going to be real up front. If your dog has regular cushings (and not atypical cushings) it is NOT following protocol to start with the low dose that you mentioned. In fact those $8+ pills are being wasted. You cannot obtain the desired load by skipping the 'loading period'. We have seen this before countless times and it just doesn't work. It ends up costing you money, time and tons of stress in the long term. It also is a sign that your vet is either afraid of the drug or not very experienced in treating cushings (or both).

I don't mean to upset you but this is what happened to me too and I wanted so badly to believe my vet but multiple people posted and convinced me that I should read up on it (I'll link you to our resource section where there is tons of info that is written by world wide specialists) .. after reading these articles I knew they were right and I switched vets.

So please post the dosing prescription you are currently giving as well as your dog's weight so we can make sure it is not too high of a dose.

Ask any questions you want - we are here to help. Kim
http://www.k9cushings.com/forum/forumdisplay.php?f=10

[sunshinehoman]

I will get the results of the 8 hour test in tomorrow. They first did a regular blood test then the 8 hour I think it was called a dex test?
They have given me 250 mg to split in half and take 2x per week, these pills are kind of like brown soft gooey chewables, not really pills.
I am concerned on your advice as everything I have read so far talks of the induction period, and I have not heard anywhere of skipping this. It made sense when the vet said that it was safer, but now im not so sure :(
I dont know what to do..
She is a 10 lb min pin
her symptoms are excessive drinking/urinating, hind end weakness, panting, food guarding, she hesitates to jump up on couch and go up and down stairs.

[frijole]

Whoa. I couldn't sleep and am glad I decided to check in. Let me get this straight. You have already been given and have started dosing on lysodren but you don't even have the test results from the ldds test yet? That would be like starting on chemo meds before a cancer diagnosis was confirmed.

I know I am someone you just 'met' online but trust me - I have treated a dog with lysodren for over 4 1/2 yrs and I know right from wrong. ;) Please don't give any more lysodren until you have the results back from this test, have posted us all you can from previous tests. This will also give you time to take some deep breaths and get up to speed on what cushing's is, how to treat it and a comfort level in making a decision best for your dog.

You didn't mention what symptoms your dog has or how much she weighs. BTW I love her name. We need to know her weight so we can calculate what the correct dosage should be (we use the established protocol established by the vet community)

You mentioned diet - I would not make any changes to the diet at all as you start on a new drug. If your vet instructed you properly you would know that signs of too much lysodren are changes in appetite, vomiting and diarrhea. So if you had a diet change that resulted in any of those symptoms you wouldn't know if it was the lysodren or the diet change.

If Sunshine has cushings you just want to make sure that she doesn't get table scraps and that her diet is low in fat.

Again, I'm not trying to scare you but it is just crazy that you would start lysodren before getting test results back. If you started it before the test was taken the results are skewed and I would demand a refund.

Like I said - don't feel bad because we see this alot. In fact, if this didn't happen alot this forum wouldn't exist. If you go to the link I gave you start out with the link for people new to cushings. Then go to the link that talks about lysodren loading. Anything you read will tell you that you give the drug daily until appetite or water intake is reduced and you then stop and have an acth test done to see if the cortisol is within desired range. This is the "quickie" version but I'm just trying to give you a high level crash course. :)

Don't feel overwhelmed - we have all been there! Again, tell us all about Sunshine and we will help you as best we can. Kim

[sunshinehoman]

Sorry... the results are back I was just going to go get the results from the vet tomorrow to post.

Sunshine is 10 lbs she had diluted urine when she had a urinary tract infection. Her urine was still diluted after 3 weeks on antibiotics and the infection was clear. I requested blood work which showed elevated liver enzymes. Then we did the 8 hr test, results were positive for cushings, I did not ask to see the results of the 8 hr test, why? I dont know..Guess I was just not thinking at the time about reading results. I will get all her tests tomorrow (later today) and post them here.

Her symptoms are:
excessive drinking/urinating, hind end weakness, panting, food guarding, she hesitates to jump up on couch and go up and down stairs. My dogs self feed so I really didnt notice any major change in her feeding habits. We go for walks every night so that was probably keeping her weight down.

Sunshine and Cylcone our other Min Pin are both on a diet of Nutro Senior, they do not get table scraps, butt we do give carrots as treats, I will not change their diet until all this is sorted out! I have read quite a few of the articles on this site and they are very informative, that is why I am concerned about the dosage she was given..
Thank you very much for your responses! They are really helping me get under control. I was so worried that everything had to be done right away!! and the longer I waited the worse it would get!
Sunshine is my little savior,as she helped me get through breast cancer, I will forever be in her debt for that! Now I want to do anything and everything I can to help her!

[frijole]

Whew... relieved about the ldds test. If that is the only test that was done i would ask for an acth test before starting lysodren because there are frequently false positives on it due to other non adrenal issues that skew the results. (My other dog was misdiagnosed and had multiple false positives - turned out it was a tumor and not cushings)

Anyway.. since you gave me her weight - at 10 lbs protocol is that she would be given between 113 and 227 mgs of lysodren daily during loading. I have never used the chewables (they weren't invented when my dog was around :p) so I'm not sure how easy they are to cut into two - because you want to make sure you get the exact amount each dose (especially during loading)

Others will chime in but there are companies that will compound the product for you so you could give a pill that is the exact dose you need. Some compounding companies are more reputable than others - Diamondback out of AZ is used by alot of folks here. Their prices are less expensive than vets offices too.

But we can worry about that later. Looking forward to the ldds test results and also get a copy of the blood test that was done that showed high liver enzymes. Just type out the values that were high. Give us the value and then the normal ranges for each. Example: Alk Phos 500 (Normal = 50-130)

OK... I've got to get up in 4 hours so I need to get to bed. Hope this helped! Kim

[addy]

Hi and Welcome,

Kim has started you off really well. I had a conversation with Dr. Oliver from Unniversity of Tenn- they do the complete adrena panel, testing for typical and non typical Cushings.

He had mentioned he has seen some dogs respond to a maintenance dose without loading and that each dog is different. Having said that, the next expert, Dr. Peterson, told me he would highly doubt that it would help a dog with high cortisol for the reasons Kim states.

I am glad you found us and just know that there is a wealth of experience here and much needed moral support.

[Squirt's Mom]

Hi and welcome to you and Sunshine! :)

We are also a Lyso house, my Squirt has the Atypical form, and I can tell you that unless Sunshine had blood drawn that was sent to the University of TN in Knoxville, your vet cannot and has not diagnosed her as Atypical because this is the ONLY place that tests for this form of Cushing's. The treatment schedule he has started Sunshine on is in keeping with the way Atypical is treated, tho. Some basic info to help you understand -

In Atypical Cushing's, the cortisol is always normal while one or more of what are called the intermediate hormones are elevated. In true, or conventional, Cushing's the cortisol is always elevated while the intermediates may or may not be elevated. If the cortisol is elevated, the pup has true Cushing's and must be treated as such.

When treating true Cushing's with Lysodren, doing what is called a loading phase in which Lyso is given twice a day, is critical in order for the drug to do it's job - which is to erode a miniscule layer of the outer cortex of the adrenal glands. Once this is accomplished, then the pup goes to being dosed 2-4 times a week VS twice daily, called maintenance...which is how your vet started Sunshine. In other words, if her cortisol is elevated, he skipped a step. ;)

Now, having said all that, don't panic. :);) Like Kim said, all you are doing is wasting money if she has true Cushing's. It is unlikely the Lyso will cause Sunshine any harm as it hasn't been allowed to do it's job properly. IF any of her intermediates are elevated, the Lyso will help lower them with the possible exception of one called Estradiol. The problem with that is this - if her cortisol is elevated the dosing schedule she is currently on will probably not be able to address the cortisol so it will continue to rise even as the intermediates lower. And the cortisol is what does damage over the long-term. ;) Please note the phrase "long-term". Cushing's is not one of those disease where immediate action is required - it takes years for this disease to cause permanent damage; Cushing's moves at a snail's pace, as one of our admins says.

So, here is my recommendation for now. Stop the Lyso (for no reason other than to save you some money and stress) until you can post the test results here so we can see exactly what your vet is working from. If she has true Cushing's, it isn't likely this dose is going to help her right now anyway and if she has Atypical Cushing's, stopping for a day or so won't hurt the process. We can look at the testing she has had done and should be able to give you some direction from there. ;) Right now, we are sorta working blind. :D Take the the next few days to get the test results, and do some reading and question asking of your new family here. And have no doubt, you and Sunshine are family! :)

As for the diet, I agree - don't change anything you don't absolutely have to right now. If you babies are doing well on the feed they currently eat, don't rock the boat. ;) The Cushing's picture can get confusing enough without adding changes that will make it hard to determine what is causing any problems that may arise. ;) One thing I will say, tho - home cooked is the best way to feed in my opinion if, and ONLY IF, a canine nutritional consultant or veterinary nutritionist works with you to design a diet specifically for each of your dogs. Feeding home-cooked meals that are considered generic, in other words that any dog can eat like many found online or in books, is risky at best. It is critical that all vitamin and mineral requirements are met and that is not an easy thing for a layperson to determine. So feeding ad hoc home cooking or using a recipe found online or in a book is not the way to go. If one is not able or willing to use a consultant/nutritionist, then feeding high-quality commercial is the way to go. Unlike many these days, I am not a fan of raw feeding until everything else has been tried and found not to work, then try raw as a last resort. Never, ever feed by what is called the "prey model" in which only raw meat and raw bones are fed - this is very unbalanced and not at all what our domestic companion animals need to thrive. They are not wolves and never have been. ;) One other thing - unless your babies have problems with grains, grain-free isn't necessary - this is just another marketing ploy to get us to purchase the feed. Dogs, like humans, use carbs for energy and removing the grain removes some of the energy source. BTW, wolves did and do eat grains. ;) Do you really think they would pass up a deer tummy full of sweet grass and all those organs chock full of nutrients provided by grains? nah, they know what's good for them. ;)

I'm glad you found us and look forward to learning more as time passes. Remember, you are family now and that means you will never be alone. We are here for you and Sunshine all the way.

Hugs,
Leslie and the gang

[sunshinehoman]

WOW just wanted to say how wonderful you guys are!! I really appreciate all the input and help!!

I am going to stop Lysodren for now, her next dose isn't until Monday anyway. I will be getting the tests results today and asking why they started her on the lower dose and not the loading dose.

So far she has had 3 tests
Urine analysis
Blood panel
8 hr test
Is there any other tests you recommend to confirm diagnosis?

The vet also recommended to give Milk Thistle and Sam-e, they told me I could start that right away so I did. Is this OK to begin giving Sunshine seeing as I am not continuing with any more Lysodren this week?

As far as the food they are on Nutro Senior right now, but I was told that Instinct Raw Boost Grain Free Chicken is much better. Does anybody know about the Instinct food? Is it better? If not then I will not change over, I did give some (treats) of the Instinct and both dogs went crazy over it!

Thank You Everyone!

Shannon & Sunshine

[Squirt's Mom]

Hi Shannon,

The milk thistle and SAMe will be fine with or without the Lyso on board. One thing to keep in mind with the milk thistle - it needs to be given in 3 month cycles. Give it for the fall and spring, skip winter and summer, or vice versa. Three months on, three months off. I didn't know to do this with Squirt and she has developed an intolerance to milk thistle now. SAMe needs to be given on an empty stomach, too. ;)

Hugs,
Leslie and the gang

[sunshinehoman]

Ok just returned from the vet with all the tests, they tried to explain it and I understand minimal amounts...more research! This is so overwhelming!!

The vet recommended an ultrasound....... Should I go with this test next or is there a better test for the next step?

They are looking to know if it is adrenal of pituitary, aren't the treatments the same for both?

I am also interested in the difference between Lysodren and Trilostane? Is one better than the other?


Blood test results:
chem 21 + comprehensive CBC

Comprehensive CBC will just give high values for now

test name ---- result ---- Refrence range
platelet ---- 533.00 ---- 200.00-500.00

Chem 21

Alkaline phosphatase---- 406.00 ---- 10.0-84.0
ALP

ALT ----- 78.0 ----- 5.0-65.0

AST ----- 34.00 ----- 16.0-60.0

Cholesterol ----- 287.0 ----- 150.0-275.0


Dexamethasone Supprssion
test----result----refference range
Pre dex------6.5----1.0-6.0 ug/dl
post 4 hr dex----5.9----less than 1.5 ug/dl
post 8 hr dex----6.8----less than 1.5 ug/dl

There is a lot more information on this page not sure what exactly what else you need to help me understand these reslults!



Urine Specific gravity test
8/25/08---- 1.020
7/6/12----- 1.010
7/20/12---- 1.010
7/30---1.010

Thanks,
Shannon & Sunshine

[frijole]

I'm at work so can't research this but this doesn't look like cushings to me. Can someone at home check out the ldds to confirm this? The alk phos isn't very high at all.

Why did the vet recommend an ultrasound? Curious also as to the explanation on the low dosing approach.

Gotta get back at it. Kim

[labblab]

Hi Guys,

The LDDS is definitely consistent with Cushing's (both the 4-hour and 8-hour readings are way higher than the norm of <1.5). However, the results do not help distinguish between the pituitary and adrenal forms of the disease. So my guess is that the vet has recommended an ultrasound to help make the distinction.

Marianne

[sunshinehoman]

Really you dont think its Cushings? even with her symptoms? If you dont think it is Cushings then what can this be??

Just to recap..Her symptoms are:
excessive drinking/urinating, hind end weakness, panting, food guarding, she hesitates to jump up on couch and go up and down stairs. She has some slight hair loss by her rib area, but it has always been sparce there. My dogs self feed so I really didnt notice any major change in her feeding habits. We go for walks every night so that was probably keeping her weight down.

The reason behind giving low dose Lysodren is all 6 Dr's headed by Dr Bodam Rudowski, have had some tragic results on the loading phase, not lots but a few, and they feel a few is to many. They have done research and have decided to follow a "different" protocol in regards to Lysodren. The Dr's here have seen results in starting their patients at a maintance dose rather than the loading dose, with less side effects. They did state that it takes a longer time to achieve results 1-3 months depending on animal, but they still get the results. That is what I got from the explination

[labblab]

In addition to the LDDS, I do think the other lab results are consistent with a Cushpup. Although Kim is right that we've definitely seen much higher elevations in ALKP, the overall results of high ALKP, ALT and cholesterol and at least moderately dilute urine could all be found in Cushpups. So in conjunction with the symptom profile, I'm on board as far as the Cushing's diagnosis. But I join the others as far as feeling concerned about your vets' treatment approach. The fact that they've had enough tragic results to scare them away from accepted Lysodren treatment protocol makes me very nervous about their experience with the drug. No vet should be having multiple "tragic" results. The worst case scenario should be conversion of the dog from Cushing's to an Addisonian condition. But Addison's can be managed effectively longterm, if necessary. If your vets have experienced multiple worse outcomes than that (like patient death?) either they were not following accepted loading protocol or had the misfortune to have noncompliant owners who did not exercise proper oversight during their dogs' loading process...

Marianne

[sunshinehoman]

I do understand your concern as it is mine also. I do not believe they had any deaths, I did not get into it very deeply with them yet. I might switch vets although I have been going there for over 18 years and they have never been wrong about any problem, surgery, diagnosis yet... There is to much other information I need at the moment.

But honestly with the Lysodren do you have any reason to not try maintance first? Is it bad for my puppy? What are the ramofications of no load dose? Addy mentioned Dr Oliver of Tenn has seen results this way.

How about the other Trilostane? I have read everything I can find on both, but there isnt much info out there on Trilostane, it seems safer and that is what I am looking for


So do you bleieve the next step would be the ultrasound? Or is there another test you recommend?

Again I appreciate all the support!! Im sure Sunshine does too, although she is sleeping right now and cant voice her opinion :)

Thanks!
Shannon & Sunshine

[frijole]

:) This is what I call group think :)

Thanks Marianne for checking on the ldds test. Shannon I'd do the ultrasound for two reasons. One, it confirms if the diagnosis is correct because you can have false positives. Two, because the ldds came back as inconclusive as to which type of cushings you are dealing with (pituitary vs adrenal). knowing this could impact the dosing levels required and meds.

Trilostane and lysodren are equally effective. They just work differently. Both of them can cause problems if they aren't administered properly. To be honest lysodren has been around for 50 yrs and trilostane (in the US) around 5 now. Trilostane doesn't require the induction period so some feel it is easier and alot of vets are not as experienced with it if they've always used lysodren. Some vets (inexperienced) will make assumptions that nothing can go wrong with trilo and that is false. Ask the members here whose dogs overdosed. Both require a vet on the ball and an owner who is engaged and up to speed.

To answer your questions there is no reason to not do a maintenance dose (unless your dog has a totally different type of cushings called atypical and yours does not). Go back and read Leslie's post where she described how lysodren works - she did a great job of explaining it. If you don't do a loading phase you may never achieve the desired result of lowering the cortisol. And you have to keep going in for expensive acth tests that are $240 or higher each... like I said, money out the window

Oh and Dr Oliver was a specialist in atypical cushings (which your dog doesn't have) - let's just say it is very different and only those dogs are treated with maintenance doses from the beginning and its because they have a different issue they are resolving and don't require a larger dose. So that is why you saw that posted. good question though!

OK... enough for now. xoxo, Kim

[labblab]

I just want to "second" what Kim has said above ;). The value of the ultrasound is to hopefully determine the type of Cushing's, and also to gain info about the status of the other internal organs in addition to the adrenal glands -- making sure there is nothing else ominous going on that could be causing the lab/behavioral abnormalities.

And I think what Kim meant to say is that there is no reason TO start out with only a maintenance dose unless a dog's cortisol status is normal and any elevations are in adrenal hormones other than cortisol ("Atypical Cushing's"). For a dog with elevated cortisol, it's not that initial maintenance dosing will harm your dog in and of itself, it's just that it's highly unlikely that it will do any good. As Kim has said, this will cost you money and time during which your dog's excessive cortisol level is not being adequately treated.

We are all here to continue learning as much as we can, however. So if your vets can point us in the direction of any studies or written protocols that endorse starting out with only maintenance dosing, that will be great info for us to know about. If not, I'd strongly encourage you to request referral for a consultation with a vet specialized in managing diseases such as Cushing's (this would be an IMS or "Internal Medicine Specialist"). It is wonderful that you have had a great relationship with your vet throughout all these years. But I think it would be helpful to get an expert's thoughts about your dog's treatment. This doesn't mean you'll lose your current vet -- just that you'll have the added benefit of an expert's thoughts and guidance. In many instances, dogs here continue on with their primary vets at the same time that they are receiving input from a specialist about the Cushing's issues. I will come back shortly and add a link to a website from which you can search for specialists in your area.

Marianne

P.S. Here's that link: http://www.k9cushings.com/forum/showthread.php?t=182

[sunshinehoman]

I have an appointment for an ultrasound on Thursday August 9th. Hopefully this will point us in the right direction as to what type of Cushings Sunshine has.

Since my dogs feed themselves I really did not know what her appetite was, now closely observing her over the last few days she does not have the ravenous appetite everyone keeps talking about, she would prefer to sleep over eat, although she does eat a normal amount of food. Maybe that is why she hasn't become overweight. She defiantly has the monstrous thirst, and urinates longer!

In the meantime I am looking into Trilostane vs Lysodren lots of info on Lyso not so much on Trilo, but what info I have found so far on Trilo is very interesting, I kind of like what I am seeing there doesnt seem to be as much toxicity as with Lysodren, but it has not been out or used as long as Lyso...

I obviously wish no meds were necessary but hopefully the ultrasound will point us in the right direction!

I again want to thank everyone for all your support and help!

I know this is a hard road and requires tons and tons of research and difficult decisions. It is wonderful to know that there are people out there that are willing to give great advise and help to those of us who honestly are NOT thinking clearly.

Sunshine is a huge part of my life and I love her more than anything, I will do the best I can to give her the best treatment possible

Thanks again
Shannon & Sunshine

[labblab]

Shannon, if you are considering treating with trilostane rather than Lysodren, here's a reply that I recently posted elsewhere that discusses the fact that both drugs carry risks (and therefore, owners need to be given supplemental "rescue" prednisone to keep on hand regardless of treatment choice):



Even though you are treating with Vetoryl, I'm hoping that your vet has given you some prednisone to have on hand for Cocoa, too. Although the effects of trilostane diminish in the body after approx. twelve hours for most dogs, there are always exceptions to every rule. And should Cocoa become overdosed on the medication and exhibit ill effects (especially at night or on a weekend ), for your peace of mind and Cocoa's safety, it is important to have emergency prednisone available to you at all times.

In answer to your question above, I believe that many vets continue to prescribe Lysodren because it is a drug with which they have had excellent treatment success and they see no reason to "rock the boat" by switching to the more recently introduced trilostane. Trilostane has only been FDA-approved in the U.S. since 2009, whereas Lysodren was the treatment of choice for many years prior to that. Therefore, many vets who have been practicing for some time have had more extensive history and experience with Lysodren, and its action is well understood.

Trilostane is the newer kid on the block, and has some attributes that have made it more attractive to some vets, seemingly especially those who are younger and have had less personal history with Lysodren. One of those features is what we have already mentioned -- that for the majority of dogs, a medication overdose may be more quickly and easily reversible than is the case with Lysodren. Since the therapeutic action of trilostane does not involve actual physical erosion of the adrenal gland, it is more likely that a dog will return more quickly to a baseline cortisol level when trilostane is discontinued. So simply discontinuing the medication for a few days may be all that is needed in the event that a dog is overdosed on trilostane. Since the adrenal cortex must regenerate in a dog overdosed on Lysodren, this process may take a longer time and sometimes the regeneration never occurs at all.

Having said that, we know from our experience on this forum that there are some dogs who have been overdosed with trilostane who never return to baseline cortisol production, either, and who may require longterm prednisone supplementation in just the same way as do dogs who have gone Addisonian as a result of a Lysodren overdose. I do not think that even the manufacturers of Vetoryl yet understand exactly what has happened in those situations, and more research is needed (and this may be a reason why some vets prefer to stay with Lysodren). If you read the U.S. Product Insert for Vetoryl, you will see that out of 107 dogs who were treated with Vetoryl during clinical trials, two developed unexplained adrenal necrosis, and two other dogs developed unexplained longterm Addisonian conditions. So there are genuine risks associated with trilostane, just as there are with Lysodren. But I am guessing that for vets who now prefer trilostane, their belief/experience is that the incidence of irreversible Addisonianism is lower with trilostane than with Lysodren. If your dog is one for whom this happens, however, you probably don't give a whit as to the statistics!

So to come full circle, this is the reason why we encourage all owners to request prednisone from their vets, regardless of which drug is being used to treat their dog's Cushing's. It is so much better to be safe than sorry -- at all times!

Marianne

[mytil]

Hi and belated welcome from me.

Firstly, here is a link for Internal Medicine Specialist in case you would like to have a second opinion on this - http://www.k9cushings.com/forum/showthread.php?t=182.

IMO, the symptoms do point towards Cushing's, but if you can, please get a second opinion, especially on the treatment protocols. If your vets are using a different than usual dosing protocol with Lysodren, I wonder how familiar they are with Trilostane?

FWIW, I came across a vet one time who told me (after we discussed Cushing's and she found out I knew more than most) that she tells most of her patients to start low. However she went on to say this is specifically because she does not trust the owners to follow exact instructions and are too lax in looking for the signs of loading and therefore there are problems. This could the case here.

Please keep us posted.
Terry

[Squirt's Mom]

Morning Shannon,

I want to reinforce what has been said about the presumed safety of Trilostane (Vetoryl). This is a MYTH - flat out a myth. Trilostane carries the exact same risks as Lysodren.

When my Squirt was first diagnosed, like you I started researching and talking to any and every one I could. Everything, everything, seemed to tell me that Trilo was the way to go, that is was the "safe" drug. However, as I read and learned and watched pups here, I realized rather quickly this was simply not true. As time passed, my thinking did a 180 - I prefer Lysodren, I am more comfortable using Lyso than I would be using Trilo, I have more faith in Lyso and how it works, Lyso is tried and true while Trilo is "the new kid on the block". I am one who does not like "new and improved" anything until it has been around a while and I can see if the hype is true or not. The hype about Trilo has not proven true. It IS as dangerous as Lysodren while at the same time it IS as life-saving as Lyso. There is no such thing as a "safe" drug. Drugs of any kind introduce chemicals into the body that were not there naturally. Any drug can be life-threatening if mishandled. Baby aspirin can be deadly. ;)

In your shoes, I would not be afraid of Lysodren but I most certainly would be afraid of your vets who admit they have had a difficult time with it, have been less than successful with it, and YET refuse to follow the experts who have and do use it successfully - but rather choose to follow their own screwy methods.

When I read your post where they said skipping the loading phase would be best, a story my dad told me came to mind. He was a dentist and during his years of practice they came out with a new way to make crowns. Dad said the new method didn't produce a better crown but it did require the patient to come back to the office more times to have the crown made and seated. In his eyes, the only thing this new method did was make more money for the dentist and cost the patient much more to have the work done. This is how I see the plan your vets have set up. You and Sunshine are going to have to go back much more often for ACTHs to see how his levels are doing, to see if this method that has been proven to be less that successful will work for them when it hasn't for others, which will also increase the stress level for both of you. The difficulty your vets have had with Lysodren is not due to the inherent properties of the drug but due to their use of it. As Marianne said, less than diligent parents probably played a role as well - but, again, that makes me wonder how well the vets explained what to watch for. Did the parents even know they should watch for anything?

Now for a reminder - Cushing's is a very, very slowly progressing disease. This means there is usually no rush to treat leaving the parent plenty of time to learn as much as possible before starting treatment with either drug. So many other conditions mimic the cush signs and do effect the testing, causing false-positives, that thorough testing is always the best route to take. I am so glad Sunshine is have an U/S. This is a great diagnostic tool! They will hopefully be able to see both adrenal glands as well as many other organs. An U/S saved my Squirt's life and disproved her original diagnosis of pituitary based Cushing's. ;) I'll come back later and share her story with you.

Keep up the good work! You are doing a great job of educating yourself and that is THE most important factor in caring for our cush babies. ;)

Hugs,
Leslie and the gang

[frijole]

:D I only have one thing to add to all the great comments and thoughts. I just want to know how many doses of lysodren you gave before quitting. The reason is because when switching from lysodren to trilostane or vice versa you must wait 45 days for the body to wash out all of the previous drug. I have no idea if this holds true if you only gave it two times for example but I just wanted to make sure you are aware of this. Kim

[sunshinehoman]

In response to the dosage I gave her it was 1 pill @ 125 mg..
And I requested Prednisone before I would take the meds, they seemed a little surprised that I asked, but completely willingly gave it to me! I had done a little research(NOT ENOUGH) that recommended getting prednisone with Lyso in case of OD

Actually their pills were chewable, which I did not like at all as I could not divide it correctly, it was to mushy. If I can not divide something correctly then I am not sure of the exact dose I am giving and I will NOT continue with any medication especially of that magnitude with out knowing exactly what dosage I am giving! That is another reason IF I stay with this vet that I might choose Trilostane is I didn't like their pill form.

This could also be a reason why they had loading problems, but I do think the responsibility fell more on the parent! I did not get into details with the main Dr., but believe me I will be having a talk with him eventually. In the mean time I sent an email to find a specialist in my area, and I will also ask the Ultrasound specialist that I am going to If they have or know of any specialists in my area.

I do understand that both drugs are dangerous, they both have their pos and neg sides. I guess my thought after doing research was Lyso Destroys (downside)where as Trilo doesnt (upside)...Trilo is new and not proven as long as Lyso (downside) Lyso is been around treating forever (upside) There are way more upsides and downsides to this story, but at least you can see where I was going and how I was trying to decide.

There are people on here that have done both and I am getting positive feedback from both drugs! That is a good thing!

What ever drugs she ends up on I will be a very well informed mommy as that is my promise to my baby Sunshine! I will give her the best care I am capable of! She helped me through my Chemo I will help her through hers!

I do have a question for anybody that knows a little about Nutrition. I give my dogs Nutro Senior right now, and since I am not starting meds immediately I thought it might be a good idea to upgrade their food, I have been adding some Nature Valley Instinct raw boost Grain-free kibble to their Nutro. They Love it!! It is higher in protein and Grain free.
Just wanted to know if anybody knows anything about the Instinct grain free food?
Should I keep the 50/50 mix or just switch over all together? OR just go back to the Nutro?
I have read conflicting reports..some where grain free food is an excellent diet and some reports where you should not get rid of the grain or purine.
Any help would be appreciated, I want to get the food situated, and have her on the best possible diet before I start any meds as I don't want a food switch to mix up any symptoms that meds could be showing me! Although they have been eating both for about 3 days now and showing no signs of gastric distress.

Thanks again
Shannon & Sunshine

[frijole]

Shannon, You are doing just great. Both of the drugs are chemo drugs so they are both very strong and that is why regardless of which we must be on our toes.

I only remember a couple times where people used the chewable lysodren and never for loading. So don't make that a part of your decision - it is available in pill form and liquid. LIquid has the same issues re dosing accuracy. Since your dog is so small you might have to have both drugs compounded so you get a dose small enough.

I would also say that if your vet has never used trilo you might not want to be his/her guinea pig. Often the decision made has to do with vet's experience because in both cases there is tweeking and monitoring that has to be done.

Kim

[lulusmom]

Hi Shannon,

Unless Nutro's senior food has changed recently, The first ingredient listed is a grain (rice) and five out of the first six ingredients listed are grains. In my opinion, Instinct is an excellent food so if you can afford to feed 100%, then do it. My dogs haven't had grain in their food for several years.

Selecting a diet for your dog is a very personal thing and I'm glad you've been reading. In doing my own research I discovered that wolves don't find grains in the stomach of their prey very yummy. Direct quotations from world's leading wolf biologist, L. David Mech's book entitled Wolves: Behavior, Ecology, and Conservation, Chapter 4:


"Wolves usually tear into the body cavity of large prey and...consume the larger internal organs, such as lungs, heart, and liver. The large rumen, [which is one of the main stomach chambers in large ruminant herbivores]...is usually punctured during removal and its contents spilled. The vegetation in the intestinal tract is of no interest to the wolves, but the stomach lining and intestinal wall are consumed, and their contents further strewn about the kill site." (pg.123)

"To grow and maintain their own bodies, wolves need to ingest all the major parts of their herbivorous prey, except the plants in the digestive system.

http://en.wikipedia.org/wiki/L._David_Mech

If one believes all dogs evolved from wolves, then it seems to me that dogs don't need grain. After putting my dogs on a commercially prepared raw diet, it was evident that grains played a huge role in a lot of my dogs problems in the first five years of their lives.

Glynda

P.S. Both of my cushdogs have treated with Lysodren and Trilostane and did beautifully on both. The reasons for the switch(es) is a long story and in hindsight, if I had to do it over again, I'm not so sure I would have switched them. If you are an educated and observant mom, you won't have a problem with either drug as long as proper protocol is followed. Of course, if your an educated mom, you'll know when protocol is being breached.

[sunshinehoman]

Yes Glynda that is what I have read and researched! Dogs dont really need grains in their diet. But I have begun to second guess myself on everything lately :(

How come you had to switch From Lyso to Trylo?

I will be making a decision on what drug to use after I get the results from the Ultrasound and get a second opinion. I think I will probably use a specialist in my area, hoping I can find one, I did write an email to IMS for a referral, but have not heard back yet..probably Monday.

What do you mean by getting the drug compounded? Is that something that the vet does or do I contact a company for that?

[addy]

Hi,

Quite a few members use Diamond Back in Arizona for compounding. You want to make sure it is a reputable company. Also, with the extreme heat we have had this summer, it may be problematic sending drugs through the mail. I have my Zoe's eye drops compounded by a company the ophthalmologist likes in North Carolina and I have been concerned about the mail delivery with the temp in the 90's.

We started out with name brand drug Vetoryl but sometimes the dose does not make that possible. My thought was to start with name brand to try to eliminate variables and then switch to compounded once I knew Zoe was stable.

As for the food, according to my ophthalmologist, Cush pups can develop "crystals" in their eyes ( not a good thing) most likely akin to the plague from calcinosis cutis they can get on their skin. He also has mentioned a high fat diet can contribute to that condition as well. Since our pups are also prone to Pancreatitis, you may just want to watch the fat content in the food.

hugs,

[sunshinehoman]

When searching for a Specialist on the link provided, I can not seem to find any IMS that specializes in Cushings? Do you know if I should just start calling around to find a Dr. that has had experience?

Ultrasound on Thursday....Nervous

[molly muffin]

Hi you are in essence looking for an IMS with experience with Cushings, which most specialist are. I don't know that any specialize in it, unless you go to a University hospital. I simple took mine to a Internal Medicine Specialist. A specialist goes beyond a regular vet in their education and experience, and specialize in small animal or large animal internal medicine. That is what you are looking for. What you should ask is, are they experienced is in treating/testing cushings and do they regular attend the latest seminars and conventions in Internal Medicine.

Good luck Thursday. We just did the ultrasound not that long ago and it's not bad at all and certainly will give you peace of mind as to what is actually happening inside their little bodies.

Hugs,
Sharlene

[sunshinehoman]

Another question sorry...

If you remember I had given Sunshine 1/2 pill of Lysodren chewable which was 125 mg on Thursday. (before I was thinking)
Have not given any more, but I was wondering if that small dose would affect anything?
This morning she was not very interested in food, did eat some but not what I am used to seeing? Her water intake has decreased a little cant give exacts as we have 2 dogs and the only thing I can go on is my observations.
Any thoughts?

[mytil]

Hi again,

I have a sec, but wanted to answer your question with my thoughts.

I am wondering if her tummy is upset because of the Lysodren. Some dogs have this problem. But I am also wondering why when on Thurs you gave her the meds and she is still off of her food and her water intake is down.

Glad you are not giving any more Lysodren at this point. I would contact my vets and at least let them know for the record and I would specifically get that appointment with the IMS as Sharlene mentioned.

Terry

[Squirt's Mom]

Hi Shannon,

I doubt the Lyso given Thurs would be affecting Sunshine today. It should be mostly out of her system by now as it reaches its peak at 48 hours. So if she were going to have a reaction, I would have expected it to happen Thurs-Sat, but not two days later. However, we do have pups here who simply do not follow the rules! :p

Keep up the good work, Mom!

Hugs,
Leslie and the gang

PS. This is so funny to me! A while back I made a post that dogs don't require carbs. MAN! You should have read the discussion that followed! LOL Dogs do NOT require carbs however they are a prime source of energy for their bodies. So while they are not required, they are good for most dogs. Like anything, there are some who will do better without and those who do better with - you have to know your baby and what works best for her body. If you want to get really involved, you can determine which carbs work well and which don't on an individual basis. Rice - oats - barley - bran - etc - rule them out one at a time. It's great fun! :rolleyes::p:D;)

[sunshinehoman]

Thank You!!

I just returned from My Dr apt for anxiety! They put me on lexapro..

Anyway when I was in the area for my Dr apt, I remembered there was a Emergency 24 hr vet right down the street, so I stopped in, as I have been there a few times with my pups in the middle of the night. They used to only be a Emergency center, but now they have expanded and have a few IMS on staff!! MY JOY!!!
I changed sunshines ultrasound apt to this vet as it is only 10 minutes as opposed to 2 hours and we and See him on Friday! I also have another consultation with the vet down the street from the IMS who works with the IMS on a regular basis and the receptionist there said they have quite a few Cushing's patients!

Seems like we are on the right track!!

[lulusmom]

That's great and yes, it sounds like you are on the right track. I'll be anxious to hear about the appointment.

[molly muffin]

Oh my gosh, how absolutely THRILLING! It sounds so good to have the possibility of having a good experienced team working with and for you! I'll just throw a little happy dance for you as I do have a huge smile plastered on my face right now!
whoo hooo

Sharlene and the Molly muffin

[Skye]

Hello!!!! and welcome.
I am proud pet mom of a min pin as well!!!! she is 9. She had an adrenalectomy November 2011. She had her first and so far only pancreatic attack that nearly took her in October 2011 and i believe it was Septemberish??? when her senior profile was showing some barley there questionable marks. I do home cook for her now. She could not handle processed foods as her General practice vet changed her foods against my better judgement which i should have followed, 7 or more times i think in that many months or less. She has a Nutritionist, a Surgeon, and a Internal Med. doctor and of course her general vet.
questions for you
is she on any type of supplements for her joints?
any type of supplements for her liver health?
I will get you the names of the products i use which is EXACTLY the same as i would get from specialist but i found them cheaper and then even confirmed I am ocd that way, lol, and they were like yes that is exactly it. and results have been great.
i do know some about nutrition and the thing is.......it needs to be what she needs. so depending on what her labs are.....how her kidneys are, heart, liver, etc.......is going to help know what kind of diet will continue to be great for her.
:)

[Squirt's Mom]

Mornin' Shannon,

What a good deal finding an IMS so close! I would have changed the appt, too! :) I hope you find the IMS is a god-send and exactly what our sweet Sunshine, and you, need on your team.

Got your twitcher stuck in high gear, huh? Don't worry - you ain't alone! ;) Mine stays on full-tilt most of the time. If I were to have tests for Cushing's, my cortisol would be off the charts much of the time. :p In fact, Glynda said just the other day that her dog is afflicted with HAC - Hyperadrenocortisim while mine are afflicted with HAM - Hyper Anxious Mom! :p:D:p:D So, welcome to HAMMIE club where we twitch for our babies! :p

Keep in touch and let us know how things are going!
Hugs,
Leslie and the gang

[Skye]

LOL!!!!! Leslie.......I LOVE the smile you have brought to my face, your tenderness that has held me up, the prayers of strength......Shannon....what you have found here is a mass of fluttering angels....trust me.....if you have not already you will feel and hear fluttering wings about and i can say first hand all of them have held me up when i felt i could not stand, made me laugh when the mere sound of my own laughter near startled me i realized how long it had been since i did that, and when you have a moment where you snot and sob and completely go blubbering all about, will sit you down, help you breathe and get you focused. I am the crazy lady in my neighborhood cause no one knows exactly what i am doing but they know i look crazy....in my jammies chasing after my min pin with a laddle to catch that morning urine....LOL inspecting its color, its oder. LOL!!!! and know every consistency of pooh there is and in those little home made presents they expell is gold mine of what is happening in their little bodies. LOL....strange how the neighbors cant obviously see that..........LOL (hope you smiled, glad you got something for anxiety.........i have issue with that when stressed and it stinks!) hope it helps that you are now resting in the arms of angels.......you and sweet little min pins. whootwhoot min pin mom!!!! they are awesome arent they.

[molly muffin]

Laddle huh. (taking notes) that is probably better than trying to get that plastic tuperware under Molly's rear end to catch the pee in the mornings.
Isn't it amazing the tips you find on here!
Shannon, breath in, breath out, breath in, (slowly!!!) no hyperventilating, try again, breath in, breath out. Friday will be here before you know it.

Hugs,
Sharlene

[Steph n' Ella]

Veeeryyy, very good tip!

[molly muffin]

OMG, I am dying laughing. Sorry but did anyone else just get a visual of a bunch of women and men, running around in their jammies in the mornings chasing their dogs with laddles to catch pee?

I cannot Stop with the laughter. LOL

Sharlene

[Steph n' Ella]

Worse I don't have a back yard...sometimes Ella will go on my deck/patio... but usually I am stuck at the rare patch of grass that everyone in a three block radius migrates to in the morning with their dogs!

Also, I get a lotta flack from the hood rats who think it is funny that I am walking my dog at 1 am on a Friday night in my PJs while they are trying to make out on the park benches...oh city life!

[Skye]

LOL oh now i cant stop laughing.......that is quite the visual. yes in one hand i have laddle, in the other i have lid off random container.....if i cant quickly get laddle to catch that precious pee i can at very least frisbee toss the lid in the general area to slide into position both have worked beautifully. THEN tucked behind my ear......i normally have syringe. no needle. i then grab syringe before moving far at all, and pull urine into syringe. that way it is safe, wont spill. place that syringe in plastic baggy, seal it up. then put that baggy inside baggy with ice! LOL its a great organized well thought out pee collecting plan. lol. AND of course choice of laddle or random lid...(mid you a lid with depth to it of course) will depend if you have male female furbaby and of course you stellar stealth actions and movements. lol

[sunshinehoman]

OMG!! You guys got me laughing too!! I do chase Sunshine around in the morning with a flat Tupperware container, in my pajamas!! The looks she used to give me were priceless :) Now she just seems to roll her eyes at me...lol....lol...

Yes Skye Min Pins Rock! I read your story the other night at work and it had me crying half the night, I am so happy that everything went well and it gave me such a good feeling.
We recently had to say goodbye to our other Min Pin 13 year old baby Stormy, he had degenerative disc disease and after 2 surgeries and tons of therapy the boy finally gave up, he even told us it was time. This was super hard on my fiance'... Stormy was (his) baby boy. That decision is a really hard one to make, but I know he is in a better place now. I cant even think of this with my baby girl, she is my life and savior and I don't know what I am going to do without her!!!!!

As far as supplements I am giving Sunshine Milk Thistle and Sam-e, (just started on these as the vet recommended it) she is also getting Phycox for her joints.

Sunshine is still not eating like crazy, but she does eat and her poop consistency is changing with the food change, so I will keep an close eye on her and talk to the vet about it if the low appetite keeps up.

Thanks again for the good laugh I NEEDED that soooooo bad!!!

[sunshinehoman]

Well Sunshine had her Ultrasound today! She did very well and is a little tired at the moment.
I really liked the IMS vet that I saw, he was very patient and answered all my questions, without being in a hurry like so many are!

I don't have the results in my hands yet, but he said she has an enlarged liver, and no tumors on her Adrenals, everything else looks good! He feels that the correct diagnosis is Pituitary cushings, and would like to do a stim base test on Tuesday, then start treatment with Trilostane followed by another stim test 10-14 days after start of treatment.

He also suggested that I get a urine test, I don't remember what he called it but it is putting a needle into her bladder to remove the urine that way. He said that you get clean urine without any outside influence, does that sound like something that should be done right away?

I think his treatment plan is a good one, what do you guys think?

[molly muffin]

Okay so the IMS is going with Pituitary cushings. At least you know now and can adjust accordingly.
Did they say what dosage of Trilo they are thinking to start Sunshine on?

That is what they call a clean urine draw. Rule out any UTI issues maybe?

I think you are on the right track. Don't put that ladle away yet though!!

Hugs,
Sharlene

[sunshinehoman]

Here is the results of the Ultrasound: Thoughts appreciated!!

Presenting Complaint: Sunshine was examined on 8/10/2012 at 11:17 AM for an abdominal ultrasound. Seen by Dr. John Hintermeister, DACVIM (Oncology).
History: Sunshine has been treated by Fox Lake All for multiple UTI's. Recently Ms. Homan took her there for having bloody urine. Blood work showed elevated liver enzymes, urine was very dilute and it was recommended that she have a Dex. suppression test done to rule out Cushing's Dz. Test results came back as Pred dex - 6.5, 4 hours post - 5.9, 8 hours post - 6.8; consistent with hyperadrenocorticism. Sunshine was put on Lysodren 250mg 1/2 tablet twice weekly. Owner discontinued after 1st dose.
Current medications: Sam-E Milk Thistle PPA Incontinance Denamarin sm. dogs 1 SID
Examination: Temperature: , Pulse:168 / good, Respiration: 20
CRT;1.5, mm;pink
Weight: 4.580 kg, 10.08 lb, 0.28 m2
Eyes: normal Ears: normal Nose: normal Oral Cavity: normal Heart / Lungs: normal
Abdomen: normal Musculoskeletal: normal Neurological: normal Skin: normal
Lymph Nodes: normal
Diagnosis: Pituitary dependent hyperadrenocorticism
Medications: Please continue medications as previously directed.
Follow up plan: Plan to call on Monday with a recheck and additional information
Hospital Services: Blood. Pressure: 140mmHg #2 cuff right front leg
Administered 0.15m1 of Dexdomitor and 0.04m1 of Torbuterol IV.
Abdominal ultrasound: moderate diffuse enlargement of the liver - no masses noted
Left adrenal: Width: 0.44 cm Length: 1.11
Right adrenal: Width: 0.39 Length: 1.4
Clinical impressions: No noted adrenal mass
While there is no significant enlargement of the adrenal glands there is still consideration for
pituitary dependent hyperadrenocorticism based on the previous testing.
Instructions to Client/Handouts: Will advise to return as indicated for additional testing and possible start of therapy for the PDH

[molly muffin]

Hi,
I think it is the dex test, that shows cushing and then the ultrasound is backing that up with the enlarged liver. Adrenal glands so far don't seem to be enlarged.

So looking back it seems that they are suggested starting on Trilostane, retesting in 10 - 14 days, ACTH.

That is the normal procedure for starting on Trilostane. Are you comfortable with that?
If cost of the medicine is going to be a factor, then make sure to ask for a prescription for compounding. Some of the others here have used various pharmacies for compounding and can tell you about those and how you go about using them.

It sounds like you are on the right track with diagnosing and testing to me. :)

Hugs,
Sharlene

[labblab]

I just wanted to add that apparently approximately 30% of dogs suffering from pituitary Cushing's do not exhibit enlargement of their adrenal glands, especially when the disease is at an early stage. So even though bilaterally enlarged adrenals would have been a confirmatory finding, the specialist apparently feels that there are enough other indicators that point to Cushing's even though Sunshine's adrenals do not yet show enlargement.

Marianne

[sunshinehoman]

That is exactly what he said! I am really pleased with this Dr. they are a little more expensive, but the how thorough they are makes up for the difference in cost! Also peace of mind is is priceless!

[sunshinehoman]

Does anyone know where I can get this information? This link does not work?
How to Extend Your Supply of Cortrosyn and Lower the Cost of ACTH Stimulation Testing

http://endocrinevet.blogspot.com/201...cortrosyn.html

[lulusmom]

Here ya go.

http://endocrinevet.blogspot.com/2012/03/how-to-dilute-and-store-cortrosyn-for.html

[sunshinehoman]

Thank You!! Sunshine is having her pre medication acth stim test tomorrow and I wanted to give the vet this info.

I will post the results as soon as I get them!

Thanks again!!
Shannon & Sunshine

[lulusmom]

You are a smart woman, Shannon. That little tidbit of information on cortrosyn can save you lots of money.

[Skye]

hey!!!
about the urine being drawn out with needle, that is a Cystocentesis
they sort of aggravated my little girls bladder and she even had some leakage with blood in it afterward later that evening. She has had so many labs and urine tests that i try to see if "free catch" will work. She just does not handle those well after so much.
broke my heart to hear you lost your little boy....so young to, as min pins are known for longevity. worries me......she has back issues. I am trying to be careful on how she plays, she has a ramp for the bed that is custom made and is long as our cal king bed, lol! but she still jumps on and off couch, they are active little things. lol! they are simply the most amazing awesome ever!!! if you have facebook, (i may have said this already) your welcome to go view her videos and photos. Shysie Moon
sounds like you have found a great IMS makes for great peace of mind.
kisses on snout to your baby, little knub tail wave from Shysie.

[molly muffin]

Hope all went well today!

Hugs,
Sharlene

[sunshinehoman]

I have not had the urine test done yet, but that doesn't sound very fun for Sunshine...poor baby she has been through so much, I am starting to shake like her when we get near the vet!
I do not have the results back yet from the stim test probably Friday, will post then.
I also built ramps all over my house for Stormy when he was trying to get around. I do miss him :(
From your pictures I don't think you have to much to worry about! Your little girl can jump!! She looks so much like my little sunshine!! A little bigger maybe, Sunshine is about 10 lbs.

[sunshinehoman]

Here are Sunshine's Stim test results...What do you think? Along with all her other results, the Dr feels that she does indeed have cushing's. The other results are on previous posts

Thanks,
Shannon & Sunshine

The results indicate and confirm the hyperadrencorticism and would advise to start therapy as soon as possible. As discussed the use of lysodren can be considered but the trilostane may be better for Sunshine

Can recheck this week and start therapy

JGH

John G. Hintermeister DVM DACVIM



VETPATHDX Call Us : 1-630-521-9708

Client: HOMAN
Patient: SUNSHINE
Species: Canine
Breed: MINPIN
Gender: Female
Accession Status : Final
Order Date: 08/14/2012
Requisition #: -
Accession #: 12640
Ordered by: JOHN HINTERMEISTER
AETC Grayslake
1810 E Belvidere Rd, Grayslake, IL 60030
8479863757



ACTH Stimulation (1 Pre, 1 Post Cortisol)
Test Result Reference Range Low Normal High
PRE-ACTH CORTISOL 7.6 µg/dL
POST-ACTH I CORTISOL 24.5 µg/dL

Comments :
ACTH Reference Range:
Canine: Feline
2 - 6 0.5 - 5 Pre-ACTH (resting) cortisol
6 - 18 5 - 15 Post-ACTH cortisol
18 - 22 15 - 19 Equivocal post-ACTH cortisol
>22 >19 Post-ACTH cortisol consistent with
hyperadrenocorticism
<2 <0.5 Post-ACTH cortisol consistent with
hypoadrenocorticism
1 - 5 n/a Desired pre- and post-ACTH cortisol on
lysodren therapy
ACTH response test is only clearly positive (>22) in 30% of dogs with hyperadrenocorticism (HAC); equivocally positive in another 30% of dogs with HAC and normal in 40 % of dogs with HAC.*
If the ACTH response test is normal and HAC is still suspected proceed with a low-dose dexamethasone suppression test.
Dogs with iatrogenic Cushing's disease will have flatline response test results in the low end or below the normal reference range.
Both HAC and hypoadrenocorticism are rare diseases in cats.
*Reference: Feldman and Nelson; Canine and Feline Endocrinology and Reproduction. 3rd ed. W.B.Saunders Co. 2004.

[molly muffin]

Hi Shannon,

Well she went a little high on the ACTH. Not crazy though. It does seem to be a confirmation of the LDDS and the Ultrasound.

I'll wait for the more experienced to show up with their thoughts.

How are you feeling about it? How is Sunshine doing? Hope you both had a good weekend and are in the happy zone. :)

hugs,
Sharlene and molly muffin

[sunshinehoman]

Anyone else want to jump in with their thoughts please do!!

[addy]

Hang in there, I know someone will be along soon to look at your results. My Zoe was sky high over 40 ug/dl so her tests were a bit easier to figure out. If the normal reference range is over 22, she is just a tad over at 24.5 ug/dl.

I know Glynda or Marianne will be around later to give you their thoughts.

No one test is perfect, so much is also based on history.

[sunshinehoman]

Yea all of Sunshine's results seem to be right on the border? That is why I am confused...Should I begin treatment or would it be better for her to wait?

Doubting myself again!!

I only want to do what is best for her as everybody here can agree we LOVE our babies!!

Thanks,
Shannon & Sunshine

[lulusmom]

I just wanted to add that apparently approximately 30% of dogs suffering from pituitary Cushing's do not exhibit enlargement of their adrenal glands, especially when the disease is at an early stage. So even though bilaterally enlarged adrenals would have been a confirmatory finding, the specialist apparently feels that there are enough other indicators that point to Cushing's even though Sunshine's adrenals do not yet show enlargement.

Marianne

I agree with Marianne's assessment and even more so now that I've seen the results of the acth stimulation test, which is also consistent with cushing's. The only test that could be interpreted as borderline is the abdominal ultrasound as the adrenal glands appear to be normal. That would concern me if all other testing was borderline or inconsistent with cushing's. That doesn't appear to be the case. Neither the LDDS or the acth stimulation test is borderline; however, if you don't think Sunshine's symptoms are bad enough to treat yet, then there is no reason why you can't put off treatment until she is showing more overt symptoms. Remember that there is no cure for pituitary dependent cushing's and the sole purpose of treating is to remedy the problematic symptoms.

With respect to the vet's recommendation for a urine sample, he probably wants to do a culture as most dogs with cushing's have a urinary tract infection at the time of diagnosis. A culture will tell them which bacteria is involved so that appropriate antibiotics can be prescribed. The thought of shoving a needle through the abdomen to get urine out of the bladder sounds horrible but my dogs have been through a number of times with no ill effects. It's done a lot more than you know.

I hope this helps.

Glynda

[sunshinehoman]

Sunshine has an appointment Tomorrow Friday 8/24 to see the Dr. He will be starting her on Trilostane, not sure of the dosage yet. Not sure if he is going to do the Urine test tomorrow or not.
Thanks for all the help!

Shannon & Sunshine

[molly muffin]

Good luck tomorrow! We'll be waiting to see how it goes!

Hugs,
Sharlene

[sunshinehoman]

Just got home from Sunshine's Dr appointment. He wants to start her on 10mg of Trilostane 1x day and stim after 1 week.
The Dr suggested I get the drug online as their cost is very high and it would be much cheaper for me to do it that way.
Does anybody know where I can order Trilostane 10 mg online?
So nervous to start her on this drug!!

Thanks,
Shannon & Sunshine

[Squirt's Mom]

Hi Shannon,

Many here use Diamondback Drugs -

http://www.diamondbackdrugs.com/

Hugs,
Leslie and the gang

[sunshinehoman]

I contacted Diamond, but they wont sell 10mg of Trilostane (generic) because it is available from the manufacturer in 10 mg sold as Vetrol. They can compound the drug in 9mg or 11 mg Trilostane
Should I just get the Vetoryl?

Vetoryl 30 day supply = 46.35
Compounded 30 day 9 or 11 mg is 25.95

Is there a better choice? Vetoryl or Compound?

Is there another place that anybody recommends that sells vetrol so I can compare prices?

Thanks,
Shannon & Sunshine

[labblab]

Shannon, we have many members here who have been very satisfied with compounded trilostane. However, since you're asking for opinions, here's mine ;). Since you are starting out at a dose that would only require you to buy one box of 10 mg. capsules per month, if Sunshine were my dog, I would pay the higher price to start her off with brandname Vetoryl. And I would guess that Diamondback's price for Vetoryl is probably pretty competitive. You can "Google" Vetoryl 10 mg. and get some comparative prices. But probaby Diamondback's pricing is good and we have had many members who have been very happy with Diamondback's service through the years.

Once you get Sunshine stabilized on her medication and you can see how she has responded to the Vetoryl, you may then want to try substituting the compounded trilostane if the ongoing cost of Vetoryl is more than you can handle. And if she then continues to respond just as well to the compounded product, that will be great.

But just so you'll know, compounded trilostane is not the same thing as a generic version of a brandname drug. Both brandname drugs and their generic counterparts are manufactured by pharmaceutical companies under FDA oversight of testing and inspection. However, there are currently no generic versions of Vetoryl for sale anywhere in the world, so brandname Vetoryl is the only version of the drug that is FDA-approved. Compounded drugs are instead prepared onsite by individual pharmacies and fall outside of FDA approval. Some recent studies have shown that there may be less consistency or effectiveness from batch to batch of drugs compounded by some pharmacies. And any inconsistency in the product could lead to less consistent dosing control. It is for that reason that for my own dog, if I could afford the price differential, I'd prefer to start out with Vetoryl before trying a compounded alternative.

This issue is something you may want to discuss further with your vet in order to see what your vet's thoughts or preferences may be. Some vets are happy to write prescriptions for compounded versions of trilostane; others prefer that their patients stick to FDA-approved Vetoryl.

Marianne

[sunshinehoman]

Thank You Marianne!!
After slowing down and thinking again I actually came to the same conclusion :)
Sometimes you just get yourself all twisted around and freaked out for no reason :)
I have a prescription coming from Diamondback next week for the vetoryl.

Thanks again,
Shannon & Sunshine

[addy]

You will be fine, Shannon and so will Sunshine. It does get easier.

Hey, Im in Wisconsin- your are in IL, neighbor:):):)

[molly muffin]

Hey Shannon,
It's super easy to get all freaked out and have those "moments"
This is the best place in the world though to let those moments just happen and then deal with them. Everyone here totally understands them. :)

So think of it as being on the road to stability for sunshine. Any curves come up, we'll just slow down and deal with. :)

Hugs,
Sharlene

[sunshinehoman]

Where in Wisconsin?
I am by Gurnee in Northern IL (Great America)(Gurnee Mills)

[addy]

Northern Milwaukee- you are not far at all:):):):)

[sunshinehoman]

We should get together!

[addy]

I second that!!!!:):):):):)

[sunshinehoman]

I do have a quick question..Sunshine will be starting on 10mg Vetoryl on Tuesday 8/28, the vet asked to do a stim test 7 days after starting. I thought the stim tests were to be done 10 - 14 after, is the 7 day mark ok or should I wait?

Thanks,
Shannon & Sunshine

[frijole]

It varies depending on the vet. How much does Sunshine weigh? (checking dosage amt)

Key is regardless of when they tell you to go in - just be aware of how she seems to tolerate it. Signs of too much include vomit, diarrhea, inappetance and extreme lethargy (ex unable to walk, stand, etc). Anything that concerns you just ask us ok? And call the vet too! Kim

[sunshinehoman]

Sunshine weighs about 10 lbs I think it was 4.5-4.9 kg. 10 mg Vetroyl 1x day

I am actually going to start her on wednesday since I am off work and can watch her all day, and only will be gone for 2 hours on Thursday and the rest of the week she is with me 24/7!! I will then bring her in for her stim test the next Friday when the Dr is in which will be 10 days


Thanks,
Shannon & Sunshine

[molly muffin]

We'll all be here with you!!!
hugs
Sharlene

[sunshinehoman]

Hi Everyone,
I first wanted to thank everyone on this forum! I have spent many hours reading posts and learning so much information. I do have to say that I have cried and laughed along with you even though I have not directly posted to your threads I still follow and cheer on your babies every day!!
I can't express enough how happy I am to have found this amazing and supportive group!
Even though you are going through your own trying times, you still have the caring and compassion to selflessly help others. AMAZING!!
Thank You all! And love and kisses to all our babies!!

Shannon & Sunshine:)

[molly muffin]

Today is the big day. We're here, just want you to know that!

Hugs,
Sharlene and Molly

[Squirt's Mom]

You're gonna do fine, Mom! We are all with you!

Hugs,
Leslie and the gang

[Boriss McCall]

Can't wait to hear the good report. ;)

Amy & Boriss

[sunshinehoman]

Well hands are sweaty heart racing, but I gave her the first dose of 10 mg Vetoryl.... she weighs a little over 10 lbs
I took a day 1 picture and started a document on progress, does that sound way over the top? I just don't want to get confused and I think this will help me keep track of her symptoms!
Thank You for all the good luck wishes! Will stim next friday.
Does anyone know from experience how long any ill side effects would start to show?

Thanks,
Shannon & Sunshine

[Steph n' Ella]

Not way over the top! I've read here that videos are good to document progress too!

[addy]

You will be just fine. If you start hyperventalating, just come here and post.:);)

Remember the mantra:

When in doubt, withhold the pill.

Any questions, always come here and ask away!!!!

[sunshinehoman]

Just posted some pics! and learned how to look at all the other pics out there! Awesome!

[Steph n' Ella]

Yay! Pics are sooo cute! Oh boy is that a pot belly or what?! Poor sunshine...you're momma will have you feeling better in no time!

[sunshinehoman]

Day 3 of Vetoryl...Sunshine seems to be doing ok so far. Have not noticed any real changes, so I guess that is a good thing :)
Hoping I will start to see something good soon!

Shannon & Sunshine

[addy]

No news is good news for day 3

Usually the first symptoms, but not always, to improve are the drinking and peeing but, it depends, in my opinion, on just how bad they were.

so hang in there, you are doing just fine:D:D:D:D:D:D

[Squirt's Mom]

You're doing great, Shannon! It can take some time to see the muscle start to strengthen and the hair to regrow, but the drinking, peeing, and appetite should start to show improvements fairly quickly. Keep in touch and let us know how things are going!

Hugs,
Leslie and the gang

[molly muffin]

Just checking in to see how Sunshine is doing :)

hugs,
Sharlene

[sunshinehoman]

Day 4: Sunshine is doing fine, still have not noticed much of a change yet...Maybe a little less water consumption. she never did have the ravenous appetite that most cush pups have. She does however have the pot belly and trembling hind legs, reluctance to jump up on couch and food guarding. She goes in for her stim test on Friday.

Shannon & Sunshine

[sunshinehoman]

Today is day 10 for Sunshine on Vetoryl. She really had to be coaxed into eating this morning, was not interested at all, but we did eat about 1/2 our food and gave her the Vetoryl. This was the first time she didnt even want to start eating! She has a stim test today at 2:30
Other than this morning she has been doing pretty good! I have not noticed to much of a change, maybe a little less drinking, but that is about it. Was hoping to (know) something in 10 days!
I will post results when I get them

Shannon & Sunshine

[labblab]

Hi Shannon,

Just wanted to double-check what time Sunshine had her food and Vetoryl this morning? The monitoring ACTH is supposed to be performed no later than 4-6 hours after dosing (when the drug is most active in the bloodstream), and with a 2:30 testing time, I'm feeling worried that it may be scheduled for too late in the day...

Especially if Sunshine is being picky about eating, you will want the test results to be sure to reflect the maximum effect of this dose of Vetoryl. That's why the testing window is so important.

Marianne

[sunshinehoman]

I made sure she ate at around 9:30-9:45 so it would between the 4-6 hour range :)

Thanks! you guys are the BEST!!!!!

[labblab]

YAY Shannon!! GOOD JOB!!!!!!!! :) :)

[addy]

We'll be anxious for the results. Hoping for good news for Sunshine.

[sunshinehoman]

Hey everybody! Got results for Sunshine, she has improved, but is it enough? question is do we increase dose or leave as is for now as level have gone down since first stim test?
How long does it usually take to get good results?
What are optimal results?
Dr suggested either up dosage to 10 mg every 12 hours or leave as is and re stim in 3 weeks

Thanks,
Shannon & Sunshine

8/20/2012 Stim Test before starting Vetoryl 10 mg

ACTH Stimulation (1 Pre, 1 Post Cortisol)
Test Result Reference Range Low Normal High
PRE-ACTH CORTISOL 7.6 µg/dL
POST-ACTH I CORTISOL 24.5 µg/dL

9/07/2012 10 days after starting Vetoryl Stim Test

Gender: Female
ACTH Stimulation (One Pre, One Post)?Canine/Feline : PRE-ACTH CORTISOL

Test Result Reference Range Low Normal High
PRE-ACTH CORTISOL 7.1 µg/dL

ACTH Stimulation (One Pre, One Post)?Canine/Feline : POST-ACTH I CORTISOL

Test Result Reference Range Low Normal High
POST-ACTH I CORTISOL 14.8 µg/dL

Comments :

ACTH Reference Range:
Canine: Feline
2 - 6 0.5 - 5 Pre-ACTH (resting) cortisol
6 - 18 5 - 15 Post-ACTH cortisol
18 - 22 15 - 19 Equivocal post-ACTH cortisol
>22 >19 Post-ACTH cortisol consistent with
hyperadrenocorticism

hypoadrenocorticism
1 - 5 n/a Desired pre- and post-ACTH cortisol on
lysodren therapy
ACTH response test is only clearly positive (>22) in 30% of dogs with

[sunshinehoman]

Anybody have any thoughts on feeding Nature Valley Raw?

[addy]

whoa- hang on:):):) dont go to food change yet;);):):)

did I just see your ACTH results from yesterday?


Test Result Reference Range Low Normal High
PRE-ACTH CORTISOL 7.1 µg/dL

ACTH Stimulation (One Pre, One Post)?Canine/Feline : POST-ACTH I CORTISOL

Test Result Reference Range Low Normal High
POST-ACTH I CORTISOL 14.8 µg/dL

Have you seen any improvement in Sunshine? Dogs can continue to drop the first thirty days. I am sure our Trilostane experts will all be along to comment and they know far more than I do. I wonder, though, if at 14.8 perhaps you may consider a dose change.

The one thing I found out for my Zoe was that she could handle more than I thought. I went really slowly which resulted in so many extra stim tests. I wonder if I was not too conservative?

Just throwing it out there until our guiding angels come along:D:D:D

As for the food- I belive in not doing changes until a dog is stablized on thier meds. Make sure you check the fat content. There is a conversion for calculating correctly on Dogaware.com. Zoe's commercial raw was so high in fat- enough for a sled dog:eek: I feed half and half now, half raw and half Honest Kitchen.

You made it to stim one, congrats are in order:):):):):)

[sunshinehoman]

Yes I posted both stim test results first the one before starting vetoryl and the second one was 10 days after starting vetoryl

[sunshinehoman]

Where is everyone :( nobody has posted on here regarding Sunshines results?

[Boriss McCall]

I would help if I knew answers. :( Don't feel alone I bet someone will be by soon. :)
I have noticed lately I have been missing updates. Maybe there is something going on with the news feed. I hope things are going good today.

[lulusmom]

I want to let you know that I'm sorry that I've missed your posts and I promise to be back shortly to give you my two cents worth. Gotta run to a meeting now.

Glynda

[addy]

bumping up

hang in there, they will be back soon:):):)

[lulusmom]

Hi Shannon,

Again, I'm sorry you had to rattle our cages to get some feedback; however, I believe Addy did respond to you fairly quickly after you posted Sunshine's test results. She asked at that time if you have seen improvements in Sunshine's symptoms but I don't believe you responded to her. Could let us know if you have seen any improvement and if so, which symptoms.

Vetoryl can drop cortisol like a rock within days and it usually continues to do so well into the 30 day mark. Since you did the first stim test at only 10 days, I suspect that Sunshine's stimulated cortisol today is lower than 14 ug/dl. Unless you have seen no improvements symptoms, I personally would not make any adjustment to dosing until the 30 day stim test.

Glynda

P.S. For future reference, you can find a Vetoryl Treatment Monitoring flowchart in our Vetoryl/Trilostane thread in our Helpful Resources section.
http://www.k9cushings.com/forum/showthread.php?t=185

[labblab]

I agree with Glynda. :)

Marianne

[sunshinehoman]

Yes I have seen improvements!

She has a lot more pep, drinking less, food was never an issue so that has stayed the same, she has a lot more tolerance to walks, is now jumping up on the couch again, less panting. Pot belly has not gone away yet. She seems much more happy and less lethargic. I am keeping daily records and pictures, and have decided to stay with current dosage 10mg 1x day for a few more weeks. Have a 3rd stim scheduled for September 28 and will see if level have dropped any more by then.

I did have to start giving her a lateral move in food to take with her pill in the morning. She has never been interested in eating at a specific time so I was mixing her Instinct Nature Variety Raw boost with peanut butter to get her to eat, and having to spoon feed her. Now I bought Nature variety Raw and give her that in the morning with her pill and she gobbles that right up! She still has the kibble down for evening but only eats when she is hungry.

[lulusmom]

That's great news. Sounds like Sunshine is doing very well, which is another reason to maintain the status quo until you can assess the 30 day stim test. Congratulations on doing a great job, Mom!

[addy]

I hope Sunshine continues to do well and that you both had a great weekend!!!!

Next stim is right around the corner for you:) Zoe will be going the week after. We have had so many stims in the last year, our IMS cut Zoe some slack:):):):)

Happy Monday Night!!!

[sunshinehoman]

Thanks for asking!!!
Sunshine is indeed doing well, I have noticed improvements, slowly but surely! I guess the next stim will tell the tale.....
We do have to get together! I have just been so busy with Sunshine and now physical therapy and Dr visits and of course work, that I don't have a minute to myself! Although I am glad that Sunshine can come with me to work every day, it is really nice!! I have beddies all over the shop for her, so whenever I move she follows and has a bed right there with water and food!!:D:D:D
Glad you and Zoe and Koko are doing better!! Great news, you are such a good mommy!!!

Soon!
Shannon & Sunshine

[Steph n' Ella]

SO jealous that you can bring your little doggie to work! Hope cute Sunshine is doing well! Are you still taking pics of him regularly so you can see if there are any physical changes over time? I think that is such a good idea!

[Boriss McCall]

That is so awesome to have your baby at work with you all day.:)

[molly muffin]

I am completely jealous that you can have sunshine with you at work.
I'm so glad that sunshine is doing better and seems to be on the right track!

hugs,
Sharlene and Molly muffin

[sunshinehoman]

Yes I take a picture of Sunshine every morning during her breakfast! Then I put her daily progress notes in the same folder. It is awesome all I have to do is print and bring to the Dr. visit!
Yes I am very lucky that I can bring her to work with me every day :D:D Everybody likes Sunshine and she is so good when we are there, right at home!

[Boriss McCall]

Hope Sunshine is doing good today. Boriss had his first ACTH test today. I remember you said after Sunshine had one that the Cush symptoms seemed a little worse that day. Is that right? If so how long did that last? Boriss is STARVING tonight after having his today & seems really tired.

[sunshinehoman]

I switched Sunshine's food to Instinct Raw to give with her pill in the morning, so she eats all her food with gusto!! She loves it and since she was getting Instinct kibble the switch didn't bother her at all. I don't recall her eating habits changing after her stim test, but her some of her symptoms seem to come and go, but are slowly getting better! I know Sunshine is always tired after her vet visit, I think it stresses them out and they just get home and crash!
How is Borris's symptoms? Are they getting better?

Shannon & Sunshine

[Boriss McCall]

He is getting better. :) but, I have a feeling the vet is going to up his dosage. He is still having slight symptoms. Tonight he was super hungry. Now he is out like a light.. You are right the big test at the vet wipe them out. Plus I snuck him into my office today. :D So, he has had a big day. I will be so happy when he is back to his old self & not wanting food all the time.

Glad Sunshine is doing great & loving the new food!

[sunshinehoman]

Sunshine is on day 23 of 10 mg Vetoryl, we have her 2nd stim test next Friday. I see progress but I am assuming we will be going to 10 mg every 12 hours, which would be upping the dose by 10 mg. I have read that 2x a day is sometimes better with Vetoryl as it stays in their system consistently. I guess it will depend on the stim results, but I don't want to rush into upping the dose until I am sure her cortisol level is not going to drop any more. Their symptoms can continue to get better and cortisol continues to drop for about 30 days, so go slow with Boriss and keep up the good work!!!

Shannon & Sunshine

[Boriss McCall]

oh good to know! It that case I will probably ask her to keep him were he is at if possible. I want to see what he is like in a month. He has already improved so much. He doesn't spend his entire evening while we watch tv looking around on the ground for food. His water intake has dropped a lot & the peeing has gone down. I just don't want to rock the boat by changing things.:eek:

Sounds like Sunshine is doing great. I just love min-pins. My Cleo (min-pin) was the most fierce & loyal little dog I ever had. I miss being able to spoon with her in the bed. She was a good cuddle bunny. She ended up having heart failure. She was so stoic we didn't even know anything was wrong with her. She was the little leader of our pack over here.

But, that being said we loved her & she loved us so much. They are just great dogs. :)

I am happy things are running smooth for you & Sunshine. It is uplifting to read good things.;)

[sunshinehoman]

Sunshine is on day 31 of 10 mg Vetoryl for a 10 lb Min Pin, she has been showing a definite improvement! She has way more pep, likes to play again and barks at silly things again! Her back leg weakness has not changed much, but she is a lot more aggressive on walks and wants to keep going, much more pep in her step then before! She has stopped having accidents in bed, so overall she is improving.

The last couple of days I have noticed a very slight increase in eating and drinking, but not much else has changed. We go in for a stim test today at 2pm, and probably wont get results until Monday. Depending on the results, the Dr will probably want to increase her dose to 10 mg every 12 hours, we considered doing that after 14 days, but I wanted to wait the full 30.
I will post the stim results as soon as I get them!

Shannon & Sunshine

[Boriss McCall]

yay little ms Sunshine! Sounds like she is doing really good.

[Steph n' Ella]

Yay yay yay! Sounds like things are going very well for you two!

[molly muffin]

Fabulous news Shannon!

hugs,
Sharlene

[Squirt's Mom]

That is a great report, Sharon! :)

[sunshinehoman]

Sunshines 3 stim test results:

Stim Pre Vetoryl 8/14/2012:
pre-ACTH cortisol 7.6 ug/dl
Post-ACTC I cortisol 24.7 ug/dl

10 Day Stim 9/17/12:
pre-ACTH cortisol 7.1 ug/dl
post-ACTC I cortisol 14.8 ug/dl

30 Day Stim 9/28/12
pre-ACTH cortisol 1.8 ug/dl
post-ACTC I cortisol 6.0 ug/dl

Dr feels she is doing well on this dose!! :D:D:DWill re stim in 2-3 months unless I see any major changes! Seems good!:D:D:D:D:D

[Jenny & Judi in MN]

looks great! :)

[addy]

Way to go!!!!!!!!!!!!!!!!!!!!
:D:D:D:D:D:D:D:D:D:D:D:D:D

[Boriss McCall]

That is great news!

[molly muffin]

That is exciting, glad that things are looking good.

hugs,
Sharlene and molly muffin

[sunshinehoman]

Just wanted to give an update on Sunshine taking 10mg of Vetoryl 1x a day, she is 10 lbs. Sunshine is now on day 43 she eats Instinct raw 1 1/2 medallions in the morning with her pill and loves it!! She then eats Instinct dry in the evening usually mixed with a little chicken breast :)
Sunshine takes milk thistle and Same in the morning 1 hour before meal and has the chewable form of phycox in the evening for her joints.

Some of Sunshine's symptoms have gone away, such as panting, excessive drinking and peeing. She still has hind leg weakness and a small pot belly, but I think those take much longer to see results! Over all she is doing very well and likes to play, go on walks and bark again. :D:D:D

Hope this is encouraging for everybody just starting the journey! This disease can be controlled and your puppies will get better!!

Shannon & Sunshine

[Boriss McCall]

yeah Sunshine! Boriss is doing great too.. There is hope for sure. :):)

[sunshinehoman]

Awesome Boriss!! Good for you Mommy :D:D:D

[molly muffin]

Awesome news!!!!!

Hugs
Sharlene

[Skye]

((((((((((((((((((((((((((((hugs)))))))))))))))))) )))))))))))))))))

[sunshinehoman]

Update on Sunshine 75 days on Vetoryl--there is good news!!

11 lb Min Pin on 10 Mg of Vetoryl 1X day

Sunshine is doing great! :D:D:D She is no longer having accidents, her drinking is back to normal, eating is normal, she still has hind leg weakness and a small pot belly, but overall definite improvements!! She is almost back to her old self again!!

We will have another stim test around the 90 day mark just to make sure levels are still good

Hope everyone else is doing well! :D:D:D

Shannon & Sunshine

[labblab]

Shannon, this is terrific news! :) :) :)

Thanks so much for updating us, and please keep on doing so. It's wonderful to read such a good report; it brings smiles to all our faces. ;)

Please give little Sunshine a big hug for all of us here,
Marianne

[Boriss McCall]

Good news!! I am so happy things are going smooth for both of ya'll. Enjoy your holidays!!

[molly muffin]

Yay!!! Sunshine rocks the ACTH testing! whoo hooo and party on Sunshine!

Just love good news days. They are soooo special. You get a gold star for bringing smiles to our face! :)

hugs!
Sharlene and Molly Muffin

[molly muffin]

Happy Thanksgiving Shannon, to you and sunshine :)

hugs,
Sharlene and Molly Muffin

[sunshinehoman]

Happy Thanksgiving everyone!!
Enjoy each and every day with your beautiful babies!:D:D:D
Love, Shannon & Sunshine

[Skye]

WHOOTWHOOT GET IT SUNSHINE awesome. were doing the min pin bootie wiggle for you here :)

[GabbySue]

Glad to hear that all is going well with Sunshine!!
Nothing like having a Min Pin back to "normal"LOL!!!

[molly muffin]

Yay! All is well, that is the best news and exactly what a holiday week needs!

hugs,
Sharlene and Molly Muffin

[sunshinehoman]

Hope everyone had great Holidays!
Sunshine is still doing well, she will have another stim test in the next few weeks, and I will let everyone know the results!

Shannon & Sunshine

[Boriss McCall]

Happy New Year!
So glad to hear Sunshine is doing so well.

[molly muffin]

Happy New Year Shannon and Sunshine!

Health and happiness in the new year.

Cheers,
Sharlene and Molly Muffin

[sunshinehoman]

Hello everyone! Update on Sunshine:
Taking Vetoryl 1x day 10mg. Stim test results:
Dr feels she is controlled at these levels :)


ACTH Stimulation (One Pre, One Post)—Canine/Feline : PRE-ACTH CORTISOL
Test Result Reference Range Low Normal High
PRE-ACTH CORTISOL 1.3 µg/dL



ACTH Stimulation (One Pre, One Post)—Canine/Feline : POST-ACTH I CORTISOL
Test Result Reference Range Low Normal High
POST-ACTH I CORTISOL 2.0 µg/dL

[molly muffin]

Oh good results! Yay! Thanks for letting us know. :)

Always love a good results day.

Hugs,
Sharlene and Molly Muffin

[addy]

Great news!!!!!! I am so glad Sunshine is responding so well to the Trilostane. Perfect way to start the new year!!!!:D:D:D:D:D:D

[Skye]

whootwhoot!!!!! that is awesome!!!

[sunshinehoman]

Hi everyone!! It has been quite a while since we have logged in! I hope everyone is doing great and all your babies are happy :) :)
Sunshine has been on Vetroyl for about 1 year now and is doing really well! She has had a bad UTI and is on antibiotics right now, and is improving, but she seems to get at least 1 or 2 UTI's a year.
I have been extremely happy with Sunshine's results on Vetoryl 10mg 1X per day in the morning with food.
Sunshine still has hind leg weakness, but her pot belly is pretty much gone and she really enjoys her daily walks!
We get our Vetoryl from Diamond Back drugs which is much cheaper than the local vet and they send it right to our door!
If anyone is trying to decide between drugs, I have to put my vote in for Vetoryl/Trilostane I think it has been amazing for Sunshine and I am so happy to see her back to her old self again!
Hope this helps everyone who is worried or just beginning their journey :) This is the best forum and group of friends! I am thankful for every day with my baby girl!

Shannon & Sunshine

[Harley PoMMom]

Hi Shannon!

So very happy that Sunshine is doing so well!! And, thanks so much for letting us know, and please don't be a stranger! ;)

Love and hugs, Lori

[molly muffin]

So glad to hear from you and to hear that things are going so well still. :) Always love to read that kind of update. :)

don't be a stranger!
hugs,
Sharlene and Molly Muffin

[sunshinehoman]

So everything is fine then BAM Sunshine gets acute pancreatitis, we have her on IV fluids and antiobiotics.
I will be holding food back today and trying tomorrow with some cooked chicken and rice.
Does anyone have any info on diets and how much fat is to much? What kind of diet to give a baby with both cushings and pancreatitis?

Thanks
Shannon

[Harley PoMMom]

Was the pancreatitis diagnosed from a spec cPL test? If so, could you post the result?

There is acute and chronic pancreatitis; dog's with chronic do need to eat a low fat diet all the time. Dog's with acute might just need to eat a low fat diet until the pancreas has settled down and then their regular food can be slowly brought back.

A diet with less than 10 percent fat on a dry matter basis (less than 17 percent of calories from fat) is believed to be low fat.

Whether the pancreatitis is acute or chronic, it is very painful so medication is most always rx'd for pain.

Hoping Sunshine is feeling much better real soon, please do keep us posted.

Love and hugs, Lori

[sunshinehoman]

Not like me to not have test results in hand, but I do not...She had a blood test, sudden onset of vomiting for two days, took to the vet they gave her meds to calm her vomiting and then she started with the diarrhea, two days every 2 hours

[addy]

So what happened, what meds did they give you, what instructions?

I am drawing from memory here but I know it used to be dont feed them for the first 2-3 days but I thought there was new thinking in that regard. I should find Mary Beth's thread for you when Ali had pancreatitis. Ali was hospitalized I think for awhile before she could come home.

I'm really sorry to hear this especially with Sunshine doing so well. Pancreatitis is something Cush pups have to be worried about.

[Harley PoMMom]

If a dog is vomiting than no food by mouth is given, fasting should not done longer that 2 days because this starves the GI tract.
Experts recommend enteral nutritional support in all patients with pancreatitis. This excerpt plus more information can be found here: http://www.idexx.com/pubwebresources/pdf/en_us/smallanimal/reference-laboratories/spec-cpl-treatment-for-canine-pancreatitis.pdf

Keeping the patient with pancreatitis hydrated is also very important. Once Sunshine is home feeding several small meals throughout the day is recommended.

If there is anything I can help with , please let me know.

Love and hugs, Lori

[sunshinehoman]

Sunshine started throwing up last Wednesday night, I didnt give her food on thursday, Friday morning she seemed better and ate breakfast. Friday evening she didnt reallly want to eat dinner but did anyway, she proceeded to throw up all night long. I took her to the vet first thing Saturday, they gave her Fantodine and Cerenia, told me to not feed her anything on Saturday then start her on chicken and rice, small portions 3-4 times on Sunday. She ate Sunday the 3 of the 4 meals then decided she HATED rice! Great! Most of Monday she was a little off and did not want to eat much of anything, Monday night she started having loose stools which turned into diarrhea every 2 hrs all night long. I called the vet Tuesday and let them know she stopped vomiting but had diarrhea, they told me to give her a little pumpkin with her food and see if that helped tighten up her stools. Needles to say that did not work and we had another night of every 2 hours, she would drink but I knew she was getting dehydrated so brought her in first thing this morning. They did a blood test and told me she had pancreatitis, they told me to continue with the first 2 drugs and they added metronidazole and amoxicillin. The also gave me IV fluids to give her 100mg 2X a day. I am to hold food until tomorrow and again start on chicken and rice.
I know I failed not getting the test results!! I was so worried about her that everything flew out the window :(

[Harley PoMMom]

Oh sweety, you have not failed, I so do understand how worried you are about Sunshine. My boy, Harley, had pancreatitis too and that pancreas can be such a fickle organ but pancreatitis can definitely be managed.

I like this article from the dogaware site, it has a lot of info regarding diet for the dog with pancreatitis: Healthy Low-Fat Diets for Dogs (http://www.dogaware.com/articles/wdjlowfatdiets.html)

If Sunshine won't eat the rice, you can substitute it with oatmeal, barley, quinoa, pasta, or potatoes.

Marianne and Glynda also have experience with canine pancreatitis and I am sure they'll be along soon to share their thoughts and advice.

Sending you both tons of hugs, Lori

[frijole]

About the pumpkin... we have found it to be very effective in dogs with diarrhea... plain canned no spice kind... only give like a tsp at a time - if you give much more it causes diarrhea.. so just a bit does the trick. Kim

[addy]

Okay, I'm so glad you told us the whole story:):):)

We have many members with experience with pancreatitis. I know they will come by and I am so glad Sunshine is home and not in hospital.

[molly muffin]

Oh so sorry to hear that Sunshine is having a bout of pancreatis. :( Poor wee thing.

hugs,
Sharlene and Molly Muffin

[sunshinehoman]

Well the IV fluids went better this morning than last night! I was awful at it! Im sure Sunshine felt the same way! She wouldnt talk to me for a couple hours after :(
There has been no diarrhea last night or so far today, she doesnt really want to eat anything..Turns nose up at chicken and rice :( I did get her to eat a little kibble that I had been soaking in water, then she ate a bit of 98% lean cooked ground beef. Just trying different things every 3 hours or so. Any suggestions?

[Harley PoMMom]

How about some baby food (no onions/powder added), any kind of pasta, potatoes, water packed tuna, low-fat homemade chicken/beef broth.

Keeping you both in my thoughts and prayers, Lori

[spdd]

I don't know if this will help, but I've got the most finicky dog going when it comes to food.
I tried hamburger meat as I know he likes it, and I haven't figured this out. I can fry it, bake it, sautee it - LOL and no dice. Make it into a patty and put it on the barbecue and it disappears in seconds. I break it up to put in his dish, and it looks just like it would if I had fried it, but for whatever reason he will only eat it if it's barbecued. No flavoring or anything added, just plain meat.
He'll do the same at a fast food place, but would starve first before he'd eat hamburger any other way.
Worth a try !!

[sunshinehoman]

She started eating a mix of lean beef mixed with Instinct chicken kibble that I had soaking in the fridge to make it soft..Eating is good :D

[addy]

Oh so glad to read this:):):)

[sunshinehoman]

Talked to the vet this morning, I can stop giving IV fluids! :D:D:D
I really did not like doing that, although I would do anything to make her feel better!
Sunshine is eating a little better at each feeding, she is sooooo picky! I hope the worst is behind us now.
In two weeks after she if off all her antibiotics we have to address the transitional cells in her urine, hopefully there wont be any more

[Harley PoMMom]

Glad to hear that Sunshine is feeling better!! Will be keeping you both in my thoughts and prayers, hoping her appetite picks up and that she isn't so picky.

Sending hugs, Lori

[Squirt's Mom]

Glad to hear she is feeling better!

[sunshinehoman]

The vet suggested I hold off on Vetoryl until Sunshine is eating normal again.
I dont want to hold off to long, what do you think?

[Squirt's Mom]

Your vet is absolutely correct. Withhold the Trilostane (Vetoryl) until she is feeling like her old self again, eating well, nice formed stools and no nausea or vomiting. ;)

[sunshinehoman]

Thanks for the quick reply!! :D:D She is almost back to normal, still a little picky with the food but MUCH better!!

[addy]

wait a bit, dont rush it.:):):)

[Skye]

so glad she is eating, shysie is being a bit of a pistol lately with eating as well, so far i am still able to get her to complete meals but she REFUSES to eat her green beans and sneaks them off to her sister, and the rice and chicken is sometimes hand fed. anything for her to eat, i know you know exactly what i mean. proud of you for doing the iv fluids. good job mom!

[Skye]

It is soooooooooooo very scary, pancreatitis. I remember when my little one went through it. I just wanted to tell you again you are so brave and such a beautiful mom for doing the IV fluids for your little one. You really held it together and gave her such comfort and strength. You are a rocking awesome pet momma for sure.

[addy]

Checking in on Sunshine, hope things are ok:)

[sunshinehoman]

Sunshine is back to eating and drinking normally!! She is still on one of her antibiotics for another 6 days, then we go back to the vet for a check.
Mom must not have gotten enough sleep through this ordeal as I have been really sick for the last 5 days, Sunshine has had to take care of mommy the last few days, she is so precious!!

I treasure each and every day with her

[Harley PoMMom]

So happy to hear that Sunshine is eating and acting normally!!!! Now, Mom best take care of herself ;) Hope you are feeling much better soon.

[Skye]

get wll soon!!!!!! do you watch the big bang theory? we could all sing to you soft kitty........LOL (hope you smiled)

[Squirt's Mom]

Good news on Sunshine! :cool::):cool: And what a sweet nurse you have by your side! I hope you are well soon and back to your normal routines.

You're a good mom!
Hugs,
Leslie and the gang

[sunshinehoman]

I have not yet seen Big Bang Theory, although it is on my list of things to watch! I have just caught up with Game of Thrones and Once Upon a Time. I have heard BBT is really good cant wait!
Now if I could just get rid of this terrible cough.......

[Squirt's Mom]

I get my daily laughs with Big Bang Theory! I dearly love Sheldon tho in real life I'd have to bang someone like him over the head with an iron skillet on a regular basis! :p

Game of Thrones is one I want to watch but it isn't on the free internet sites yet. One of these days.....

[molly muffin]

I'm a BBT fan too Leslie. Love that show. Keep trying to get hubs to sing Quiet Kitty when I go to sleep at night. ROFL!

On my white board at work, I have BAZINGA written really big in purple. LOL

Great to hear good news about Sunshine!

hugs,
Sharlene and Molly Muffin

[sunshinehoman]

Hello everyone! Sorry it has been so long since I have posted on here. Sunshine is still with us and doing well! Sunshine will be 14 on June 15th, she was diagnosed with Cushings 3 years ago. We went through a lot to finally get her regulated.
She is taking Vetoryl 10 mg 1X a day
She eats Raw food only
She does battle UTI's, usually 1 really tough one each year, we are actually coming of one now.
She has had a few bouts of pancreatitis, before I switched her to a complete raw diet.
I do give her other supplements such as dried cranberries, joints(mushroom supplement) and colostrum..These seem to help her.
I have to say this forum and the people in it are the best for anyone just starting out and trying to deal with this disease! I have never forgotten all the help and support everyone here has given myself and Sunshine! We will forever be in your debt!

Love Always,
Shannon & Sunshine

[Squirt's Mom]

It's good to hear from you again, Shannon, and especially to hear that our sweet Sunshine is doing so well! YIPPEE! Thank you for dropping and letting us know.
Hugs,
Leslie and the gang

[molly muffin]

Great to hear that Sunshine is doing so well. :) Awesome!

[sunshinehoman]

Sunshine celebrated her 14th Birthday June 15th!! She is such a happy, sweet baby...Love her so much

[labblab]

Congratulations to Sunshine!!!! :) :) :)

(And now her thread title has been revised in celebration of this special milestone! ;))

All best wishes to you all,
Marianne

[mytil]

Happy Birthday Sunshine!!!!

(any photos of the birthday girl?) :)

Terry

[Squirt's Mom]

Happy 14th Birthday, Sunshine!

[molly muffin]

Happy Birthday Sunshine!!! :) :)

[sunshinehoman]

I put 2 pictures in the album of Sunshine on her 14th Birthday :D

[molly muffin]

She's looking really good!

[sunshinehoman]

I have been struggling with what we thought was pancretitis..1500 cpl a week later down to 600 a week after that up to 900, two weeks later up to 958.
Background:
Sunshine is a 15 Yr old Min Pin who presented with classic symptoms of pancretitis 4 weeks ago. She did have a bout with accute pancretitis approx 1 year ago.
Sunshine was diagnosed with Cushings disease in July of 2012 and has been on 10 mg of Vetoryl controlling symptoms well
She does have frequend UTI's
Sunshine stopped wanting to eat approx 4 weeks ago and was diagnosed with a UTI and Pancretitis
Appetite did not resume after 1 week on antibiotics and subQ fluids and Vetoryl was discontinued
Appetite resumed UTI gone, but CPL levels are not going down

Could the CPL levels be higher due to the Cushings and not on Vetoryl?

[sunshinehoman]

Thanks couldnt find original thread

[judymaggie]

Hi! I merged your current post with your original thread about Sunshine so that everyone will have access to her history.

I am sorry to read that Sunshine has been battling pancreatitis again. I do not have personal experience with pancreatitis and, hopefully, others that do will be along to add their thoughts.

I do have a few questions. Does Sunshine continue to have any symptoms of pancreatitis other than the high CPL? Is she on a special diet now? What has your vet told you about the high CPL?

I do not believe that Cushings, treated or untreated, has any effect on the CPL.

[sunshinehoman]

Sunshine is not exhibiting typical symptoms of Pancreatitis: She does have a gurgling tummy and once and a while will "stretch" assume the praying position ( but that could be just stretching) She does not seem to be in pain, vomiting or have loose stools.
She is on a raw diet, which since the first bout of pancreatitis, I slightly cook. She takes probiotics.

I have read a few studies that concurrent diseases can affect CPL test results and one of them is Cushings...
Wondering if anyone else has heard this

[Joan2517]

What are the signs of pancreatitis? Lena had a gurgling stomach quite often and Gable, who I thought just has a sensitive stomach, has been to the vet numerous times because of soft stool, diarrhea and vomiting. We just had blood work done again and it came back perfect. I have flagyl for him for any flareups, and try to keep my husband from giving him chewy treats, which he usually just swallows and off we go to the vet!

[sunshinehoman]

Classic signs of pancreatitis in dogs

Hunched back
Repeated vomiting
Pain or distention of the abdomen (dog appears uncomfortable or bloated)
Diarrhea
Loss of appetite
Dehydration
Weakness/lethargy
Fever

[Joan2517]

Okay, doesn't fit with Gable...only after he swallows them whole instead of chewing. Even Lena didn't have those symptoms....

Thanks!

[sunshinehoman]

I have exhausted all resources that I can find, if anyone has insight on this please let me know :)

[molly muffin]

I'm wondering if it could just take awhile for the cpl to come down. If the body dealing with other things makes it take longer?
Is she eating and drinking?

[Harley PoMMom]

I have read a few studies that concurrent diseases can affect CPL test results and one of them is Cushings...
Wondering if anyone else has heard this

Yes, I have read that too, an excerpt from one study:
Pending further study, SNAP and SPEC results should be interpreted cautiously in dogs with HAC to avoid false diagnosis of concurrent pancreatitis. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4857952/

I know with my Harley we were never able to get his spec cPL numbers in the normal range and that was frustrating and worrisome. Harley's pancreatitis was found on his first ultrasound and it was puzzling to me that at that time he wasn't showing any symptoms of pancreatitis. :confused:

Lori

[sunshinehoman]

What was Harly's CPL numbers? Sunshines are around 950 after a month off Vetoryl and treatment.
She is eating and drinking and maintaing weight, she is showing signs of the Cushings symptoms again due to being off the Vetoryl for a month. Increased thirst and panting mostly. I think the increased hunger is what is keeping her weight stable

[Harley PoMMom]

His initial result was 528 and the lowest we could get that number was in the 300's.

[sunshinehoman]

We are having an abdominal ultrasound on Wednesday. Poor baby now has conjunctivitis in both eyes :(

[Joan2517]

Oh, nooo...

[Harley PoMMom]

Oh I am sorry to hear this, poor little girl :( Did the vet put her on any medication for this?

[molly muffin]

Oh my goodness! When it rains it pours seems like. I'm sure you can get this under control though.

[judymaggie]

Hopefully, today's ultrasound is going smoothly. Be sure to get a copy of the test results/summary.