Daisy Cushings (vetoryl) and now diabetes

[JoannH]

I'm new to the forum. Daisy was diagnosed with Cushings about 6 weeks ago. She's been on Vetoryl and her cortisol levels at the last test were 3.4 ug/dL

I first knew something wasn't right in late July and early August when she kept waking me up at night for no reason. Then one night she went behind the couch to lie down. She had never done that before. So I took her to the vet and her liver enzymes were super high. Her ALKP was 2024 and her ALT was 2326. She went on Denamarin and in a week they dropped to ALKP 645 and ALT 123. In the mean time, I had an ultrasound and biopsy done. The liver and adrenals were enlarged and there was no infection or cancer. The low dose dex test showed that she had Cushings. She's still taking Denamarin and as I said is taking 30mg of Vetoryl in the morning.

I'm trying to get a handle on her insomnia. she is still waking me up multiple times through the night. She doesn't seem to want anything in particular, I think she just can't sleep. The vet recommended 1 mg of melatonin. I've been giving her that for about a week, but I haven't noticed any improvement. He thinks she might just be anxious and said if it doesnt improve he might put her on Xanax. That sounds a little extreme.

If the ACTH shows the cortisol is normal, shouldn't this symptom subside? Does her cortisol level increase at night? She takes the med in the morning.

Thanks for any input.

[Squirt's Mom]

Hi Joann and welcome to you and Daisy! :)

Some pups will do better on twice daily dosing with Vetoryl (Trilostane) so you might talk to your vet about this. There is a method of testing whether this would help Daisy but I will let those more familiar with Trilo fill you in on that.

Another point to consider is the timing of the monitoring ACTH and whether she was fasted first or not. With Vetoryl, the test has to be performed at the 4 hour mark since the last dose so if she gets the med at 8am, the ACTH has to be performed at noon. Fasting can make the ACTH for Vetoryl inaccurate so if she has been fasted before the ACTHs, they may not reflect her actual cortisol level.

Daisy can probably take a higher dose of melatonin, too. My Squirt, at 15 lbs, gets 3mg am and 3mg pm as part of her treatment. Personally, I would definitely prefer a higher dose of melatonin or an herbal nervine to Xanax, Valium or other pharmaceutical sedative. But I would want to verify that her cortisol is being controlled throughout the nite first. ;)

I'm glad you found us and hope you find the same support and wealth of knowledge here that I have.

Hugs,
Leslie and the gang

[frijole]

Hi. It's the high cortisol that is causing the insomnia... think adrenaline excess. As the cortisol is reduced by the trilostane this will improve! I gave my 17 lb schnauzers 3 mgs of melatonin twice a day fwiw. I think you need to increase the dose. It isn't narcotic like at all - just chills them. Kim

[JoannH]

Thanks.

I will increase her melatonin, the vet said that would be ok. Daisy is 18 pounds of pure canine perfection; she's a poodle mix. I agree that I want to stay away from Xanax.

I am also interested in finding out how to tell if she would be better on twice a day of the Vetoryl. If anyone knows please let me know. I already had a discussion with my vet but need more info.

She was not fasted before her ACTH test. I gave her her medication with food at 6 am and then dropped her off at the vet. I'm hoping they timed the test right. I will call and find out. I don't have confidence in the vet I was going to, so I switched last week to someone I know is competent and compassionate...he's just opening his own practice. Daisy gets tested again on Oct. 20th.

Thanks again for your help. This is all new and overwhelming. The week after I found out she had high liver values, I shed a lot of tears not knowing what was wrong. Then the vet hospital messed up. She went in for an ultrasound and biopsy. The traveling vet that does the ultrasound totally messed up and didn't do the biopsy. Then my vet was talking about exploratory surgery to get a biopsy! I was devastated! I had to put Daisy through another ultrasound/biopsy instead. It's been an emotional rollercoaster. I'm just grateful I found this forum and have a new vet that I can trust.

[molly muffin]

Hello and welcome.
From what I've read on here, a lot of people end up doing the twice a day dose if the dogs continue to have problems in the evenings. So, what Leslie said is good advice. Maybe after trying an increase in the melatonin and see how that works. It won't hurt Daisy so trying an increase would be okay.

Welcome again to the forum.
Sharlene

[molly muffin]

I posted before I saw your last reply. It's important to have a vet you feel comfortable with and that has a lot of experience treating cushings. I'm having a sort of love hate relationship with mine over this.
It is very scary to see those liver numbers so high. I'm glad they are coming down. One of the people who are doing the twice daily does should be able to stop in at some point and tell you what the factors are to look for when making that decision. We have several who are doing the twice daily.

Sharlene

[Harley PoMMom]

Thanks.
I am also interested in finding out how to tell if she would be better on twice a day of the Vetoryl. If anyone knows please let me know. I already had a discussion with my vet but need more info.


An UC:CR test is an aide for deciding to switch to twice a day dosing.

Quote take from Plumb's Veterinary Drug Handbook Sixth Edition:
If the serum cortisol concentration is within that goal and the UCCR is abnormal, the medication should be given twice daily.http://www.scribd.com/doc/72234998/135/TRILOSTANE

Also I am providing a post from Dr. Bruyette. Dr. David Bruyette is a renown Cushing's expert.


Yes. The same would apply when looking at urine cortisols in the initial diagnosis of Cushings. Ideally 3 morning pooled urine samples collected by the owner at home and refrigerated.

With regards to trilostane we have done as you described and made the switch to BID dosing when the 4 hour post ACTH is controlled and the symptoms return at night.

Dave

Hope this helps.

Love and hugs,
Lori

[JoannH]

How quickly does the melatonin start helping? I increased to 2 mg...and another difficult night. As soon as I gave her the Vetoryl in the morning, she fell fast asleep.

[frijole]

I saw results within an hour. But I used 3 mgs for my dog about the same size. I think most dogs are started on that amount and it can't harm the dog so I would try 3 mgs. Give it to her an hour before bedtime and see if that helps. Kim

[JoannH]

I gave Daisy 3 mg of melatonin, and she slept until 5 am. Thank you for all your help!

[frijole]

:):):):):):):):):)

Wonderful news!

Kim

[addy]

AWESOME:D:D:D

Happy zzzz'sssss

[molly muffin]

yay!!! *snore*

hugs,
Sharlene

[JoannH]

Well, I had three good nights. Daisy was up at 4 last night and wouldn't let me sleep. I gave her the 3 mg melatonin. I don't know why it didn't help her sleep longer.

Any ideas?

[Squirt's Mom]

Hi Joanne,

If I were you, I would talk to her vet about twice daily dosing. Are you seeing any other cush signs showing up later on in the day like an increase in appetite, drinking, and/or urination? Does she sleep through the day or most of it? I wouldn't increase the melatonin without talking to the vet about causes for this behavior.

Hugs,
Leslie and the gang

[frijole]

Two things - you mentioned an acth test but I didn't see the results posted. I am curious as to what the cortisol readings are. It would seem they are still high. I'd like to confirm that.

As Leslie mentioned one option is splitting the dose in half and that way it continues to work throughout the night. The other possibility (depending on the acth test) is that you need to slightly increase the dosage.

Just know that there is a reason for the insomnia and it is because the cushings is not controlled in all likelihood. Kim

[addy]

I also would not throw in the towel just yet with the melatonin 3mgs. If it happens 3 nights in a row, maybe then. Sometimes my Zoe will have a night or two of wakening an hour or 30 minutes early but then she is back to normal. 4-5 o clock is only an hour. See what happens tonight. Maybe you will make it to 5 again.

[goldengirl88]

JoannH.
I wanted to say welcome. I am new here too, and still a novice at some of this. My Tipper started out at one dose of Vetoryl a day. I noticed many of the symptoms returning by evening. She is now on a split dose which greatly helps. She had the insomnia also, the vet said it was from the cortisol level. She gets 10Mmg in the morning and 10 mg at night. She weighs a little shy of 17 lbs. Gradually she is sleeping better. I think the dose at night has helped her substantially. Maybe you could look into that aspect. Good luck to you and your baby.

[JoannH]

Daisy is on 30 mg. I don't know how I would split the dose. I really want the melatonin to work. I barely make enough to keep a roof over out heads and provide for her medication as it is. If I had to buy extra medication to split the dose, I don't know how I could swing it financially.

Also the ACTH cortisol levels after 2 weeks on Vetoryl was 3.4 ug/dL.

[goldengirl88]

JoannH.
The cheapest and best place I found was Lambert Vet Supply. It is a Vipps rated pharmacy so you don't have to fear of getting something you shouldn't, as they get it straight from the manufacturer. I checked them out thouroughly. I have to buy Tipper a split dose, and that is where I get it. Maybe you could check it out. I know these drugs and tests are very expensive so it is hard to do all that you need to. Good Luck.

[frijole]

They come in 10 mg increments so you could give 20 in am and 10 at night. CAUTION - DO NOT TRY TO SPLIT PILLS. It is written in the product sheet - it is dangerous. I never used trilo so I don't know details but didn't want you to try it.

To be honest - if that acth reading is accurate and you are at 3.4 after only two weeks you might end up LOWERING the dosage. It seems to have a cumulative effect and so please keep an eye out should her cortisol go too low. Again, just a word of caution. Others that have used the drug will hopefully chime in.

Kim

[molly muffin]

Hi, hope the sleeping issue is going better now.

It certainly wouldn't hurt to call and find out the cost of the trilostane from the other pharmacy, Lambert Vet Supply. Maybe it is cheaper than what you pay now?

Sharlene

[josif]

I have understand your problem and don't worry I will also experience
and face same like this problems just increase the dose of melatonin,
if you give twice a daily dose and not recover the position then make
three dose daily dose regime with food containing fats because it has
100% crowning efficacy which always on head.

[JoannH]

Daisy did a little better last night. After the next ACTH test, I'll have a better idea of where the cortisol levels are. I plan on having a long conversation with her vet about twice daily Vetoryl and the dosage.

I did find Vetoryl at Dr. Foster and Smith for about the same price as Lambert after you figure in that over $49 they have free shipping.

[frijole]

I never used trilostane but many members here have purchased from a company called Diamondback Pharmacy. They buy it online. Hopefully someone who has/is using them will provide greater details as I think their pricing is pretty good. Kim

[JoannH]

Daisy still has insomnia. She had a couple of good nights. I was wondering if someone could tell me the dangers of having cortisol levels at night high enough to cause insomnia. Seems to me in the long run it could cause other problems to her body. After I give her her medication in the morning she is able to finally rest.

thanks.

[JoannH]

Daisy is not sleeping well again on 3 mg melatonin. She was up at 1:30 and was scratching and chewing at herself all night. Is there anything that I can do to help her with this? I spoke with my vet about the insomnia. We are going to wait until we get the results from her next blood test to change her dosing to twice a day. Do you think the itchiness is related to the Cushings? It's driving me crazy, so I can only imagine how much worse it it for her.
Thanks,
Joann

[frijole]

Yes I think the itching is a result of cushings - lots of cush dogs have skin issues. Some give oatmeal baths to help give relief. The key is to get the cortisol under control (lower) and with time the skin issues are resolved. When was the last acth test? What were the results? Kim
PS It could be that it is the ITCHING that is keeping her awake. Hopefully those that have dealt with this will chime in. Otherwise you might look for oatmeal bath options online/at a pet store.

[lulusmom]

I agree with Kim that it could be the itching that is causing the increased activity at night. Dogs with cushing's do have skin issues which eventually resolve with treatment. However, a more likely scenario is that dogs with uncontrolled cushing's have been self medicating themselves with high levels of cortisol (a steroid). Once treatment drops the circulating cortisol, those natural anti-inflammatory effects disappear and once masked allergies or autoimmune problems are unmasked.

I don't recall what symptoms Daisy had at the time of diagnosis but her last stim test pretty good so I'd think you would have seen some good improvements. Aside from night time activity, have all of her other symptoms resolved?

Glynda

[JoannH]

I have noticed an improvement in her other symptoms. Her eating and drinking is normal again. She does not pant excessively. The symptom that prompted me to get blood work done to begin with was the insomnia. That's when we discovered the high liver values which led to her eventual diagnosis with Cushing's. With her past insomnia though, she was not itchy and scratching. This is recent...started a few nights ago.

I think the itching is what kept her awake last night. I know she has had allergy symptoms in the past, pre-Cushing's. I will call the vet on what to do about the itching. Not sure it he's open tomorrow though.

Her next ACTH test is on Oct. 20th.

[JoannH]

Hmm. I've been thinking. I don't really notice excessive itching during the day. And once I give her her medication in the morning, she falls to sleep.

This is such a puzzle. I just wish I knew the answer.

[JoannH]

Daisy's itchiness has not improved. She's getting these tiny scabs on her that I think are from scratching. I have shampooed her with Oatmeal shampoo and have been using Vet's Best Hot Spot Formula which has Tea Tree Oil and Aloe Vera in it. It seems to provide only very temporary relief. I feel so bad for her. My next vet appt is next Saturday for an ACTH test.

[Anniston's Mom]

I so understand your anxiety. Our Anni was diagnosed in June, started treatment with Lysodren, but is now on Trilostane. We were dosing twice a day Trilo with great results. However, off meds the past three days as she was showing significant signs of cortisol being too low. Today is better and we will likely do another ACTH STIM next week to evaluate re-starting Trilo.

[JoannH]

Daisy is so itchy that she is developing scabs on her legs and sides and a red spot on her back! I'm so worried. I'm not sure if it's allergies that are surfacing now. The vet recommended benadryl, but it doesn't seem to be helping. She goes for blood work this weekend. I'll let you know the results as soon as I hear.

If she has food allergies, is there any food you would recommend. She's eating natural balance now (diet) because it's low in protein and easier on her liver. Previously she was eating Orijen. She ate that for about 2 years and seemed find but it was super high in protein. Not good with liver issues.

[StarDeb55]

Joann, I have not posted to you before, but saw your latest post about allergy issues. I have had 2 severely allergic dogs in the past 10 years, so have plenty of experience. One of these 2 was my first cushpup, Barkley.

When it comes to food, it is usually recommended that the allergic pup be on a food with a single source of protein, & single source carbohydrate. This usually means you will have to purchase an allergic prescription diet from your vet, something like fish & potato, or duck & potato. Barkley ate the duck/potato kibble for years. Now, when it comes to OTC antihistamines, you aren't just limited to benadryl. My derm vet had given me a long list of OTC meds with the appropriate dosing for pups a long time ago, but I seem to no longer have it. The one thing I can tell you is that my 2nd allergy pup was helped quite a bit by Zyrtec. He took the same 10mg. pill that I do. My derm vet's rule of thumb with OTC meds was you try one for 3-4 weeks before you decide that it's not working, & move to the next one. Perhaps your vet can provide you with a similar list with the appropriate dosage for canines.

It's very likely that Daisy's allergies are starting to manifest now that her cortisol is coming down to a therapeutic range. Cortisol is a natural anti-inflammatory, so her high cortisol was basically self-medicating her allergies. There are a number of options that can be used to treat the allergic cushpup, but I'm afraid your best bet is to seek a referral to a vet dermatologist, if there is one in your area. Trying to manage Cushing's, along with severe allergies can be a high wire act, & a specialist is usually the one you want taking care of this, since the usually treatments of prednisone, Temaril-P, etc. can't be given to our pups.

Hope you find this helpful.

Debbie

[JoannH]

Thank you. I will definitely take your advice. I will talk to my vet. He has already suggested the possibility of putting her on steroids which I will not do. I'm not sure if there is a derm vet around my area. I will ask.

I will also look into an allergic prescription diet. I'm not sure if that's the problem because I live in a high allergy area...York PA. Even I developed allergies last spring for the first time after moving to the area.

[JoannH]

I am taking Daisy in for her ACTH stim test tomorrow to see how well the Vetoryl is working. The vet wants her in between 8:30 and 9:00 am. At what time should I give her her dose in the morning?

My understanding of the ACTH test is that there are two blood draws, once before the ACTH is administered and then a few hours later. The instructions that came with the meds says "conduct a 4-6 hour post-dosing ACTH stimulation test..." Does the "post-dosing" refer to the ACTH or the trilostane?

I'm just unclear as to the timing of everything. Can someone explain what happens with the test and the timetable involved?

Thanks,
Joann and Daisy

[lulusmom]

Hi Joanne,

The acth stimulation test must be done within 4 to 6 hours after dosing. A prestimulation blood draw is done and then the dog is injected with a stimulating agent. A second blood draw is done one hour after injection. UC Davis has their patients come in 3 to 5 hours after dosing so if your vet wants Daisy in by 9 am, then make sure you give her the dose with food by 5 or 6 am.

Glynda

[JoannH]

Thanks. Daisy usually wakes me up by 4:30 with her scratching and insomnia. :)

MODERATOR NOTE: I have merged your post about ACTH testing into Daisy's original thread. We normally like to keep all posts about each pup in a single thread as it makes it easier for members to refer back to the pup's history when needed.

[molly muffin]

Hope everything comes back good on Daisy's ACTH test today!

Sharlene

[JoannH]

I took Daisy in last Saturday for her ACTH test. It was the 30 day after the 14 day test. The vet called on Monday and said the results were good and to keep her on the same dose. He actually left a message. Today I called to get the actual numbers he said it was 1.7 ug/dL pre and 8.0 ug/dL post. I looked it up and that's not in the good range. The only real symptom she's having now is the insomnia. She's on 30 mg in the mornings. Her 14 day test was better. It was 3.4 ug/dL post.

Any suggestions on what I should do?

Thanks!

[Harley PoMMom]

When treating with Trilostane/Vetoryl a post number can be as high as 9.1 ug/dl as long as clinical symptoms are controlled.

With Daisy's post of 8.0 ug/dl and with no obvious Cushing symptoms, I believe no dosage adjustment is due as of yet. If Daisy should start showing more symptoms, than another ACTH stim test can be done and a dosage increase may be needed.

[JoannH]

Thanks. I was worried about the number with her insomnia. Maybe that will let up after a while.

[JoannH]

My vet wants to give Xanax a try to treat Daisy's insomnia. Does anyone have any experience with this?

[frijole]

No experience - sorry but my mom got hooked on it (thanks to her doc) and it took her years to wean off of it. I wouldn't touch it with a ten foot pole personally but that's a very personal opinion.

I go back to the question someone asked - the last acth was 8 and that is not controlled cushings. Has your vet made any changes to dosing to help control the cushings. This would probably cure the insomnia since that is why cush dogs get restless.

Lastly some dogs do better with twice daily dosing as it spreads it out more evenly and that way it hasn't worn off at night.

Kim

[JoannH]

I was told that 8 is controlled because the range should be between 1.45 and 9.1 for long term monitoring. The vet doesn't want to change dosing because he said it is controlled.

I tried melatonin 3 mg and it didn't seem to help.

[frijole]

What symptoms did your dog have before you started vetoryl? What symptoms does your dog have now?

[JoannH]

Before diagnosis and treatment she had excessive panting, drinking and a voracious appetite. She also had insomnia. The only symptom that she still has is the insomnia.

[addy]

I am wondering if twice day dosing would help the insomnia. Does your vet have any thoughts on that? It might be worth a discussion before you try the xanax.

Hang in there, Joanne, you are doing just fine but I know you are in need of sleep at night. That is so hard on you.

Love ya

[molly muffin]

hmm, insomnia is what started you on this path right? What an increase in the melatonin? That might help and it isn't going to hurt at least. Or a split evenly dosage on the Trilostane like Addy mentioned.
I do hope that you and Daisy can both start getting some rest at night.

Sharlene and Molly Muffin

[JoannH]

My vet seems to insist that it's better to try the xanax because he doesn't think it wise to change dosing schedule if she is doing well otherwise. I gave her xanax last night and she may have slept through the night, but she had to poop!

[molly muffin]

Oh geezz, poor Daisy And you. All ready to curl up for a good nights sleep and have to get up for a poop. It seems so unfair!
Hoping for better results tonight.

Sharlene

[Squirt's Mom]

Xanax does the same thing to me when I have to take it! :eek: So much for relaxing. :rolleyes::D

[molly muffin]

Hi! Just wanted to stop in and say Happy Thanksgiving! Hope you are getting a good nights rest these days!

hugs,
Sharlene and Molly Muffin

[JoannH]

My vet suggested giving Daisy her medication (Trilostane) in the evening instead of the morning to help with the insomnia. Does anyone have any experience with this? It seems that morning is the usual time.

Daisy's insomnia has improved ever so slightly with her taking a small dose of Xanax.

Moderator's Note: I have merged your latest post on Daisy into Daisy's original thread. We, normally, like to keep all post on a pup in a single thread in case other members need to refer back to the pup's history.

[addy]

Hi Joanne,

If you are on once a day dosing and you give the dose at night, the ACTH test must be done within 4-6 hours of giving the pill. How late is your vet open to adminster that stim?

Would you maybe be better off switching to twice day dosing then?

[molly muffin]

I know that quite a few give morning and night split dose to get the levels more regular for the full day. Some of that appears to be due to issues at night, restlessness, urinating, etc. that appear to be a problem at night.
Have you looked into that option?

Sharlene

[JoannH]

My vet said we could change the dose back to morning a few days before the test...but I'm not sure that's the best option. She's on 30 mg. How would I be able to split the dose since I can't break the pill in half and it doesn't come in 15 mg. I'm not sure if I could have 15 mg pills made so that I could afford them.

[SoggyDoggy]

Hi JoannH

I've been doing quite a bit of reading lately on 2x daily dosing of Trilo as my boy is due to restart tomorrow after too high a dose on 1x day.

Apparently a percentage of dogs on Trilo also don't suppress past 12 hours, so that could also be why your baby manages to sleep in the morning after her dose, but not at night. Maybe she is one that needs the more consistent dose in her system? All of the studies I have read indicate a lower dose is used when giving 2x day, symptoms may take longer to control initially, but become more effective and tend to have fewer side effects.

I mention this because the specialist I saw recommended 10mg twice a day, or if I only wanted to dose once a day, 30mg. Now if that is coming from an Internal Medicine specialist, parallels with studies I have read, I tend to trust that word.

Speak to your vet about the twice daily dose, but as Vetoryl is available in 10mg doses, you may be able to do that rather than a 20/10 split or even compounding 15mg caps.

If I ever manage to re-find the study I saw that mentioned specific dosing regimes I will post the link, but the general trend I find is that they recommend a lower dose when going 12hourly.

This is from an abstract from a study about 12 hour effectiveness:

PROCEDURES:
47 dogs were treated orally with trilostane (0.21 to 1.1 mg/kg [0.1 to 0.5 mg/lb], q 12 h). All dogs were reevaluated at 2 weeks and 2 months, 38 dogs at 6 months, and 28 dogs at 1 year of treatment.

RESULTS:
9 of 47 dogs had an adrenocortical tumor causing NOH, and all had good responses after 2 months (mean trilostane dosage, 0.89 mg/kg [0.40 mg/lb], q 12 h). All successfully underwent surgical adrenal tumor extirpation. Thirty-eight dogs had pituitary-dependent hyperadrenocorticism (PDH); 15 dogs did not require a dose increase during the study, and at each of 4 reevaluations, 10 of 15, 13 of 15, 14 of 15, and 11 of 11 had a good response. Twenty-three dogs with PDH had their dose or frequency of trilostane administration increased during the study. Mean trilostane dosage at 1-year reevaluation in dogs with a good response was 1.7 mg/kg (0.8 mg/lb), twice daily, or 1.1 mg/kg, 3 times daily. At each of 4 reevaluations, 17 of 23, 14 of 23, 17 of 23, and 13 of 17 dogs with PDH had a good response. Five dogs became ill because of trilostane-induced adverse effects, but only 1 required hospitalization.

CONCLUSIONS AND CLINICAL RELEVANCE:
Administration of initial lower doses of trilostane to dogs with NOH is effective.

*NOH is Naturally Occurring Hypoadrenocorticism (hope I spelt that right).

Not having access to the full article, I can't give any more info than that, but here is the abstract link. It is a UC Davis study from last year.
http://www.ncbi.nlm.nih.gov/pubmed/21627507


Hope this helps, or at least gives you something else to consider. My boy kept me awake last night freaking out over lightning. I get how precious sleep is! :o

Disclaimer: I don't pretend to be a full bottle on cushings by any means, in fact I am very new to it myself and there are a lot of people on here who know a heck of a lot more than I do, this was just to help with some info I have found.

[lulusmom]

Hi Joanne,

I personally think it is a really bad idea to give a dog his once daily dose in the evening and switch him back only to do a stim test. Not good in my layperson's opininon. I've gone back and reread your thread and it looks like Daisy had insomina prior to her cushing's diagnosis. Her last post stim was 8 ug/dl and all symptoms associated with cushing's have resolved. Vetoryl (trilostane has a short half life so it's possible that Daisy's cortisol is climbing high enough to make her restless in the evenings. I would think, however, that you would be seeing some of the usual cushing's symptoms. Since you are not seeing the return of the cushing's symptoms, there is a distinct possibility that what you are seeing in the evenings is something called Sundowner's Syndrome. People with Alzheimers experience this and so do dogs with cognitive dysfunction. They sleep quite well and a lot during the day but become very restless and confused at night.

How old is Daisy? Have you observed her whining or crying for no reason, staring at a door, wall or off into space, does she bark for no reason, is she still responding to her name, does she act distant/less sociable or appear to no longer know who you are? If you answered yes to any or several of these, it is very possible Daisy has cognitive problems, aka doggie dementia.

A friend called me yesterday about her 15 year old pomeranian who has been keeping them up for the last several days. She said the dog would sit down and immediately get up and start pacing like she was in pain. She whines and barks all night. They have had her to their vet twice and Monday night they took her to the ER when it really escalated. They did every test they could think of and could not find anything wrong with her. Her bloodwork was good, imaging was good and no sign of pain when manipulated. My friend was adamant that they do something because there is something wrong. The ER vet go very rude and said the dog was ancient and wanted to know how much money she wanted to spend to run every test under the sun. :mad::(:mad: I asked about the various symptoms I listed above and she was shocked because she recognized at least three of the symptoms but didn't put two and two together.

I also have a friend who is a permanent foster mom to a little old guy I pulled from a shelter. I suspect that he was already displaying early onset of dementia with his owner, which is probably why he ended up in the shelter. He was always a little different and has always needed to wear a diaper but four months ago he was more than different. He would start screaming if you touched him and he would cry constantly like he was in excruciating pain. It was heartbreaking. This happened three our four times and it was always at night. He was put on Xanax which helped a little bit. He was subsequently put on Anipry,l which is an FDA approved drug for canine cognitive dysfunction. He's still in diapers but is much, much better. No more evening nightmares but he does wake up his mom at 4:30 every morning but he does go back to sleep after the lets him out.

Glynda

[frijole]

Glynda, Excellent points! Question ... could a dog on trilostane also use anipryl? I know they couldn't use lysodren. Curious. Kim

[Harley PoMMom]

Question ... could a dog on trilostane also use anipryl? I know they couldn't use lysodren. Curious. Kim

Yes, Trilostane and L-deprenyl (Anipryl) can be used together.

An excerpt from Dr. Peterson"s blog:
...you can certainly use the drug selegiline hydrochloride, also known as L-deprenyl (veterinary trade name, Anipryl) along with the trilostane that the dog's already getting.


http://endocrinevet.blogspot.com/2011/04/q-pacing-and-circling-in-cushings-dog.html

[JoannH]

Daisy isn't displaying any of the signs of cognitive issues. The only issue is the insomnia. I will talk to my vet about twice a day dosing and going to 10 mg for starters. I'm not sure that he is completely up to date on the research, so any articles from journals would be appreciated. I could send them to him. He likes the medicine part of being a vet and seems to like learning the latest research.

One problem is that I thought we were set on the dosing, so I purchased a two months supply of the 30 mg! Not sure what do to about that.

[Boriss McCall]

If you are stuck with the 30mg maybe someone on here would want to buy it from you? Not sure if that is acceptable? :o

[labblab]

Amy, unfortunately federal law prohibits the sale or even free transfer of prescription medicine among private individuals. So our forum rules cannot allow public offers of medication for sale or exchange.

Joann, one option might be for you to try to find a local compounding pharmacy that could repackage your 30 mg. capsules into a smaller dosage. There would be a charge for that, of course, so I don't know whether or not that would be a reasonable option for you. But you could at least check it out.

Marianne

[Boriss McCall]

Thanks Marianne! I had a feeling something like that would be the case. :)

[JoannH]

Thanks. I looked into a compounding pharmacy and found one near the school where I work. (I work near a hospital). They will do it but seemed too disorganized to give me a price. I plan to go in again next week to press them on the cost.

[JoannH]

OK...I'm going to talk to the vet tomorrow about twice a day dosing. Does anyone else have experience with reducing the daily dose for twice a day? She's on 30 mg and they don't make 15 mg, so has anyone else gone to 10 mg twice a day with success?

thanks!:)

[JoannH]

Ok venting...annoyed with my vet. I've found this with a lot of vets. They can be condescending when you ask questions. He responded like he was annoyed that I was asking a question, as if I should know the answer ahead of time. Very frustrated!

[molly muffin]

You can do 20/10, but the cost is more because you're buying extra boxes of the 10mg. You could try lower and see if that works too.

Maybe some of the others with experience with the double dosing will add their recommendations.
Vets can be aggravating sometimes. Some are wonderful working with the pets families, others aren't. If normally he is really good, then maybe he had a bad day. If not, just stick to your point, that it is his job to make recommendations. I know it is frustrating.

sharlene and molly muffin

[NoonelovesmelikeNorman]

Norman, my dachshound, is 24 pounds, how much melatonin do you think I should give him and how often?

[JoannH]

I was giving Daisy who is 18 pounds 3 mg in the evening. You should probably check with your vet though. Or someone else on the forum might know. I"m not sure if the 3 mg helped much which is why I'm going to try twice a day dosing on the trilostane.

[Harley PoMMom]

Norman, my dachshound, is 24 pounds, how much melatonin do you think I should give him and how often?

I would try 3 mg and dose twice a day.

[JoannH]

Ok...tomorrow morning I am starting Daisy on 10 mg of Trilostane twice a day. I found a compounding pharmacy that took some of my 30 mg capsules and made them 10 mg.

I'll let you know how she responds. My vet is kind of frustrating me. He doesn't seem too concerned about having the ACTH test in 2 weeks. He said 3-4 weeks and just keep an eye on symptoms returning. The pharmaceutical company that makes the Vetoryl says to have her tested after 2 weeks following a dosing change. I know symptoms go hand in hand with the cortisol levels but seems to me that checking the levels is important.

[lulusmom]

Hi Joann,

I'm really glad that you found a pharmacy to repackage your Vetoryl into 10mg capsules. As for your vet's attitude, I can so relate to cavalier attitudes, ignorance and total disregard for protocol. The rescue I work with has a vet who gives us a great deal on services but he's a country vet who may be great with day to day ailments but is clueless about cushing's. I had to educate him on how to assess an acth stim test for purposes of monitoring treatment. Fortunately, this vet doesn't have an ego and is open to listening to me, or at least I think he's listening......his eyes don't seem to glaze over when I'm talking to him. :D

Glynda

[JoannH]

I don't think I had enough capsules made at 10 mg. Bummed. I just wish that the vet would be more helpful. I guess I need enough for at least 3 or 4 weeks. I only have enough for two. :( It stinks that this all costs so much. If the results of her ACTH test are too high, should the dosage be increased right away? Should I insist on having her tested at 2 wks as recommended? I'd just like a sense of how many 10 mg capsules I'm going to need. I'm so frustrated.

[frijole]

I'm not going to answer the dosing questions as I never used trilo. Someone else will help you there.

Re getting the acth test done at 2 weeks - my first vet (that I fired) was like yours and the way I handled issues like this was simple - When it was a couple days away from the 2 week period I called the front desk and set up an appt for an acth test. I think the med techs actually do the testing. My vet had too many things going on and I"m sure never even noticed I had ignored is advice to wait for further testing.. I figured it's my dog and my money - test him.

What's he going to do - fire you as a customer? :D:confused::D AT some point you might want to start looking for another vet. hang in there. Kim

[labblab]

In Daisy's case, given her history, I do think the testing interval is kind of a judgement call. Personally (and of course, I am not a vet!), I am most concerned about maintaining the two-week testing interval for a dog taking trilostane if I'm worried that the dog may be dropping too low on cortisol, and especially if it is the first monitoring test after initiating treatment. In Daisy's case, this is not so much a worry because her post-ACTH result while taking 30 mg. daily was up around 8. In switching to the twice daily dosing regimen, you are now decreasing her daily total to 20 mg. So as you are expecting yourself, I 'm guessing the issue will be more as to whether or not she will be needing a dosing increase. And in that sense, I'd almost rather give her the benefit of 30 days to settle in on her new twice-daily regimen before making yet another dosing change. So in this case, I think I'd actually agree with your vet and leave things status quo unless you do see an increase in symptoms.

Dechra's published recommendations notwithstanding, I have been noticing that some specialists are trending away from performing full ACTH tests at the 10-14 day mark and are instead only checking baseline cortisols at that point. As long as the dog is clinically doing well and the baseline cortisol is above around 2.0, there seems to be reasonable comfort that the cortisol is not dropping too low, and the desire is to wait until the dose has been maintained for 30 days before performing the full ACTH test and making dosing increases. Of course, this is all premised on the dog looking and doing well. Safety is the biggest issue, and if there is any question about cortisol having dropped too low, then you want to proceed with the full ACTH immediately.

So in summary, if Daisy's symptoms remain in check and she seems to be generally well, I actually don't disagree with your vet's recommendation to wait out the 30 days before re-testing. At that point, you should have a better idea as to the long-term effectiveness of this dose. And as for the capsule size, I'm afraid I don't know how useful the 30 mg. capsules will ever be to you unless you decide to ditch the twice-daily regimen and return to the original 30 mg. once a day. If you stick with the twice-daily dosing, I guess the only scenario in which I'd see you using them is if you decide to increase to 40 mg. daily, split between 30/10. Otherwise, your existing trilo will probably be most useful to you if it is all converted to 10 mg. capsules. That will probably be very expensive, but give you the greatest dosing flexibility if you do decide to stick with the twice-daily dosing regimen. :o

Marianne

[lulusmom]

I realize your vet is not very receptive to your questions and doesn't seem to have much appreciation for a proactive pet owner but it's very much worth your while to talk to him about ways to save you money. One is using the baseline cortisol reading as explained by Marianne and another is splitting the vial of cortrosyn, the stimulating agent used in acth stimulation tests. Cortrosyn is called liquid gold for a reason. It is this little vial that makes the acth stimulation test so darned expensive. A lot of gp vets don't know that you can get multiple stimulation tests out of one vial of cortrosyn if you have a dog weighing under 55 lbs. The vial is 250 mcg and instructions say to use the entire vile for all dogs but it has been known for some time that you need only 5 mcg per kg. Daisy weights 18 pounds which converts to 8.18 kg. Amount of cortrosyn needed for one stim test for Daisy would be 41 mcg which would be rounded to 50 mcg. That means you could get five acth stimulation tests out of one vial of cortrosyn. My Lulu weighs less than 4 lbs so we could actually get 10 acth stim tests out one vial but it's highly unlikely that we would ever be able to use that many syringes of frozen agent. A dog weighing 55 lbs would require 125 mcg which would give you two acth stimulation tests. The smaller the dog, the bigger the savings.

Again, this is very well worth discussing with your vet and hopefully, he will be willing to split the vial for you. We have had a number of members who have done this. If your vet has never heard of this, please provide him the url below to Dr. Mark Peterson's veterinary blog, or you can print out the blog and take it to your next appointment.

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

Glynda

[JoannH]

Ok here's a question about compounding. I called Medicine Shoppe about converting my 30 mg caps into 10 mg. They said what they do is just turn it into a liquid form and I would administer it with an oral syringe. I've never heard of that. Would that change the effectiveness of the trilostane? To do that is a lot cheaper than turning it into capsules.

[labblab]

JoAnn, I'd recommend you call Dechra directly to see what they advise re: converting to liquid. I know that we've had some owners over the years who have administered liquid trilostane, but I don't know whether it is a drug that takes "kindly" to a liquid suspension or whether doing so alters the active properties or shortens the shelf life of the drug. You can tell the Dechra vet that you've got 30 mg. Vetoryl capsules that have to be altered and you want to know which option is safest and most effective. Here's the contact info for Dechra's Kansas office:

http://www.dechra-us.com/Default.aspx?ID=365

Marianne

[JoannH]

Thanks, I sent the a message to ask. I'll let you know what their response is.

You have no idea how much I appreciate all the help on this forum!

[JoannH]

We began twice a day dosing of Vetoryl on Friday. We went from 30 mg once a day in the morning to twice a day at 10 mg in the am and 10 mg in the pm. The past two nights have been the worst for the insomnia! I am hoping this will change and that it's just her initial response to the change in dose. I also noticed she did something that she had not done since she started treatment...she preferred to sleep on the floor for part of the night.

Does anyone have experience with this? My vet's comment about a week ago was that he doesn't have much experience with twice a day dosing. His comment worried me. I don't want Daisy to be his guinea pig to learn the dos and don'ts of twice a day dosing.

[frijole]

I'll let the trilostane answers chime in but I just wanted to say that just because your vet hasn't tried it doesn't mean it isn't a sound practice. Go back thru this thread and you will see this suggestion was made on more than one occasion. The reason is because we have seen other cases where twice a day dosing was necessary. It is what is recommended by the specialists in the field - not just us .

Perhaps the problem has to do with the fact that the overall dose was lowered from 30 mgs to 20 mgs.? REmember we suspect the restlessness has to do with cushings that is not under control. Hope this makes sense. Kim

[JoannH]

I have no doubt that the twice a day dosing is a good idea. I'm just concerned that his lack of experience will prevent him from determining the best course of action given the symptoms. I am hoping to have some input here so I know if this is normal to have a recurrence of some of the symptoms when the change is made and the dose is lowered and whether or not it then improves. My vet will not be able to tell me this because of his lack of experience.

Thanks!

[lulusmom]

I am not surprised that you are seeing a return of symptoms as 10mg in am and pm is most likely too low. Optimum would have been to get her on 15mg twice daily. The manufacturer actually recommends that you bump up the once daily dose and split it half. In other words you would increase the once daily dose of 30mg to 40mg and give 20mg in the morning and 20mg in the evening.

It infuriates me that a vet simply looks at you and tells you that they aren't familiar with twice daily dosing. Geeze, if you don't know enough about the disease and the serious drug you are prescribing, you shouldn't be taking on any dogs with cushing's. As a layman, I can go to any number of sites and find educational information and I would suggest your vet either do the same. If he doesn't want to do that then he should refer you to somebody who can help both you and Daisy and never accept the responsibility for treating another dog with cushing's. Ignorance is a cushdog's worst enemy.

Marianne suggested that you call Dechra, the manufacturer, but I would recommend that your vet call Dechra. Some members have called Dechra and they would not discuss anything with them and told them to have their vet call. It seems they are more willing to speak to a pet owner if their vet has established a record with Dechra. They have continuing education material for vets on their site and it would behoove your vet to utilize it. Dr. Mark Peterson, a contributor to Dechra's continuing education site, has a blog for veterinarians. Vets write to him with questions and he answers them and there is a ton of information on his site.

Your vet's ignorance is not helping Daisy and it's probably wasting your hard earned money. In my layperson's opinion, you are probably flushing money on a dose that is going to continue to be less effective than the once daily dosing at 30mg. If you are that confident that your vet will be unable to answer your questions, I would highly recommend that you find another vet or better yet, an internal medicine specialist. If that is not possible, I would insist that your vet either call Dechra or an internal medicine specialist to discuss Daisy's case and decide on the best plan of action. It is simply unacceptable for him to fly by the seat of his pants at the expense of his patients and pet owners' hard earned money.

I've read every sanctioned, peer reviewed study I can get my hands on about this drug, including the material submitted by Dechra to the FDA for approval. I believe Marianne (labblab) has too so she can back me up or share her own opinion. If I were in your predicament and could get no help from a vet, I wouldn't do an acth stim test at this point to determine the obvious. I would try increasing the morning dose by 10mg and if you see no change in 5 to 7 days, I would increase the evening dose by 10mg. There can be an overlap in dose at some point during the day so just keep an eye on Daisy for signs of low cortisol.

Glynda

[milosmom]

i agree with glynda on her suggestions.i am currently working with my vet and she also,as well as,myself have had conversations with dechra.they are truly helpful but do want your vet to call them directly for further conversation.i also got myself more information at dr.petersons' blog.my milo has been on vetoryl for 10 months and was doing ok with it.he has had sveral increases in his dosage and presently has been taken off because of side effects of shaking and lethargy.hope you can get your baby regulated soon.we are all watching for good news.patty and milo

[labblab]

Joann, I'm afraid there are a lot of question marks about Daisy's behavior that are not easy to answer without trial and experimentation. First and foremost, what is the true cause of her insomnia? Obviously we are hoping that switching to twice-daily dosing will help that. But at first blush, it is even worse. Is this because the trilo dose is too low? Likely so, but are you seeing an increase in any other Cushing's symptoms as well? I would think that if the culprit is the dosing level, you'd be seeing a return of other symptoms, too.

On the face of it, I don't disagree at all with Glynda's suggestion that you increase Daisy's morning dose in a few days if you don't see improvement in the insomnia and especially if you see a return of other symptoms. However, the reason why I thought it was reasonable to first start off at the lower dose is because there is a lack of consensus as to how multiple dosing actually effects a dog's overall medication needs. It is true that Dechra recommends increasing the overall total when switching to a twice-daily regimen. But noted U.S. endocrinologist, Dr. David Bruyette, has explicitly written here on the forum that dogs dosed twice daily tend to require a LOWER daily total, and actually need to be monitored more closely because there seems to be greater risk for oversuppression with the multiple dosing. Plus, in recent research summarized on this link, Dr. Edward Feldman at UC Davis also observed that dogs who were dosed twice daily in his study did not seem to require even the lowest daily total recommended by Dechra.

http://www.k9cushings.com/forum/showthread.php?p=80146#post80146

For these reasons and since the twice daily dosing of 10 mg. was easier for you, it seemed reasonable to start out that way with Daisy. But if you see a return of Cushing's symptoms, then a dosage increase seems justified to me, too. But as I said above, I'm afraid this process may take some trial and error. Because, unfortunately, the trilostane may not resolve the insomnia under any dosing regimen. And if that turns out to be the case, you may want to revert to the once daily 30 mg. dosing since all of Daisy's classic Cushing's symptoms were resolved and that dosing regimen is a lot easier for you to administer.

Marianne

[JoannH]

It may not seem significant, but as I mentioned, Daisy slept on the floor last night. That was a big red flag that something was wrong when I initially took her in for testing last August, that and her insomnia. That led to the diagnosis. I guess I'll give it a few days, then call the vet? Is there ever a case where a dog is given 20 mg in the am and 10 mg in the pm?

[Tundra's Mom]

Hi Joann,

I can't help with the dosage questions, and my Tundra is still in a kind of pre-diagnosis limbo, but you mentioned that Daisy slept on the floor which is unusual for her, and I just want to say that Tundra has been sleeping in odd places as well, and that is one of the things I first noticed when I decided to take him in to the vet because I knew something wasn't right. Even during the day he sometimes lies down in odd spots -- not his usual places.

I don't know whether this can help you. (Tundra is not yet on medication, we have to wait until January for an ultrasound and more tests.) But I just want to let you know that it may be significant that Daisy slept on the floor, because we are having that same type of experience here. I would be sure and mention that to your vet.

You know your dog better than anyone, so trust your instincts! If sleeping on the floor is a new or strange behavior, then it is significant! I just can't tell you whether this is related to her meds, because I am new here, and, as I mentioned, Tundra isn't on meds yet.

Good luck, and trust your instincts!

--Annie
(Tundra's Mom)

[molly muffin]

Hi Joann,

Sleeping on floors, looking for cooler spots to lay on, is one of the signs of the cortisol being too high. It makes them feel warm and want to cool down.
Yes, there are pups here who have done 20mg Am and 10mg pm, or more likely if that doesn't work would be to go up to 20/20 even. Since you actually went down when you moved to the am/pm dosing, it is completely possible that this would need to be an adjustment. The thing is that the cortisol wasn't controlled enough all day with just the morning dosage, so that is why you are moving to the twice a day. It happens in some pups that they need all day control. Others don't. Daisy though seems to be having symptoms during the night, which is why the double dosing. As always with a change in dose, you watch them closely to see how they are reacting to it.

Sharlene and Molly Muffin

[JoannH]

Should we wait to change the dose until after the ACTH test in two weeks or change the dose based on the symptoms returning? It seems that it may be obvious that her dose needs to be adjusted. The test might just be flushing money away if we already know what the results will say.

Would 15/15 dosing be better than 20/10?

Like I said, I need as much info as possible to inform my vet.

Thanks for your help.

[lulusmom]

I personally would prefer 15 and 15. One of my dogs was on that BID dosing for two years and did great.

[JoannH]

I think I"m going to explode. I called the vet in the morning. He never got back to me. Then I just called him and I guess the reason he never called back was because he "had nothing to add." Huh? I told him that she was very agitated at night and sleeping on the floor. I told her there was an obvious difference between when she was on 30 mg once a day and now 10 mg twice a day. My question was simple...should we keep her on 10 mg twice a day for a while longer or not. She's been on that dose since Friday. His response..."I don't know what to tell you." His "I don't knows" have me angry and confused. Um...isn't it his job to know?

Lulusmom, you mentioned that "the manufacturer actually recommends that you bump up the once daily dose and split it half. In other words you would increase the once daily dose of 30mg to 40mg and give 20mg in the morning and 20mg in the evening. " Is there any documentation of this? The vet told me the opposite. He said the manufacturer and endocrinologists say that you should decrease the total daily dose. I know some studies say to decrease the total dosage.

I'm so confused. "I don't know" is not an acceptable answer. He's leaving it up to me to make these decisions then says I shouldn't rely on what you guys say...but you're all I have at this point! Now he's saying maybe I should go to 15 twice a day. Has she been on 10 mg twice a day long enough to know if it will work?

I need help. I don't want to do anything to hurt Daisy. I don't know any vets that would know in the area.

[labblab]

Joann, here's the excerpt from Dechra's U.S. Product Insert that contains the dosing recommendations to which Glynda was referring:


Once daily administration is recommended. However, if clinical signs are not controlled for the full day, twice daily dosing may be needed. To switch from once daily to twice daily dosing, increase the total daily dose by 1/3 to 1/2 and divide the total amount into two doses given 12 hours apart.

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

So based on Dechra's recommendation, it should be safe to go ahead and switch to 20 mg. twice daily if you have enough capsules on hand to do that. As I pointed out earlier and as you already know, there is not total agreement among researchers/clinicians as to the desirability of increasing the total dose. But Dechra gives it the "go-ahead," and since Daisy's last post-ACTH result on 30 mg. was up around 8, she has some breathing room before falling too low on her cortisol level. If you feel that you are already seeing a rebound in her symptoms, then I'd think you could go ahead and try the increase and see how she responds.

Marianne

[JoannH]

Ok, just got off the phone with Dechra. I spoke with Dr. Fertig. He said keep an eye on the appetite (which has slightly increased in the past few days) and her behavior and to keep her on the same dose for a few more weeks until her ACTH test to see what the results are.

He told me to have the vet call him with the results and talk to them. I do feel a bit more at ease that someone who actually knows the drug is helping now. He had me give him a rundown of her medical history so he had a good picture of Daisy before he offered any advice.

[labblab]

Joann, I'm glad that you had the chance to speak directly to the Dechra technical rep. Since you've now got the recommendation straight from the horse's mouth, so to speak, you can disregard what I wrote above. However, at least you now have the quote from Dechra's published literature for future reference.

Marianne

[JoannH]

Thanks Marianne,

I will write that down and have it available for reference. I just have to make it through the next two weeks. I have a feeling that the dose will be increased, but I'm going with what Dechra told me directly. I needed someone with some certainty in their voice to direct me. If my vet does not respond well to the Dechra vet, I may have to find yet another vet.

[JoannH]

Hmm just curious. I was reading earlier that some studies said to decrease the total daily dose? I'm perplexed.

And with the except from Dechra, why would the Dechra vet say to stay on 10mg twice a day when she was originally on 30 mg?

[labblab]

Hmm just curious. I was reading earlier that some studies said to decrease the total daily dose? I'm perplexed.

And with the except from Dechra, why would the Dechra vet say to stay on 10mg twice a day when she was originally on 30 mg?
Of course I can only speculate (and it will be a good question for you or your vet to ask Dr. Fertig when/if speaking to him again). But Dr. Fertig is making his recommendation in relation to Daisy based upon her specific history and symptom profile as you presented it to him. Also, we know that there are other aspects of Dechra's published literature that they are verbally updating in direct conversations and presentations to vets. That written info was compiled a couple of years ago when Vetoryl was first being considered for FDA approval. Since that time, additional research has accumulated which may be altering the verbal advice supplied by Dechra's current technical reps in relation to twice daily dosing. As I say, it will be a good question to ask Dr. Fertig in the future.

BTW, did you have a chance to ask his opinion re: converting the Vetoryl into a liquid suspension?

Marianne

[addy]

Hi Joanne,

Some studies have shown a dog may need a lower dose on twice a day than what the once a day dose was. Twice day dosing is still fairly new so there is some contradiction among endocrinologists and I would guess the Dechra doctor via phone, not seeing your dog in person, would rather take the conservative course.

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

[molly muffin]

Yay, glad you are getting some help from Dechra. I agree, when not seeing the dog in person, they can only go by what the owner reports, the medical history as given, and error on the side of caution. One can always go up, it is much harder if you over medicate, unless caught very early in the medicating procedure. I think it is probably the reason that so many here have had to make adjustments with dosage, because they don't want to take that risk of starting high. I agree completely with that, which my vet disagreed with and my IMS completely agreed with. So you can see that even within the Vet community there is not always agreement on how to treat.

Well, yea, my vet told me not to pay attention to online, internet "stuff" too. The way I see it though, is that if I had solely followed my vets advice, molly would have started on 30mg vetroyl, even as her LDDS was completely negative and we didn't have a firm diagnosis. Instead I insisted on the ultrasound and seeing a specialist. I don't regret that one bit.

Here what you have is a bunch of people, going through the same thing as you and Daisy, or already gone through, some for many years with a huge amount of experience dealing with the testing and numbers and vets and possibilities. Accumulative it is a HUGE network of knowledge that you have available to you. A Resource you might say. How can that be bad? You have various vets comments on treatments by reading the various threads, you can see what others have tried, what has worked, what you have to watch out for. I could go on and on, but you already know all of this.

The best thing, is that you have a support network. :)

hugs,
Sharlene

[JoannH]

I agree that this forum is awesome. It has a wealth of experience to offer and lots of love and support.

When my cat was diagnosed with diabetes years and years ago, the feline diabetes forum was a life saver. I learned so much and was able to test her myself...every day. The vet wanted me to go in once a week and charge me about 50 bucks. They also helped me when my cat finally passed away last year at the age of 16. It was a sad day. Her blood sugar dropped suddenly. :(

So I know I'm in the right place. I want what's best for Daisy. I would have never called Dechra and would be in tears right now if I didn't have you all!

[molly muffin]

Joann you are stronger than you know. :)

hugs,
Sharlene

[JoannH]

Daisy's ACTH results as of December 29, 2012: Pre 2.6 and Post 7. This is good right? She is now on 10 mg twice a day dosing.

[SoggyDoggy]

I'll let others comment on the results, they are a lot better at that than me, but I've been wondering how she is going with her insomnia and restlessness at night?

How does she seem overall? Are you still doing the melatonin and other bits or just the trilostane? Sorry for the questions, but I've actually been wondering for a while how she is going. :)

[Harley PoMMom]

Daisy's ACTH results as of December 29, 2012: Pre 2.6 and Post 7. This is good right? She is now on 10 mg twice a day dosing.

As long as her symptoms are controlled, those are great numbers! Good job!

[frijole]

I agree! So long as the symptoms are gone that is an acceptable score and you should celebrate. So tell us... how are the symptoms? :p Kim

[JoannH]

Thanks for the encouragement. Daisy is not taking melatonin. I helped a little, but I had a hunch the twice a day might be better. Her sleep is mostly good. She is now an early riser...but I think she wakes up early to eat the wet food I give her with her meds. She knows if she wake up about 5 am she'll get it; she's got me trained. Fortunately, when I can go back to bed (Saturdays) she falls to sleep too.
I'm a little concerned about her liver numbers. The vet isn't concerned about having her tested again. I'm thinking I should. it's been several months.

[molly muffin]

Yay, so glad you are finally getting to rest through the night. That is a big change!

I get nervous about the liver numbers too, so I completely understand. What I do is just get the ALT and ALP checked sometimes, to compare and see how they are. Are you also giving a liver supplement? I'm giving Heppato support supplements to molly.

hugs,
Sharlene and Molly Muffin

[JoannH]

Daisy gets Denamarin daily.

It's funny...whenever I tell someone that Daisy is sleeping through the night...the very next night she makes a liar out of me. Twice in the past week I told two different people that and then Daisy had me up between 2 and 3 am!

[JoannH]

Terrible insomnia the past few days. Calling Dechra.

[addy]

Hi Johann,

Let us know what Dechra says. I wonder if her cortisol is rising. I noticed you said you went to twice day dosing and don't give the melatonin any more. My Zoe sleeps much better with twice day dosing and her evening melatonin. It took awhile and we had some good nights and some early rising but she is now sleeping until 5 - 5:30 instead of getting up at about 4:30 and she is not restless during the night. I cant give it to her every night because it seems like it bothers her dry eye disease. Perhaps you can check with Dechra if it is okay to give to Daisy. Maybe the combo will bring you some relief (if her numbers are not rising). Last year, it took Zoe forever to adjust to going back to standard time when the clocks changed in November. This year was not as bad. So hang in there.
I know no sleep is no fun:(:(

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

[JoannH]

How much melatonin are you giving Zoe? I might have to try that again.

[addy]

Zoe is 17 pounds and I give her 3mgs. She slept until 5:15 am this morning and hardly did any snoring as well last night. Any extra minutes of sleep we can get helps:):):):):):)

[JoannH]

Daisy only woke me up once last night 3:30 am. I couldn't get back to sleep, so I don't know if this would have continued. I'm waiting for a call back from Dechra.

[JoannH]

So bummed. I didn't get the same person at Dechra. I got a technician and she didn't help at all. She said talk to my vet...well that's the problem. I have no confidence in him. :(

She did said that insomnia is an unusual symptom. I was under the impression that it wasn't. She said that usually when dogs wake the owner up in the middle of the night it's to go out. But Daisy is just wide awake and doesn't usually need to go out.

[lulusmom]

Hi Joanne.

Does Daisy get any exercise like going for a walk regularly? If not, taking her for a walk in the late afternoon or evening might help her sleep through the night. I know that my dogs conk out a lot faster and stay asleep longer when they get exercise. We went for a really long walk yesterday and everybody was still sleeping hard at 5:30 this morning. They are usually waiting for breakfast by 5:00.

How old is Daisy and besides the Vetoryl, is she getting any other medication?

Glynda

[JoannH]

She hasn't been getting as much exercise lately. I have been working really late to make ends meet and pay her vet bills :)

I leave her with my brother when I'm at work, and he's had the flu. I think exercise is part of the problem, but even when she did get more exercise she still had insomnia. The problem with walking her is that she stops to sniff and pee on everything and if I try to keep her moving she does the stands with her front legs spread to keep from moving. She's so stubborn! :) I don't think her walks end up being much exercise.

She's 9 1/2 yrs old. No other medications.

Talked to the secretary of the one vet I am considering. She said the vet said that he does the low dex test for monitoring Vetoryl instead of the ACTH test because it's less expensive and does the same thing. Did anyone ever hear of this?

Daisy had her liver enzymes checked on 1/22/13. Her ALT 184 and ALP 804.

Her first liver enzymes 8/11/12 ALT 2326 and ALP 2024
She was started on Denamarin.
Next results 8/20/12 ALT 123 and ALP 645
Then 9/20/12 ALT 144 and ALP 593

Could her new numbers be from going to twice a day dosing? Are her new numbers dangerous? Is there anything else I can do? She's still taking Denamarin every day.

[JoannH]

Any input regarding my last post would be appreciated. I'm trying to figure out the liver thing especially. thanks!

[molly muffin]

Gosh I don't know how I missed your last post. I must have read it at work and not had time to respond at that point.
I haven't heard of monitoring vetroyl with LDDS test. I haven't read that in any of the protocols set out by either Dechra or the experts like, Dr. Peterson or Dr. Feldman. I would be a bit nervous about that. Maybe one of the others have heard of it.

Most cushings dogs have high ALP values and sometimes the ALT's come down in response to treatment, to at least a more acceptable level. Overall I don't think compared to where the liver values were at that there is a problem with the current numbers. They do bounce around a bit though and that seems to be the case here. Anyway, ALP I wouldn't worry about. ALT, do you know the range for that? The number is very good compared to 2326. I'd think that is good progress.

I take Molly out for her last walk around 10pm before going to bed. Not a long one usually as she isn't that interested late at night, unless it's summer and a bunch of us are going together. Then I give her a glucosomine treat and that is it, she is pretty much ready for bed after that. So, even if not a big walk, but a small one before bed time, might help.

Sharlene and Molly Muffin

[SoggyDoggy]

Hi Joanne,

If it helps, Livers can take months to repair themselves, and my vet said to me give it 3 months after stabilisation to run the tests again and see where we are. I would think that if Daisy's numbers have improved that much in such a short space of time, that she is going great guns! Keep it up and see how she goes, that is a significant improvement!

(I wish we could get denamarin here!)

[Harley PoMMom]

Talked to the secretary of the one vet I am considering. She said the vet said that he does the low dex test for monitoring Vetoryl instead of the ACTH test because it's less expensive and does the same thing. Did anyone ever hear of this?

I have never heard of a vet using the LDDS test to monitor a dog on medication for Cushing's. Only the ACTH test should be used. The ACTH stimulation test measures how well the adrenals are responding by testing the amount of cortisol the adrenals produce after being stimulated by synthetic form of ACTH.



Daisy had her liver enzymes checked on 1/22/13. Her ALT 184 and ALP 804.

Her first liver enzymes 8/11/12 ALT 2326 and ALP 2024
She was started on Denamarin.
Next results 8/20/12 ALT 123 and ALP 645
Then 9/20/12 ALT 144 and ALP 593

Could her new numbers be from going to twice a day dosing? Are her new numbers dangerous? Is there anything else I can do? She's still taking Denamarin every day.

I believe that is a significant drop in those liver enzyme values. It does take a while for a dog's liver enzyme values to normalize, and sometimes they never do.

You are doing a great job!

[Squirt's Mom]

Hi JoAnne,

Using the LDDS to monitor treatment would be a waste of your money and put Daisy under unnecessary stress for nothing. The LDDS cannot tell how much cortisol is being stored in the adrenals and that is what we want to know once treatment has started. The LDDS is a suppression test; the ACTH is a stimulation test. Not the same; will not provide the same information.

I just lost faith in your vet. ;)

Hugs,
Leslie and the gang

[JoannH]

Fortunately he's not my vet! I 've been shopping around for a new vet...this guy is now off the list!

[JoannH]

Quick question.

A while ago someone mentioned how you could save on the cost of the ACTH for small dogs by using less of the Cortrosyn. Can anyone refresh my memory so I can talk to my vet about this?

Also, what is your experience regarding the openness of vets to do this?

Thanks

[Squirt's Mom]

Here ya go, JoAnne -

How to Extend Your Supply of Cortrosyn and Lower the Cost of ACTH Stimulation Testing
http://endocrinevet.blogspot.com/2012/03/how-to-dilute-and-store-cortrosyn-for.html

[JoannH]

I just had Daisy in for an ACTH test. According to the vet her numbers were pre 2.5 and post 2.0. He said her numbers were good and that I wouldn't have to bring her in again for three to six months.

Problem is that Daisy has been panting more lately and her insomnia and restlessness at night is worse. She is also preferring to sleep on the floor more often.

I did not get to talk to the vet yet about this because he has been "too busy". I'm going to be saying adios to this vet soon. I have lost confidence and trust in him because at my last appt, even though I paid to have Daisy's ear examined, he at no time bothered to speak with me directly. Which is also why I did not have a chance to tell him about my concerns about the other symptoms.

Is it possible to have "good" numbers and poor symptom control?

[Budsters Mom]

I have had vet issues also. I know how disheartening that can be!:confused::( Buddy sleeps better if I try to keep him up a little later into the evening. That means entertaining him for a few hours, but that doesn't always work.

hugs to you and Daisy,

Kathy and Buddy:)

[molly muffin]

Are you still giving the melatonin in the evening?
How are her liver enzymes now since starting the deramarin?

It still sounds like the cortisol could be going up in the evening, but I wouldn't risk increasing her dosage.
It could also be a learned behavior in that she has been up at night for so long now that it is natural for her be up and about.

What about another call to Dechra? Normally you do see symptoms subside once cortisol is controlled.

hugs,
Sharlene and Molly Muffin

[addy]

I spent the day at a speciality clinic yesterday in a cardiology room waiting for tests with my Zoe. I happened to read through some of the literature since we were there forever and I read all the other magazines so needed something to do. Some of literature talked about heart issues and that some of the signs were restlessness at night, panting, insomnia, a lot of the same signs as Cushings.

I have not looked back through your thread but wondered if Daisy has had her blood pressure checked? Just a thought, I dont mean to scare you.

[JoannH]

I decided to switch vets yet again. I think I picked a good one finally. Lots of good recommendations. Daisy's first appt will be next Tuesday. I will discuss the possibility suggested that there might be something else going on in addition to the Cushings, just in case. I am much more at peace that this vet and the three others who work with her will be more thorough and have more concern. My other vet was way too casual. thanks so much for the encouragement.

[molly muffin]

Good luck. Glad you found a vet that you are comfortable with. We'll be anxiously awaiting an update after the visit with the new vet. Hopefully you'll be able to get to the bottom of the insomnia too.

hugs,
Sharlene and Molly Muffin

[addy]

I hope things go well with the new vet.

Will be waiting to hear how it went.

[JoannH]

Hi again.

Love my new vet. She really knows what she's doing and is humble enough to call Dechra when she has questions. One thing that came up was the protocol that my previous vets followed when doing the ACTH test. They waited 2 hours between blood draws instead of 1 hour. Would that make a difference? Also I had received no instruction on when to give the trilostane beforehand. I gave it about 4 hours before the first draw.

[molly muffin]

Hello, how lovely to hear from you again. :) How is the insomnia doing now? Hope it is better.

Giving the trilostane 4 hours before the test with a big of food is exactly right.

I think and one of the others will know exactly what the two are called, but there are two different types of agents that they might use for the ACTH test. With one of them it is 1 hour between draws and with the other one it is 2 hour between the draw.
So that is all perfectly acceptable.

That is wonderful that you have a vet who is good with calling Dechra. I like that in a vet. I hope we'll be hearing all kind of good news coming from you soon. :)
Hugs,
Sharlene and Molly Muffin

[JoannH]

Sharlene,

Insomnia is not better! Last night Daisy did something new. She woke me up at 2 am (not unusual), then at 3:30, so I took her outside...usually she comes back in and sleeps, but she woke me up again at 4 am. She then walked all over the bed and on top of me trying to wake me up and was whining.

[molly muffin]

Oh no. That actually seems to be getting worse then. Did the new vet have any theories about what is causing the insomnia?

Sharlene and Molly Muffin

[JoannH]

She thinks it's behavioral, but wants to do another ACTH test soon. No other vet has done any other bloodwork besides liver enzymes. She recommended a CBC panel in addition. She said the trilostane can affect other functions of the adrenals.

I'm wondering if maybe Daisy's stomach is bothering her or something. She hasn't vomited and her stool only looks funny when she eats grass.

[molly muffin]

Hmmm, like what other functions was she speaking of? The intermediary hormones? I have heard that those can be affected.
Some of the others here are more familiar with these than I am, so I'll let them comment.
I think there is a test that is sent to the UofT that does a full panel on all the hormones though.

Hang in there, it sounds like you have found a good vet that will work with you.

hugs,
Sharlene and Molly Muffin

[doxiesrock912]

If Daisy is eating grass, I would say that her stomach is bothering her. Hope that she feels better soon!

[lisamak]

We had insomnia from CDS for a few year's before our Cushing's dx. Here's some things we tried and if they pass/fail the Vince test:

melatonin - did nothing
bendadryl - did nothing
valium - did nothing (so I took it, just kidding...I considered it though)

FYI Vince has been on anipryl for the CDS and after about 9 months started to sleep through the night, but we still get periodic bouts of insomnia (and it all kicked up again heading towards the Cushing's dx).

Pet Naturals of VT/Vetriscience (same company) make a great soft chew treat called Calming Chews (Pet Naturals) or Composure (Vetriscience). The Composure has the same ingredients but stronger strength (I get them online at Entirelypets.com). We give them post-pee break and they help settle him down.

Thundershirt - this was kind of a last resort we started about a year ago for really bad nights. Vince seems to have some seasonal issues with insomnia so he started going back to sleep - for like 2 hours - then was up again (just restless, didn't need pee break). So we added the Thundershirt in. We get up, go for a break, get a soft chew and put the Thundershirt on. I was very surprised but he actually will usually fall over like a log and sleep through the night once the Thundershirt is on. Even now when we're adjusting meds for Cushing's and all that - it has definitely helped.

I hope this might give you some additional ideas - I'm too new here to chime in on much else you and your pup are dealing with - but insomnia, I know ;)

[Squirt's Mom]

ooooo, good ideas, Lisa! :cool: I've used the Composure with an uberhyper foster I had and they helped. He was still bonkers but not near as bad. :p And what a great alternate use for the Thundershirt! I bet the TTouch body wrap might work the same way. Cool! :cool:

[JoannH]

I will discuss the ideas with my vet. The insomnia is progressively getting worse. I am a teacher, so I leave my dog with my brother during the day. He's on disability, so he mostly sleeps all day, so I think Daisy does too. In a few weeks, maybe a better schedule for her will help too. I plan to call the vet tomorrow.
thanks.

[Squirt's Mom]

ah HA! That could be a big part of the problem right there - she sleeps most of the day and is full of energy at night. She may just have her nights and days mixed up. If your brother isn't able to give her exercise and stimulate her during the day maybe there is someone who could come take her for walks during the day or play with her a bit? Does he have a safe yard where she could spend a good part of the day outside, which would help stimulate her?

[JoannH]

I think it is a big part of the problem. I am fairly new to the area, so don't have anyone I really trust to take Daisy out. He has a yard and we put a fence up, but I honestly don't want her out there without supervision. I called the vet today. She suggested either Composure, Harmonease, or a diffuser (comfort zone/DAP). I'm going to try composure.

[JoannH]

Daisy was diagnosed with Cushings in Aug. 2012. She is on 10 mg Vetoryl twice a day. Her last ACTH was 2.7 post and her blood work was normal (her ALP is still a bit high). But her glucose was normal. This was on Oct. 13th.

Over the past two weeks or so she began drinking more water. Then I noticed her peeing much more. I took her in yesterday and her glucose was over 500. They have her on 4 units of insulin twice a day. When I left the vet, she was at 162. I have her home and am giving her the insulin myself. (my cat had diabetes, so I am comfortable with the injections.)

I was just fb messaged with a vet that I don't really know that well, but has a good rep with rescues and just graduated from U. Penn a few years back. She has me really worried that it could be very serious. I was feeling confident that everything would be good after I left the vet today, now I am very anxious.

I have no reason to doubt Daisy's vet. But this other person says I should go to an internal medicine specialist because Cushings is so complicated.

can someone help me sort this out a bit? Does anyone have experience with Cushings and diabetes?. Is it odd that the diabetes/high glucose came on so suddenly?

[Roxee's Dad]

Hi and Welcome to you and Daisy,
We do have a few dealing with both Cushings and Diabetes. We also have a sister site that deals with K9diabetes. From what I have read over the years, getting cushings controlled also helps to get the diabetes better under control. I am sure our members that are dealing with both will stop by and share their knowledge and experience.

Can you tell us more about what led up to the cushings diagnosis, what diagnostic testing was performed. How much does Daisy weigh? I assume that since she is on 10 mg twice a day, she is about 10 to 15 pounds?

Hang in there, many more will be by to help you through this. By the way, if you haven't checked out our sister site for canine diabetes, here is the link. Wonderful people that will share their knowledge and experiences..

http://k9diabetes.com/

[JoannH]

Daisy was panting a lot in July 2012, then she went behind the couch, which she never does. I took her to the vet and they did blood work and her liver enzymes were over 2500. They then did the low dose dex test and diagnosed her with Cushings. She has had consistently good numbers for the ACTH tests since. Her last one in Oct. was 2.6 post and her bg level was normal when they did the CBC last month. I've been very careful to get both blood work and the ACTH done every 3 months.

Daisy weighs 15-16 pounds. I have her Vetoryl compounded at a pharmacy near the hospital and give her the 10 mg twice a day.

Her behavior is normal. I plan on getting a glucometer to monitor her at home. I'm trying to decide which one. I'm thinking the Alpha Trak even though it's super expensive just because with the Cushings I want the most accurate readings. What do you think?

I am in the diabetes forum too. They suggested posting here because of the cushings. I'm so overwhelmed because the two together seem so complicated.

[Roxee's Dad]

Yes, I am sure this is overwhelming. Hopefully our members that are dealing with both will stop by soon and share their thoughts. Hang in there, it's kind of slow on the weekends, but I am sure they will be by soon.

[frijole]

Hello. It is not uncommon for a dog to get both cushings and diabetes but it can be trying. You have to come to a balance and oftentimes a regular vet is over their head when trying to treat both. But not always! That is probably why that vet suggested contacting an IMS.

Right now the most important thing is regulating the diabetes. It can be difficult when cushings is not controlled. However your last acth test shows that the cushings is under control (low cortisol) so that is a very good thing!

The folks at k9diabetes.com are very helpful and that is where you should direct diabetes questions due to their experience.

Meanwhile hopefully those with diabetic/cush dogs will chime in and offer their thoughts.

I merged your two threads so your entire history is in one place. I am changing the thread title to reflect the diabetes so others will be more likely to read it. Kim

[JoannH]

Thank you for replying. The diabetes forum referred me back here. I'm getting as much info from both. I just want to know if there is something more I should be doing. Daisy will likely get another ACTH within the next couple of weeks although she's not due until January. I am super careful in monitoring her. I will keep you up to date. I appreciate the support.

It just seems crazy that her bg went so high so quickly, so I has hoping someone who has a dog with Cushings and diabetes can help me understand what went wrong.

[frijole]

I have 3 relatives whose dogs developed diabetes and in every case it was 'overnight'. I don't think it was anything you were doing. Daisy looks like she is a normal weight and had you not treated her cushings it might have caused the diabetes but you have treated it and her numbers look great. You should be proud!

In short some dogs and breeds are predisposed to getting diabetes. The key will be getting her regulated. I hope those that have done it can tell you what impact it might have on her dose of vetoryl. It seems to me some have had to tweak it a bit in order to keep everything in balance. But those people were trying to regulate both at the same time and you are already there with the cushings.

Hang in there and I'm sure both boards will be very helpful to you. Kim

[JoannH]

I have a question about the liver. Daisy has Cushings which initially caused her liver enzymes ALP and ALT increase. Her ALP has been remaining about 600-700 after it dropped from 2000+ when she was first diagnosed with Cushings in August 2012. Her ALT decreased to within the normal range after the Cushings became regulated. Daisy was diagnosed with diabetes on December 7th and had ketones in her urine. After she began getting insulin the ketones were negative. Her latest Cushings blood work and blood panel as of last Saturday show her ALT is elevated at 175 (up from 48 in October when she had her previous ACTH and blood panel). Could this elevation have occurred when her liver was metabolizing the fat when it produced the ketones? I'm thinking if it did then maybe the ALT will go back to normal levels. I know you probably can't say for sure but is it a possibility? She is taking Denamarin for her liver and will be seeing the internal medicine specialist on Wednesday.

[JoannH]

For anyone with a dog with both Cushings and diabetes. I am doing a 24 hour curve. Yesterday was an insane day. I spent the day with my mom in the ER (she's okay). I got home in time to test Daisy, feed her and give her her insulin. That was the beginning of the curve. I checked her every two hours through the night. Woke up at 6 am and went to feed her and realized that I missed last night's Vetoryl! Will that mess up the curve? Should I try to do another night? I know Daisy gets annoyed by the end of the 24 hour curves, so if you think that the curve will be typical with the missed dose of Vetoryl, I'd be relieved...and so will Daisy.

Thanks

[JoannH]

Daisy has both Cushings and diabetes. She is an 11 year old poodle mix, about 16 lbs. She is on 10 mg Vetoryl and 5.5 units of insulin. Her blood glucose level has been high lately, so we are adjusting the insulin. Her last stim test in late July was good.

We think Daisy has a touch of arthritis. She isn't enjoying her walks much. She had surgery when she was younger on a luxated patella. The vet suggested that maybe she needs a non-steroidal anti-inflammatory. What do you think? Would this affect her liver? Is there an alternative? She doesn't seem completely miserable, but she isn't doing steps much (her eyesight is also a bit of a factor although she doesn't have cataracts). Also, when I take her for walks I often have to carry her home because she doesn't want to walk anymore.

I want what is best for her. Please help with any suggestions. Thanks.

[lulusmom]

Hi Joann and welcome back.

In a few weeks, it will be two years that you joined us here so happy early anniversary! I have merged your most recent post with your original thread so that all of Daisy's history is in one place.

Do you have Daisy on any joint support such as chondroitin and glucosamine. If not, I would try that before any NSAIDs. Don't get me wrong because Metacam has made a world of difference for my old gal with spine problems but her pain was so bad nothing else was helping. I personally like a joint supplement called Cosequin and I was surprised to find that Walmart carries it. You might want to give that a try to see if it helps Daisy. You can also talk to your vet about adequan injections. Some folks have seen great results with adequan but others, not so much.

I'm so glad that you return from time to time to keep us posted on sweet Daisy. I'd love to hear a recap on what has happened since you were here last. When was her last stim test and please share the results if you have them.

Glynda

[JoannH]

Daisy has been doing well until recently. I took her to a specialist last winter, soon after her diagnosis. Her regular vet kept increasing her insulin which caused her blood glucose to rise because of rebound/Somogyi effect. So we settled on a lower dose of insulin of 5.5 units. Her stim tests were great and her diabetes was okay (not ideal, but good).

Well this summer, I moved and there was a lot of stress. I'm sure Daisy picked up on it. Her stim on July 29th was good. But her diabetes is no longer controlled. I'm waiting to hear from Dr. Rodriguez, her specialist. I don't want to just increase her insulin without his input.

And now she seems to have arthritis developing. I just heard from a friend who recently graduated from vet school. She recommends Zoom. It's a supplement. This is the ingredient list:
• Contains Rimoxen (Hops extract) COX-2 inhibitor (Read the Rimoxen Study)
• 99% pure Glucosamine HCL
• US sourced Chondroitin Sulfate
• US sourced MSM – a natural anti-inflammatory
• EPA and DHA – Cold water fish oil
• Complete multivitamin with each dose