Black Labrador Tara cushings and other issues

[thewickedpickett]

I would be grateful for any advice regarding my beloved 12/13 year old black lab Tara who has been having multiple problems for a while now.

Tara was on metacam and tramadol for joint issues and about 4 weeks ago she vomited a few times and had urinary accidents in the house and I took her to the vet. The vet suspected liver or kidney issues due to the metacam (NSAID) so ran bloods and undertook an ultrasound. The vet also noted that her urine was quite dilute. I should add this is a somewhat condensed version leading up to cushings diagnosis. Anyhow the ultrasound showed liver was slightly enlarged but nothing especially worrying. She had had an ultrasound several months previous and nothing had changed. Her ALKP was 620 and ALT 180. She then had a liver bile test which came back normal.

A few days later she vomited again but this time something was wrong. She became extremely lethargic and couldn't walk and was breathing rapidly. I rushed her to the emergency vet who admitted her to be stabilised. Whilst in hospital the vets ran chest X-rays and diagnosed pneumonia. They also ran another ultrasound specifically to check her adrenal glands but they could not find them on the scan. I was told this made cushings less likely. Incidentally they also found she has a partially collapsed larynx which will need repaired surgically hence the further investigation into adrenals etc.

Tara was put on a triple course of antibiotics (noroclav, antirobe, baytril) and sent home. Her chest cleared up quite well but before any larynx surgery the vet wanted to find out what was behind the dilute urine/incontinence. This led to the LDDS which she tested positive for cushings. The vet carried out the ACTH test today and I'm awaiting the result of it. Does anyone have an opinion on running these tests so soon after lung infection and concurrent antibiotic treatment?

As you can see there is quite a lot going on. I have several concerns over treating the cushings if diagnosed definitively. She has arthritis and skin issues. The heightened cortisol would seem to help with that as she is still mobile despite coming off metacam. Has anyone else treated a cushings dog who was also arthritis and atopic? Similarly her larynx needs fixed ASAP to help with breathing and prevent reoccurrence of aspiration pneumonia. What complications does surgery for a treated or non treated cushings dog bring?

Apologies for the questions but there is a minefield of information on the Internet and I'm struggling to process it all.

I should add Tara is drinking more but still under 2L a day and she weighs 25kg (weight loss of 1.5kg over last few months). The urinary accidents and dilute urine are the biggest symptoms indicating cushings. Her last liver enzymes were down slightly ALKP 420, ALT 148 presumably due to coming off the metacam.

Any opinions or advice would be gratefully received.

[molly muffin]

Hello Alan (?) I took the name from your other comment in our December thread.

Well, you have been through the wringer lately haven't you. So, first off, you aren't going to want to treat for cushings until the other issues are cleared up. Even the test results can be off due to other illnesses. Not to say that Tara doesn't have cushings, just that the tests might or might not be off due to the pneumonia. (how long ago was the pneumonia) Weird that they can't see the adrenal glands. Did they use a high resolution machine?
Her liver numbers aren't really all that high for a cushing dog, we see ALP's in the 1,000 and even over 2000 at times.
Is she still on antibiotics? Do they not want to the do the surgery for the larynx until after they sort out the cushings issue? Any kind of stress or illness can make the cortisol go up too.
Weight loss isn't the normal with cushings, weight Gain is, since they are usually ravenously hungry and thirsty.
Do you have copies of the test results that you can post? Just the abnormal tests high/low and range? Including the ACTH when you get those and the LDDS. That would help get us started on what could be going on with Tara.
I'll leave it to those with more knowledge to jump in with better details on starting treatment, testing during illness, etc.
I did want to say welcome. We all know scary and confusing the diagnosis of cushings can be. It is manageable with appropriate treatments and with an informed person on their side though and a normal life span can be lived out, as many of our members have had happen.

Sharlene and Molly Muffin

[thewickedpickett]

Thank you. I've been reading this forum for hours and it is a superb resource.

I will get the full results of all tests and post. The antibiotics have just finished today for the pneumonia which means 3 weeks since diagnosis. It was only a week or so before that it all started.

I too queried the ultrasound results regarding being unable to locate the adrenals but I'm told the vet is skilled at the scans. I live in Ireland but I believe the machine is high res yes.

They are reluctant to operate on her larynx until they get to the bottom of the urine and liver enzymes issue. I was however informed if it is cushings she can still have the larynx surgery presumably once the cushings is under control.

[frijole]

Hello from me as well! I'm going to come out and say I am not sure Tara has cushings. The first reason is because a dog with cushings over produces cortisol and therefore would probably not need the tramadol. :) They self medicate - that's a benefit to cushings.

Also the LDDS test is very very prone to false positives, particularly when other non adrenal issues are present - basically any time a dog's body is fighting an illness it creates cortisol as a natural response so the test can certainly be flawed. I had a dog that had many many false positives before I finally convinced the vet that he was wrong. (I had another dog that DID have it)

The same dog had an ultrasound where they could only view one adrenal gland and that was the one that had the adrenal tumor on it so I don't buy the fact that that means they don't have cushings. I am thinking it had more to do with either the equipment or the operator of it.

The vomit and weight loss also makes me concerned because neither of these are signs of cushings. Urination could be caused by diabetes or even hypothyroidism. I'd check those out.

Others will chime in but those are my initial thoughts. Glad you found us. Kim

[Harley PoMMom]

Hi and welcome to you and Tara,

Since Tara does have multiple health issues going on any tests for Cushing's should not be done. As Kim has mentioned, non-adrenal illnesses can create false positive results on all Cushing tests.

When a dog is vomiting the first thing that comes to my mind is pancreatitis. The only way to confirm pancreatitis is to perform a spec cPL test.

Adequan can be used for dogs that have arthritis, and I believe some members dogs have seen improvement with Adequan.

Please know we will help in any way we can so do not hesitate to ask any and all questions.

Love and hugs,
Lori

[GabbySue]

I'm going to say given the medications she is on I would suspect Kidney issues first thing, also the Metacam can cause vomiting as well as while Nsaids can also cause kidney failure. I had a dog that went into acute kidney failure after a quick surgery and one dose of Rimadyl(this same dog can can take Previcox with Pepcid with no issues)



There are many other drugs you can add to her regime to make her more comfortable. The first is Adequan injections , these can be given SubQ at home easily and a weekly course for 1-2 months then spread out to tolerance would be tremendously beneficial.
Also many dogs do better withe the Cox 2 inhibitor NSAIDS versus the regular ones, and with Labs this is more common that is the case, the can take Deramaxx,Previcox with less side effects than with Rimadyl and Metacam.

I have found that giving a stomach/GI protectant is imperitive with a dog on NSAIDS .

The current regime I have my Lab on that has one really,really badly degenerated hip, he is 12, is Adequan injection every 1-2 weeks,sometimes 2-3, he gets Tramadol 50mg every am,Neurontin (Gabapentin) 100mg every morning and Previcox 227mg 1/2 to 1 tab every am, with Pepcid (Famotidine) 10mg to protect his stomach. He also takes an Enzyme/Probiotic supplement to replenish anything lost, and at his age I find it's helped him.(He had vomiting and loss of appetite as well as tarry stools so I knew he had a GI bleed as well from the Metacam)


Firstly if she were mine I would get the GI issues under control first and get to root of the urinary issues before doing more work up for the Cushings.
My JRT that had Cushings but is now Addisons tore her Cruciate and while she is on a daily dose of prednisone she still needed Tramadol for quite a while after her tear as well as an NSAID, and at times still needs a dose if she over does it as she is too small for a repair.

Best of luck with Tara I hope you find out more answers quickly.

[thewickedpickett]

Thanks for the advice guys.

I'm told her kidneys are fine. What are the normal tests for kidney function?

One of the reasons I suspect cushings it that since coming off metacam she is still fairly mobile. When she has came off metacam in the past she has been very immobile.

At the moment the situation is the pneumonia and GI issues are gone. The symptoms at the minute which might indicate cushings are drinking a little more, excess dilute urine, accidents during the night.

If the ACTH test is positive as well is this enough to confirm cushings diagnosis?

[thewickedpickett]

ACTH test consistent with cushings as well. I have not got the actual results yet but will do shortly.

The vet is suggesting starting on a low dose of vetoryl but also suggested leaving treatment for a while if I wanted. The problem is Tara is up twice nightly now for urinating and whilst this is not a particularly serious clinical sign it is making home life difficult.

Do you think low dose vetoryl is the correct decision?

[frijole]

Please post the acth test results and also please advise what the vet means specifically by a 'low dose'. Oh and we'll need Tara's weight. We'll let you know if it is really a low dose. It is best to start at the low end and work up. But if she is vomiting I wouldn't start any treatment because vomit is a sign of overdose and would make monitoring very difficult. We need to find out why she's vomiting. Kim

[labblab]

Thanks for the advice guys.

I'm told her kidneys are fine. What are the normal tests for kidney function?

I "second" what Kim has said above. Also, in terms of kidney function, results you would be looking for include BUN and creatinine (CR) on blood tests, and the presence of red blood cells (hematuria) and/or protein (proteinuria) in the urinalysis.

Also, has a urine culture been performed on a sample so as to rule out the presence of a urinary tract infection? A UTI could be causing excessive thirst/urination.

Marianne

[thewickedpickett]

Collecting the ACTH and LDDS full results tomorrow.

Vet wants to start Tara on 60mg vetoryl a day. She weighs 25.1kg.

She has been tested for a UTI with negative results. Vomiting has also stopped for 3 weeks now since the pneumonia is gone.

Basically at the moment the only sign anything wrong is excess dilute urine and getting up twice a night to go. Also an occasional urinary accident in house especially during night if I don't hear her get up.

[labblab]

OK, Tara's weight converts to approx. 55 pounds for those of us in the U.S. So a starting dose of 60 mg. does equal the low end of Dechra's recommended initial dosing formula for Vetoryl. I, too, would have felt a lot more comfortable if her adrenal glands had been visualized and assessed on the ultrasound, and I will be very interested to see those test results. But if you do decide to proceed with the Vetoryl, at least this does seem to be a reasonable dose.

Marianne

[thewickedpickett]

I only received the ACTH results today. Getting the actual results is not easy it seems.. Anyway here they are below.

Cortisol pre acth 102.0 nmol/L reference range 25.0125.0

Cortisol post acth 742.0 nmol/L reference range 125.0520.0

[mytil]

Hi,

I have converted the nmol to ug/dl (take number and divide by 27.59). The results do show consistency with a diagnosis. When you get the chance, post the results of the LDDS test. It does seem some vets are reluctant or lax about giving actual results - do not know why.

Cortisol pre acth 102.0 nmol/L reference range 25.0125.0 (converted to ug/dl = 3.69)

Cortisol post acth 742.0 nmol/L reference range 125.0520.0 (converted to ug/dl = 26.89)

Terry

[thewickedpickett]

I'm starting Tara on 60mg vetoryl tomorrow. I have to take her in 10 days to get cortisol levels checked. On the morning of the test do I give the vetoryl as normal or is it fasted test etc?

[labblab]

Vetoryl should be given along with breakfast on the morning of the testing. In order to be metabolized properly and thus to provide accurate test results, the drug needs to be given along with food. Good luck with the dosing, and we'll be anxious for updates all along the way!

Marianne

[thewickedpickett]

Thank you. I just pray her arthritis doesn't come back with a vengeance. She already gets acupuncture and lazer therapy. Not sure if that will compensate for lower cortisol levels. If it does not then i don't think vetoryl is the way to go. The problem then is how best to manage the incontinence issues brought about by drinking more. Ill know more soon I guess.

[molly muffin]

We'll be crossing our fingers for you and hoping that this is the answer for Tara. Just do the normal watch for any kind of lethargic reaction, vomiting, diarrhea, etc. Anything out of the normal.

Good luck, we'll be anxiously awaiting updates!

Sharlene and Molly Muffin

[molly muffin]

Merry Christmas and Happy Holidays to you and Tara.
Day 1 of Vetroyl. Hope everything is going well.
Have a safe and wonderful holiday.

hugs,
Sharlene and Molly Muffin

[thewickedpickett]

Same to you and everyone else, thanks for the support. Reading the numerous stories on here really helps.

Day 2 and nothing much to report. Tara is perhaps drinking slightly less but urine is still dilute and plentiful with the odd accident.

[thewickedpickett]

5 days on vetoryl now and very little to report. She has all the same symptoms as before. If this dose (60mg) was going to work would I know by now?

[molly muffin]

You won't really know how the vetoryl is working until it's time for the ACTH test, which is about another 6 days. Then you'll see how those numbers are pre and post (the post is the one that you are going to really be looking at) and that will tell you if the cortisol is coming down or not. As the cortisol Does come down, then you should see some let up on the symptoms. Pay attention especially around day 10 for any reduction in symptoms. I don't know why I always think of day 10, just that seems to be a day that we often see some signs if the vetroyl is kicking in.
Often you won't actually look for a dosage change within the first 30 days unless there is really no drop at all, or even just very minimal. Some vets say that the cortisol won't continue to drop for 30 days, but based upon the results that we see on this board, where we are all cushings all the time, it can continue to drop and often does.
So, hang in there. You're doing A-okay.

Sharlene and Molly Muffin

[thewickedpickett]

Thanks I guess I can be heartened that she has tolerated this dose at least. She goes in on 3rd jan for the ACTH test again.

[thewickedpickett]

Day 14 of 60mg vetoryl. Tara has had her follow up ACTH test at day 10 and I'm waiting on the results.

No real positive change so far. Still drinking more and having accidents. Noticed she's not just as mobile as she was and is licking herself some more. Both signs that cortisol is lower I suppose.

[molly muffin]

When do you expect to get the results?
Could be that the cortisol has come down, but not enough yet. Will be interesting to see what the ACTH is.

Sharlene and Molly Muffin

[thewickedpickett]

Next few days. I forgot to ask the vet to send it next day delivery.

I'm worried bringing cortisol down more will further expose arthritis and skin issues. Guess we will see.

[thewickedpickett]

Tara's ACTH test came back at 217 nmol/L and the vet is pleased with that. That is down from 742 nmol/L. Vet wants to leave her on this dose and do the test again in 4 weeks.

[addy]

Hi,

I am not certain about converting nmol to ug/dl. I thought it was divide by 27.59. Hopefully someone will come around and confirm how to change the units. I think Tara is under 9ug/dl and so waiting another 4 weeks would make sense as the cortisol can still drop.

Lets see what our math experts say :)

[labblab]

Addy, you are exactly right about the conversion, and so I think Tara's actual post-ACTH result is approx. 7.8. And since the ACTH was performed at the 10-day mark, I totally agree as to leaving the dosage unchanged for the time being. However, if you don't begin to see any improvement whatsoever in the thirst and urination and those symptoms are bothersome to you and Tara, I don't know that I'd wait for another whole month from today to retest. That would put her six weeks out from the start of treatment. And per Dechra, you can start to think about dosage changes after the first 30 days.

However, I realize that you are walking a fine line as far as not wanting to lower her cortisol too far. So I guess my point is just that, if you're not seeing any improvement at all in her Cushing's symptoms, I don't think you'd be amiss if you move up the recheck a bit earlier than a whole month from now. For instance, depending upon where her cortisol level and symptoms are at that point, you might want to consider trying a shift to twice-daily dosing in order to see whether that helps with things.

Marianne

[thewickedpickett]

Thanks guys. Perhaps it is misplaced but it seems that she's drinking a little less and isn't doing big floods of urine any more. I'll maybe give it another week and if there really hasn't been any improvement I will opt for an earlier test. The other signs (stiffer, itchier) would indicate cortisol is lower but as you say it really is a tightrope hoping it does not have to go any lower. The vet suggests the urinary/drinking problems can take a little longer to settle?

Off to the acupuncture vet today. This will be the first session of it with cortisol tested lower. It'll be interesting to see how it helps her joints now.

[addy]

Just popped back in to say I juggle alot of health issues with my Zoe. I did not see a difference in water intake until we went to twice day dosing.

I hope acupuncture goes well today.:):):)

[thewickedpickett]

Thanks. Was this even with cortisol lowered on single dose?

[addy]

Yes, I had Zoe on a single dose with her numbers finally under 5 than about 5, no change. I switched to twice day dosing, her numbers were even higher 6-10ug/dl (she bounces around alot) but her symptoms got better (except for her hair:( but Dechra said I have to have her under 5 ug/dl for that to improve but that is hard to manage). So that was totally weird, numbers got higher but symptoms improved. You just never know.:rolleyes:

All dogs are different. I just wanted to share.:):)

[molly muffin]

Good luck with the acupuncture today. If you aren't seeing as much improvement as you'd like schedule her for another test at 30 days from original dose and then adjust as needed.

Sharlene and Molly Muffin

[thewickedpickett]

Thanks folks. Always appreciated. I am so much better informed with the vets now it definitely helps focus the treatment.

Tara is definitely more mobile since acupuncture and laser today. I would definitely recommend it as an alternative to drugs or when drugs are not an option. Just had her on a short walk there and she was bounding along so that was great to see.

[thewickedpickett]

Tara seems to be drinking as much as ever. Maybe more.

She has not had any urinary accidents lately though and does not seem to be passing as much urine. Is this normal?

Edit: spoke too soon, still having accidents too

[molly muffin]

It's entirely possible that Tara isn't controlled at this dosage and may not get controlled. When you do the next ACTH test, you'll know if you need to up the dose, go to twice daily dosing or what based upon those results. Part of the results also is seeing a decrease in symptoms.
At day 14 (7.8ug) she is not controlled, but the possibility is that it could still go lower on the dose she is on and that until the next stim you really won't know if that is happening or not.

Sharlene and Molly Muffin

[thewickedpickett]

What is the ideal cortisol level? The vet seems to think her cortisol level is fine and symptoms will begin to disappear. If it comes back at 7.8 or so at next test and symptoms still are there I assume the answer is to up dose to lower cortisol more?

[addy]

< 1.45ug/dl Stop treatment. Re-start at a decreased dose
1.45 to 5.4 Continue on same dose
> 5.4 to 9.1 EITHER: Continue on current dose if clinical signs are well controlled
OR: Increase dose if clinical signs of hyperadrenocorticism are still evident*

> 9.1 Increase initial dose


Dechra guidelines for ACTH tests :):)

[thewickedpickett]

Thank you.

Tara still having accidents but has drank less these last few days.


The problem now is her joints. She is very stiff despite tramadol and acupuncture. Does anyone know if they bounce back a bit once their cortisol levels stabilise for a while? My wife is starting to question why we are treating the cushings given what it has unmasked. I'm not there yet but it is difficult to watch.

[mytil]

Cushing's affects the muscles and makes them weaker and it could be that your Tara is having some of these troubles because of this and over time the muscles will redevelop to support her joints better. I see she has been on meds for this for some time now - before Cushing's.

I will say that yes, lowering the cortisol can unmasked arthritic problems but IMO I think it is too early to tell between muscle wasting issues (that will be resolved over time) or severe arthritis or joint issues.

Terry

[thewickedpickett]

Thank you I think there is still a chance she will improve even with cortisol lower. I think another problem is that her larynx problem means she can't exercise much if at all for fear of the aspiration pneumonia returning. This must make her stiffer too.

[molly muffin]

I'm sure you are correct. It is hard to stay mobile when you can't exercise, so maybe that does make her feel stiffer. However, as Terry mentioned, there are two things to think of, muscle wasting from high cortisol vs arthritis. Depending on which is causing her mobility issues would depend on treatment options.
Was an xray ever done on her hips, joints, back to see? You might have already said and I missed it, if so I apologize. But if not, that might be worth doing so you'll know better about what to do and how to expect things to progress.

sharlene and molly muffin

[thewickedpickett]

An X-ray would be a good idea. The vet previously dismissed the idea as not that much use. But i guess now we are off all NSAIDs it would be worth doing.

[thewickedpickett]

Is it possible for a Cush dog to be drinking normally after treatment but still be incontinent at night? Tara has drank normally these past 2 days but is still having accidents at night. Do any Cush treated dogs still require normal incontinence treatments too? Or is this something that will take longer to respond to the trilostane?

[addy]

Is Tara leaking urine while sleeping? If so, it is possible she may need meds for incontinence. How many times do you take her out during the day?

[labblab]

It is possible that Tara's symptoms may end up being better-controlled with twice daily dosing. Trilostane has a relatively short active life in the body, and for some dogs, the therapeutic effects wear off without controlling symptoms for an entire 24-hour time period. Many dogs do fine with only once daily dosing, and since it is a simpler regimen for owners to follow, the manufacturer of brandname Vetoryl still recommends starting out that way. But in instances where symptoms rebound in the evening even though ACTH testing results are within the desired range, the recommendation is to give half the dose at twelve hour intervals.

So let's first see how those ACTH results turn out, and then we can go from there.

Marianne

P.S. I see that Addy and I were typing at the same time and yes, her point is a very valid one. Is Tara leaking while asleep, or is she waking up in the night and having accidents?

[thewickedpickett]

Thank you both

It is difficult to tell whether she's leaking while sleeping. I think it is a bit of both. She does get up and wakes me after doing it. But at the same time I don't think she knows when it's starting. She is on 2 tramadol at night so maybe she's just so relaxed it makes t worse. Deep sleep etc. she is already on propalin syrup but the vet doesn't seem to think that's the answer for her.

I am taking her to vets later for checkup and will mention twice daily dosing and also perhaps a sooner ACTH test. To complicate matters even further the vet is suggesting doing the laryngeal tie back operation soon as she's still having trouble with coughing and gagging and exercise.

[thewickedpickett]

The vet is not keen on twice daily trilostane since we are getting favourable ACTH results. She has agreed to do the latest ACTH test on Monday instead of waiting until the end of the month. Then if everything is the same as before she recommends fixing the larynx.

As far as the cushings goes it seems my vet only looks at the ACTH results rather than any symptoms. If Tara is going to Remain incontinent on the cushings meds then I don't really see the point of treating it.

[labblab]

Hmmm...perhaps your vet could benefit from a look-see at Dechra's product insert for Vetoryl:


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

This is exactly the situation in which Dechra would recommend trying a shift to twice-daily dosing: when the ACTH result is within the desired therapeutic range on the once daily dose, but symptoms are not adequately controlled throughout an entire 24-hour time period.

Is there some way in which you might tactfully offer a copy of Dechra's recommendations to your vet? :rolleyes:

Marianne

[addy]

You know, I went through that with my IMS even though she was for it before she was against it.;) I gave in to her and wished I had not the first few times and then finally I politely told her I preferred switching to twice day dosing and why, backed up my statements with written facts and asked her has she ever used twice day dosing? At that point, I got my way. Sometimes it is a matter of being politely firm but not sure of you relationship with your vet.;)

If it is something you really feel strongly about trying, tell him exactly what you just said here about the incontinence:)

[thewickedpickett]

Thanks guys I will try but the vet politely suggested that trilostane is a harsh med and she wouldn't be keen on twice daily dosing Tara with those ACTH results in case we send cortisol too far down. She indicated that she would worry about Tara's liver etc on more of a dose. She's having accidents during the evening too when perfectly alert so there is no way it's incontinence when relaxed at night. It must be the cushings.

I don't know. I do believe the symptoms should be controlled or there is no point treating given Tara's age. At the same time is it possible the vet knows Tara wouldn't tolerate a higher dose?

I don't think I would have a problem if I was firm with vet. She knows I do a great deal of reading on Tara's problems and has discreetly U turned on other issues. It's just this one the good ACTH results and reported harshness of the drug holds me back.

[labblab]

Just want to make sure that you realize that when we are talking about twice daily dosing, we are not suggesting that you would double the amount you are currently giving once daily. It's the reverse -- you'd give half the current amount (or only a small increment more) morning and evening when making the switch. Dechra says to make a small increase in the overall daily total, but recent research out of UC Davis suggests that dogs may end up satisfactorily maintained on smaller overall doses (with fewer side effects) when the medication is given twice daily:

http://www.k9cushings.com/forum/showthread.php?t=4442

If I'm not mistaken, Tara is currently getting 60 mg. once daily. Since Vetoryl also comes in 30 mg. capsules, depending on next week's ACTH result, that may be a reasonable place to start (30 mg. twice daily) if your vet does end up thinking a switch would be worth trying.

Marianne

[molly muffin]

Oh yea, if your vet thought that twice daily dosing meant giving her 60mg twice a day, that would be definitely be alarming. Marianne explained it well though, it's splitting the dosage between morning and night. Not doubling it.

Sharlene and Molly Muffin

[thewickedpickett]

Thanks guys. I read the guidelines about splitting it. I'm not sure what vet thought but ill discuss it all with her post ACTH next week. It seems very clear to me that the trilostane wears off as day goes on.

30mg twice a day sounds fine. I can't think why that would be any more severe than get current daily dose.


So can I say to vet that it is reasonable to assume splitting the dose will result in similar ACTH results as we are currently getting with 60mg daily?

[lulusmom]

Is it possible for a Cush dog to be drinking normally after treatment but still be incontinent at night? Tara has drank normally these past 2 days but is still having accidents at night. Do any Cush treated dogs still require normal incontinence treatments too? Or is this something that will take longer to respond to the trilostane?

If Tara is drinking normally, then I would tend to agree with Addy that perhaps her nighttime leakage is an incontinence problem rather than cushing's related. Is the leaking during sleep Tara's only remaining symptom? If so, then I understand your vet's lack of interest in prescribing twice daily dosing. It is true that the excessive drinking and peeing don't always resolve right away for a dog who has been drinking and peeing buckets for a very long time. This is called medullary washout and sometimes it takes a few weeks or longer for the kidneys to regain their ability to concentrate the urine. It is known that some dogs being treated with Vetoryl never see improvements in the excessiving drinking and peeing. If Tara were mine, I'd probably wait until the 30 day mark to see where cortisol levels are and if it is still 7.8 ug/dl or below, I'd check the USG and maybe even take a urine specimen in for a urine cortisol creatinine ratio. If Tara's once daily dosing isn't providing enough control throughout the night, the UC:CR will be abnormally high.

Glynda

[thewickedpickett]

Hi Glynda I don't think it is as simple as leaking during sleep. She has had numerous accidents lately whilst perfectly alert. Recently she has been holding on all day when im at work but late evenings having accidents. Her drinking is reduced but she still can drink quite a bit at one go. I think during day with Vetoryl working she drinks less. It is hard to judge her drinking as its never been above 2L anyway. I think an extra few hundred millilitres is enough to cause accidents.

[labblab]

So can I say to vet that it is reasonable to assume splitting the dose will result in similar ACTH results as we are currently getting with 60mg daily?
Unfortunately, there's no way to know for certain how any particular dosing regimen is going to work until you try it. Per the UC Davis research, it might turn out that Tara could end up with an overall dosing decrease after having been shifted to a twice-daily regimen. But from what I've read, I shouldn't think you'd expect a major crash if you split her current daily dose in half. The timing and protocol for ACTH testing remains just the same. So you would continue to monitor and test Tara just as you have done thus far and make any necessary dosing adjustments along the way.

I am saying all this prefaced on the assumption that her ACTH results next week are neither shockingly high nor low. If either extreme is the case, then your vet may rightly wish to alter the once daily dose for the time being. And for that matter, until Tara's post-ACTH result is below 5.4, there could be justification for remaining on the once daily dose but with an increase. That would be another way to approach her evening symptom rebound -- wanting to see whether those issues will subside once her cortisol is truly down within the ideal therapeutic range on a once daily dose. So I do think you will gain more helpful info from next week's testing.

I must add that, from a financial standpoint, it will be more expensive for you to shift to the twice daily regimen. Two boxes of 30 mg. capsules will cost more than one box of 60 mg. capsules. So that is also a factor for you to take into consideration. But if you can handle the expense, and next week's ACTH results don't discourage it, my thought is that you could consider giving the twice daily dosing a trial run. If it were me, I'd print out that UC Davis article and take it in with me to the vet so as to be able to engage in an open discussion of the pros-and-cons. You can say with honesty that you're aware that there is ongoing research re: advantages to twice daily dosing, and you are still wondering about it as an option for Tara.

Marianne

[thewickedpickett]

Thank you all. I am much clearer now on where we stand. I will sit tight until results of new ACTH test. I have to say if trilostane only lasts a number of hours shouldn't they ACTH test later in the day too so gauge when/if the trilostane is wearing off. That way we would know better whether extra dose is needed. Seems to me testing trilostane when it's meant to be working is only half the story. Perhaps I'm looking at it wrongly.

I appreciate the advise regarding cost but probably the only good thing to come out of this diagnosis is that we can no longer medicate joints and skin thus the pet insurance excesses are kept down. I'm not sure how it works in USA but I pay a monthly fee for Tara then an excess for every condition and 20% of all treatment now she's older.

[labblab]

Thank you all. I am much clearer now on where we stand. I will sit tight until results of new ACTH test. I have to say if trilostane only lasts a number of hours shouldn't they ACTH test later in the day too so gauge when/if the trilostane is wearing off. That way we would know better whether extra dose is needed. Seems to me testing trilostane when it's meant to be working is only half the story. Perhaps I'm looking at it wrongly.

That is an excellent observation and an excellent question. Ideally, you WOULD want to know the cortisol level both at the peak and the trough of the trilostane dose. The problem is that ACTH testing is so darn expensive and the timing often inconvenient for most people. It's hard enough to get your dog in to the vet for testing within that 4 -6 hour time frame after the morning dose. Most vet practices would not be open in the evening to perform an ACTH test at the time that the drug would likely be waning.

From a safety standpoint, knowledge of cortisol at its lowest point is of paramount importance. The greatest acute danger to a dog is the potential of a cortisol crash. So performing the ACTH test at the time of maximum drug effectiveness is a necessity. Performing a second test to measure the drug's waning effect is more of a luxury, if you will. The information would be great to have, but not as critical to the dog's safety.

Having said that, when I treated my Cushpup with trilostane back in 2004, I believe the makers of Vetoryl ("Arnolds" at that time) did actually suggest performing an ancillary ACTH at the 23-hour mark if a dog was experiencing symptom rebound. But I don't know anybody who actually followed through. With that same goal in mind, the researchers at UC Davis had historically suggested that owners collect a urine sample first thing in the morning (prior to dosing) so that a UC:CR analysis could be performed to aid in deciding whether cortisol was rebounding to the extent that twice daily dosing would be helpful. However, per the most recent related research study out of Davis, they no longer feel that the urine tests are as useful as hoped in making dosing decisions:


Neither the UCCR nor urine specific gravity was as reliable as the ACTH stimulation test results in helping determine whether a dose or frequency of administration should be changed.

So there you have it. If you can afford to have a "second" ACTH test performed and a vet who can schedule it, I think it would be great information to obtain. But for most people, I think observations re: outward symptom rebound may remain the most common trigger for increasing dosing frequency.

Marianne

[thewickedpickett]

Tara has had her latest ACTH test today. Results on Wednesday (I remembered to ask for next day postage this time).

Tara is drinking less most of the time now and has not had any urinary accidents in several days. Although she continues to pee quite frequently. We started a new incontinence med recently too so there is still a chance that's what has stopped the accidents. I've noticed she seems very content at the moment which can only be a good thing. She almost seems a little crazed when cortisol is raging.

I did notice she drank quite a lot upon returning from the test. Is this anything to do with the test itself? The stress of being at the vet for several hours presumably raises cortisol too?

[molly muffin]

Yes, that could be a reaction to the test and going to the vets. I wouldn't worry about that. We've had reports from others of different behavior after the ACTH test, usually it goes away pretty quickly.

Crossing fingers for good results. :)

Sharlene and Molly Muffin

[addy]

They can overheat and need water or just get stressed. Zoe used to drink a huge amount when we got home or would stick her tongue out in the car on the ride home like she was so thirsty she could not stand it. Now I always take a bottle of water with me and offer her water during the test. They said she could have water. Then she is not so thirsty when we get home.

Hoping for good numbers. We sure have had a lot of stims this month

[Squirt's Mom]

That's not an uncommon reaction. The ACTH just dumped a load of cortisol from the adrenals into the body so seeing things like increased thirst, urination and restlessness are common after the stim. ;) Good job observing, Mom!

[thewickedpickett]

Test results not back until tomorrow now. I'd rather the results were instant :)

Tara had first pee accident in a week tonight and she has only drank 400ml today. Admittedly she drank most of this in one go when I got home from work. Will be interesting to see these results tomorrow.

She still seems to pass a lot of urine despite not drinking much.

[thewickedpickett]

Latest ACTH results 185 so 6.7 in the format we use on here. It was 217 last time.

Waiting on the vet calling me regarding proceeding with larynx surgery.

Can I still expect improvement in any remaining symptoms ?

Also is there still a case for dosing 30mg twice daily? I do notice she rebounds in evening and through the night though symptoms have been minimal lately.

[molly muffin]

That is good. That is the POST stim number correct?

It can continue to drop for awhile at the same dosage. If symptoms are controlled then you're doing pretty good. If you continue to notice more symptoms occurring in the evenings, then you an look at going to dosage of twice a day. It depends on how you think she does throughout the day.

Sharlene and Molly muffin

[thewickedpickett]

Post stim number yes. I discussed twice daily dosing with vet. She suggested an ACTH test later in day to see how much the cortisol is rebounding. She has concerns that halfing the trilostane each dose might not work as well and raise the cortisol but she is open to the suggestion. She is against any increase at all in doses if we were to go twice daily. Seems to think Tara is borderline for arthritis and skin returning with a real vengeance.

As things stand Tara is having her laryngeal tie back operation on Tuesday to help with he breathing and coughing. Have any Cush pups on here had this done?

Forgot to add her liver enzymes have come down to Within acceptable levels too.

[thewickedpickett]

starting to get rebound of the icontinence in the middle of the night. Vet has suggested doing an ACTH test in the evening to see how much the cortisol is rebounding. If we did go twice daily do we know how much less effective 30mg will be in the morning as opposed to the current 60mg?

Also would there be any logic in keeping 60mg in morning but adding a 10mg at bedtime?

Also is larger amounts of urine to be expected even with a treated Cush pup? I notice she still produces a lot of urine even during the day when cortisol is lower.

Finally Tara is just over 30 days on 60mg vetoryl now. Is it still possible that remaining symptoms will go away if we don't change anything?

Sorry for all the questions but It just seems that we are so close to controlling it.

[SoggyDoggy]

Hi, from what I've read here, the cortisol levels can definitely continue to drop even past the 30 day period, so yes there is a chance that it could still get lower, it just wont be as severe a drop as what occurs in that first treatment span.

As for the 2x a day dosing, it's not that cutting it in half decreases the efficacy of that morning dose, so much as it evens the system out. Rather than getting a huge dose in the morning which lasts 8-12 hours, you give a smaller dose which lasts the same time, and then another smaller dose again. The effect of this is, basically, with the big dose, there is no/little cortisol produced during the big dose period, but when it runs out 8-21 hours later, the body produces considerably more as it is now not being told not to. With the smaller dose however, the body will produces a moderate amount after the morning dose, but then before getting a chance to produce big amounts after it runs out, another dose is given so that only moderate amounts continue. The final effect is similar, but the production is more consistent throughout the day and you don't get the highs and lows. At least this is how I understand it (and my boy is on 2x a day - just FYI)

There are also some studies out there that suggest 2x a day dosing can require less of an overall dose than just once - however as all dogs react differently, the only way to find that out is to test it. As for adding 10mg at night, you will effectively be increasing Tara's dose to 70mg daily, just keep that in mind. If your vet has concerns about the 2x daily dose, there is a study done recently about the effectiveness of it. he full article is posted here if you want to have a read, and maybe even give it to your vet to look at. http://www.k9cushings.com/forum/showthread.php?t=4442


If your vet is wondering about a later ACTH to see how much rebounds, what about even a baseline reading, one at the same time as a normal ACTH, then one later in the day? Surely the point would be to see how much cortisol is floating in Tara's system, not necessarily how much she is storing later on? Not sure, I haven't come across this one yet - it is still early days for me. Could be a cheaper option, especially if done when an ACTH is required anyway.

As for the extra urine, it could be that Tara's cortisol needs to drop a bit lower still too, which would support the night time accidents. 6.7 is a good number if all symptoms are controlled, however below 5.5 (I think) seems to be the preferred. Does she demonstrate any other symptoms still?

I'm sure others will help with some advice too, I'm still in very early learning stages myself. Good luck though.

[addy]

There is some thought that it may be better to bring the post stim number under 5 ug/dl and see if that controls symptoms before switching to twice day dosing. Twice day dosing is still a debate with some of the vets although some of the top endocrinologists do think it makes more sense to have a more even control thought the day and night and often there are less side effects and a lesser overall dose can be used. Some vets hesitate because they think "owner compliance" will be a problem and the dog wont get the second dose properly.
We switched to BID and I am glad we did although I did have to push to do it.

Tara could still drop lower so maybe your vet wants to give it a bit more time? If you are giving 30 mgs at night, hopefully that would prevent the cortisol from rising as high so that the 30mgs in the am would be enough to control it.


Oh , have to run, Zoe is up wanting breakfast;):)

Are the skin issues from allergies?

[thewickedpickett]

The skin issue has been there her whole life. We've never got to the bottom of it. All allergy testing came back negative. It is under control at the minute though even with trilostane.

Thanks for the replies. The only symptom still remaining is incontinence every so often but always in evening or night.

I think I'm going to get this larynx op over her then push for trying twice daily dosing.

[thewickedpickett]

Tara very restless last night so I've delayed the trilostane dose until 11am which is 4 hours later than normal. It'll be interesting to see if this helps during the night in which case I can put a better case forward for twice daily dosing.

Tara also had fecal incontinence this morning in the house. Is this anything to do with cushings? Presumably not. She may just have a Bad tummy after all the antibiotics for her chest/throat.

[Squirt's Mom]

By fecal incontinence, do you mean just an accident or was it diarrhea? If diarrhea, do you see any signs of a drop in appetite or seeming more lethargic or any nausea? If you have seen any of these signs, hold off on the Trilo today. It is pretty much a hard fast rule that we never give these drugs to a sick pup and the good thing about Trilo is that it can easily be stopped and restarted without losing much ground. ;)

Hugs,
Leslie and the gang

[thewickedpickett]

Just an accident although they've been a little loose lately. She's been on antibiotics for over a month now to keep chest at bay until its fixed. Hopefully just that.

She's eating plenty and appears fine.

She's due to go in on Tuesday for this larynx op

[Squirt's Mom]

Yeah, that could easily be the ABs. They can be unkind to the digestive tract! ;) I hope the larynx surgery is a success and gives Tara some relief. A pup of someone I know had this done last year and her baby, a senior, is back to running and swimming and having a blast! I pray the same will be true for your sweet girl!

Hugs,
Leslie and the gang

[thewickedpickett]

Tara has come through her larynx tie back surgery fine. All being well I will get her home tomorrow.

Interestingly when discussing the rebounding of cushings symptoms at night Tara's vet suggested twice daily 30mg dosing! After ruling it out she then offers it as her own suggestion! I'm glad anyway and she is starting the new routine tomorrow so fingers crossed for good recovery and reaction to new dosing regime.

[Squirt's Mom]

YAY! Tara! So glad this is behind her and hope the recovery is swift and uneventful!

Hugs,
Leslie and the gang

[molly muffin]

Yay!!! So glad to hear Tara came through with flying colors and hopefully will be home soon.
Oh what a hoot about the 30/30 LOL

Sharlene and Molly Muffin

[addy]

Great news and I am glad your vet is now for it after being against it, :D twice day dosing, I mean:D:D:D:D:D:D

Snuggles with Tara!!!!!!!

[SoggyDoggy]

I'm guessing she went and did some research after your suggestion. How funny! But excellent result and so glad to hear Tara came through surgery fine. What a relief! And Well Done Mum, you got through it too! :D

[thewickedpickett]

Tara recovering well from the larynx op.

She is now on 30mg trilostane twice a day. She is drinking less and has not had any accidents lately. The only potential symptom I am seeing now is restlessness during the night especially nearer getting up time seemingly for food. This is not a symptom i noticed before though. Is it possible twice a day trilostane has exposed this new (for tara) symptom?

[Trish]

Glad to hear she is recovering well from the op!! That must be a relief for you.

Looks like she has only been on the twice daily dose a couple of days?? Hopefully it will settle down more once she is used to the dose after a bit more time on it :):) I hope so anyway!

[Squirt's Mom]

YAY! Glad to hear Tara is doing well after the surgery! I hope the trend continues and she is in full form very soon.

I would give her a bit longer to recover and to let her adjust to the twice a day dosing then start worrying if the early rising and restlessness continues. My first thought on the early rising was how my bunch acts in the mornings...which is to start getting me ready to get up about an hour before I am ready to do so. Squirt has taught them all that if they don't provide reminders, I am apt to forget to feed them altogether. :rolleyes:

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

[thewickedpickett]

Thank you. She seems to be in good form.

I've read success stories on here for melatonin. I can't buy it in the uk but can on eBay USA. Do I just buy human melatonin 3mg or so? Does it interact with any medications?

[addy]

I grilled our pet pharmacist on that. It is okay to give with Trilolstane, metronidazole and Tramadol as long as it is a few hours before or after the Tramadol. Other than that, I am not sure. You dont want to buy any time release capsuls, just plain melatonin. I use Nature's Bounty which is a human melatonin.

But also give the twice day dosing some time and since Tara just had surgery, I would wait a bit or discuss it with your vet if you can. That is me being super cautious, just my nature;)

[SoggyDoggy]

Also do a little bit of research on the import laws before spending the money. If you can't buy it in the UK, are you actually allowed to import it? Would be a shame to purchase it and have it nabbed by customs is all. It happened to my sister with some herbal things she bought online. Contained something prohibited here and customs seized it. :rolleyes:

[molly muffin]

Very good to hear that Tara is recovering well from her surgery and that the twice a day dosing is working as far as accidents go.
I really do think it requires some time, recovery from surgery, dosing twice a day, etc before you decide if Tara is going to need to something for night time restlessness. Maybe another week or so, then speak with your vet.
Melatonin has helped some just like it does humans. Sort of calms them down and is natural not chemical agent.

Sounds like you are doing pretty well. :)

Sharlene and Molly Muffin

[thewickedpickett]

Hope everyone and their pups are well. Tara is recovering well from the laryngeal tie back op. she breathes a lot easier now so the op was definitely worth it.

It seems like Tara is doing well on twice a day 30mg trilostane. Drinking is back to normal now and she has had no urinary accidents since going twice a day. The next ACTH test is next month so that will tell the full tale.

What do others feed their pups with the nighttime dose? I've been having trouble getting something acceptable. How big a meal does it have to be?

Tara has had a few cases of fecal incontinence in the house. I think this is due to the stiffness due to being off all NSAIDs and obviously no high cortisol to help. Similarly has anyone experienced slightly soft stool on trilostane? Tara spends a lot of time squatting outside with nothing coming out which is never a great sign for digestive health. I have ordered some probiotics which get great reviews for this type of thing so hopefully they will help.

Tara can still be restless during the night. It may be a legacy of going out to pee so much when she was drinking more but at any rate I am usually up twice a night with her. She is on two tramadol at night too which used to help her sleep. I'm considering introducing melatonin into the equation as I managed to get some 3mg tablets. Anyone any thoughts on this?

Also what is the general consensus on NSAIDs and trilostane together? My vet says not to rule it out but is not keen though I know the makers of vetoryl aren't against it. I'm just starting to wonder whether we could introduce some NSAIDs back and help her with mobility and I tend to think the anti inflammatory effect helps lots of other age related problems too.

[addy]

I did check with our pet pharmacist for the okay to give Zoe tramadol, melatonin and Trilostane. The only thing he said was to give the tramadol and melatonin a few hours apart not at the same time.

Trilostane has to be given with food. Tara cannot eat two meals a day? Is it because of the fecal incontinence you mentioned? Can you give her half the size of her morning meal?

Tramadol can cause constipation. When she is outside straining, is it because she is constipated? The straining to go and the soft stool is kind of off to me. My Zoe had a bout of that and the ER told me she had diarrhea and I said no she is constipated. We did an xray and she sure was constipated. ;);)

Your girl has been through a lot with the surgery, starting the Trilostane. Trilostane can cause a side effect of loose stool but I think the straining is something to discuss with your vet.

[thewickedpickett]

I normally feed Tara at breakfast then at dinner around 6pm. Which leaves the second dose time of 9pm more difficult regarding food. How much food is ideal to go with the dose?

Tara had her first urinary accident tonight since going on twice a day trilostane. She has it just after her second dose at 9pm. Is it usual for the odd symptom to reappear? Do we typically have to increase trilostane dose as time goes on?

Also meant to ask do we give second dose exactly 12 hours after the first?

[addy]

It is best to try to keep the doses as close to 12 hours apart as your can. Is it possible to keep half of her 6pm meal for 9pm? I am assuming you cannot feed her 6am and 6pm right?

It is not unusual to have to do some dose changes before you find that "magic number." There is usual a point then when they reach a plateau and will stay at that same dose for awhile without needing an increase. Sometimes they could end end up needing a lesser dose.

I cant tell you how many dose changes we have been through;)
I would not get to worked up about one accident. See how it goes until her next ACTH test, then we will know.

I wanted to mention, my Zoe just had surgery and her surgeon was totally against giving her any nsaid because of her Cushings. She said she really tries to avoid using them with a Cush pup.

What happened with the soft stool and straining? Did that resolve?

[thewickedpickett]

The soft stool issue has improved. I've introduced pet dophilus which is a probiotic powder. But I'm wondering if it might affect the absorption of trilostane resulting in tonight's accident. Long shot I know but it is the only change.

Yeah I think most vets aren't keen on trilostane and NSAIDs. I think trilostane is severe enough without adding NSAIDs into the equation. My vet did say she wouldn't totally rule it out as Tara's liver enzymes have come down a good bit.

What did zoe have done?

[thewickedpickett]

I've accidentally given Tara 2 x 30mg vetoryl tonight. One at 20:00 and one at 21:50. Totally forgot I'd already gave her it. This is on top of 30mg early this morning. Her dosage is 2 x 30mg a day.

I've phoned vet but waiting them calling back.

How serious is this? Tara weighs 25kg and tested at acth 185 on 60mg daily trilostane.

[addy]

Do you give the probiotic at a different time? I give Zoe's in between her Trilostane doses, never with her Trilostane, just in case.


Zoe will go along just fine and be accident free and then out of nowhere have a few accidents and then she's fine again. The intermediate hormones and cortsiol flucuate. If it starts happening alot, well then that is a different story.

Zoe had a vulvar growth removed. We are waiting for the biposy results.


Hang in there.

[Squirt's Mom]

Hi sweetie,

THis may be too much at once. You can use hydrogen peroxide to make her throw up if it hasn't been too long. Do you have prednisone? Don't give it just yet; I would try to make her upchuck first. Please let us know what the vet says.

[thewickedpickett]

On call vet useless. For what it's worth said she wasn't too worried as its a low dose. It was 12-14 hours since the initial 30mg so she thinks she should be ok. Just have to watch her for lethargy etc and not dose tomorrow morning. I mentioned prednisone and she said it wouldn't do any harm... Anyhow ill wait and see. The only prednisone I have are a few years old. Would they still be ok if I have to use them?

Making sick is not an option after her larynx surgery unfortunately. Risk of aspirating etc.

[Squirt's Mom]

Ahhh, yes, forgot about the larynx surgery. :eek: No, don't induce vomiting!

I think I'd try to get some pred that was good from the vet before they close today just in case.

[labblab]

I think you'll be fine. As your vet says, this is just a one-time dosing increase and not a massive overdose anyway. So just keep your eye on her, but I think you'll be OK. For the future, though, you really do want to get some fresh predisone to keep on hand, just in case of a crash.

Marianne

[thewickedpickett]

Unfortunately it's 22:30 here and I would have to go to the emergency clinic. Do you think I should push for it anyway? Or wait until morning.

[labblab]

I think you'll be OK this time. If something changed, you could head to the emergency clinic later tonight, right?

[thewickedpickett]

Furious with myself for being so stupid. I just didn't think. Hopefully it won't have done any harm.

Yeah I'm only 10 minutes away from clinic if need be.

[labblab]

I really think she'll be just fine, so try not to be too hard on yourself. One thing you might do to short-circuit this in the future is to get a pillbox with boxes for am and pm doses. That way, you'll always know for certain whether or not you've already given (or have missed :o) giving a dose.

I'm a really obsessive person and thought I'd never goof up with my dog's meds, but I went through a week last summer when I goofed up a couple days in a row with her phenobarb. She has a seizure disorder and has to take phenobarb every 12 hours. I for sure don't want to overdose her with that :eek:, and I really don't want to forget doses, either. So a couple of times, I honestly couldn't remember at bedtime whether or not I'd dosed her at dinner, and I was more scared of overdosing than underdosing. So I held the med, and luckily got by with no seizures. But after that I got me a pillbox ;), and it works great. I still forget a dose every once in a while, but at least I know exactly what I've done. And this way there's no chance of overdosing.

Marianne

[lulusmom]

It may be a low dose but it's still a double dose so keep a very close eye on her. If she starts to show signs of overdose, definitely give her a dose of prednisone.

[addy]

Gosh, we must have been posting at the same time earlier because all of a sudden I reading all of this:eek::eek::eek::eek:

Now, dont be so hard on yourself, we're human, we make mistakes.
Just keep a close eye on her. I'm sorry, I know how worried you are.

It will be okay.

[thewickedpickett]

Tara is fine this morning. Oblivious to the drama of last night. Thank The Lord. Now all I need is for tramadol and vetoryl makers to stop makings their tablets look so alike!

[addy]

Really glad to hear this. :):):):)

[Squirt's Mom]

So glad to hear that Tara is ok this morning! :) I remember giving Squirt something like 10,000 units of niacin once because they looked exactly like her glucosamine capsules. I just knew I had killed her. Even with the vets telling me there was nothing to worry about, I worried for a couple of days just to be sure. ;) You can get some rest today, I hope, as I'm sure you got very little last night.

Hugs,
Leslie and the gang

[thewickedpickett]

Yes no sleep last night. Tara was not best pleased at being poked every hour. At 4am she gave me a look suggesting I was insane.

If anything she was better this morning than normal. Perhaps three times daily dosing is the way forward :D

[molly muffin]

Oh I am so glad to hear that Tara is A-okay this morning. Who knew having a dog in ones life was going to require such nerves of steel. LOL

hmm, I saw a mention of 3 times a day dosing, but from what I read, it's a very hard schedule to keep to for most people, so no one really tries it or not for very long.

Sharlene and Molly Muffin

[thewickedpickett]

It seems that Tara gets a bad stomach on trilostane. She's ok sometimes but sooner or later she gets diarrhoea or loose stool.

Am I doing anything wrong? Is there anything I should give with each dose? She gets a meal with each dose and is on pet dophilus probiotic powder which has helped.

[frijole]

When was the last time you had an acth? Diarrhea is a sign of too much of the drug - perhaps the dose is too high? If not it could just be that her tummy can't handle it. Kim

[thewickedpickett]

ACTH was about a month ago. Another one coming up on 12/03.


What do we do if get tummy can't handle it?

[Harley PoMMom]

Some dogs do get an upset tummy from the Cushing meds. Giving Pepcid AC 20-30 minutes before her Trilostane dosage might help, I would ask your vet about trying the Pepcid AC.

[thewickedpickett]

She is on famotidine 20mg once a day. Could I maybe up this to twice ie with both doses?

Is antepsin better than Pepcid/famotidine?

[Harley PoMMom]

Famotidine, which is the active ingredient in Pepcid AC, can cause nausea too. My boy, Harley, started to get nauseated from the Pepcid AC so I switched him to slippery elm bark...just love that slippery elm bark. Here's a link with info about SEB: http://www.littlebigcat.com/health/slippery-elm/

[addy]

Pepcid did not work for Zoe either, it was one of the few times she vomited in the middle of the night.

But is the issue loose stools from the Trilostane? That can be a side effect of the drug that will sometimes resolve. Did Tara have any colitis type stool issues prior to starting the drug? Or as Kim mentioned it can also be a sign of her cortisol dropping too low.

[thewickedpickett]

Tara is doing well. She has another ACTH test next week to see how the twice daily 30mg is doing. I can say its controlling the symptoms well though.

I've started her on a little canikur pro with each meal. It's a probiotic paste type thing which seems to have firmed up her poos a bit.

[addy]

I am glad to hear things have improved a bit with the stools and symptoms. We will be anxious to see the ACTH results. I hope they are good.:):)

[molly muffin]

Yay, so glad that her symptoms have improved. That is usually a good sign of cortisol control. I agree with Addy, we'll definitely be interested to see what her next ACTH results are. Two thumbs up! You're doing awesome!

hugs,
Sharlene and Molly Muffin

[thewickedpickett]

I had to leave Tara with my parents for a few days while we were away on a break. Cushings symptoms seem to have rebound when she was down there (urinary accidents at night). Has anyone else noticed this? Presumably it is the increased stress of a different environment raising cortisol?

[molly muffin]

I think it is usually the added stress of a different situation. Anything like that is hard on cushings dogs. Tara should rebound now that she is home and things feel normal again. Might give it a few days though as it could take a bit for her system to readjust.

Sharlene and Molly Muffin

[thewickedpickett]

Interesting ACTH results for Tara today. This is the first test since going on 2 x 30mg trilostane. Her previous result on 60mg once a day was 185. It is now 70 which I work out as 2.5 in your money.

Vet is ok with that but wants to check potassium levels in 4 weeks and says to keep a close eye because under 50 could start Addisons..

Tara is in good form but to be honest i'm a little surprised at that result as I had been wondering if cortisol was rebounding a bit at times. But it could just be the usual rebounding as the dose wears off.

Liver enzymes including ALT are also within normal range now.

Edit: I just thought about the time I double dosed... How close was I to sending Tara Addisons given these latest results?

[Mel-Tia]

Good news for Tara on the results ACTH and liver values

Maybe it could have been a UTI that was causing her accidents, I think they are a bit more prone to picking up infections.

Long may she stay controlled

Mel
Xxxx

[molly muffin]

2.5 as long as she doesn't drop any further is fine, even optimal if she'll stay there. You always want to check things like potassium and electrolytes when you get the ACTH test done. It's just a good idea and even recommended by Dechra.

She shouldn't have any cortisol swings as double dosing keeps the cortisol pretty steady.

Sharlene and Molly Muffin

[thewickedpickett]

Im still unclear whether Addisons is reversible or not? Lets say she drops too low, can we get her back up with prednisone etc without any lasting damage? Or is it irreversible once you go too low?

[addy]

Precautions
Hypoadrenocorticism can develop at any dose of Vetoryl Capsules. In some cases, it may take months for adrenal function to return and some dogs never regain adequate adrenal function.

A small percentage of dogs may develop corticosteroid withdrawal syndrome within 10 days of starting treatment. This phenomenon results from acute withdrawal of circulating glucocorticoids; clinical signs include weakness, lethargy, anorexia, and weight loss1. These clinical signs should be differentiated from an early hypoadrenocortical crisis by measurement of serum electrolyte concentrations and performance of an ACTH stimulation test. Corticosteroid withdrawal syndrome should respond to cessation of Vetoryl Capsules (duration of discontinuation based on the severity of the clinical signs) and restarting at a lower dose

It just depends, it may be reversable and it may not. Tara is at 2.5 which is a good number but every dog is different. Some dogs need to be higher, some not. You'll have to see how she does, make sure to watch her and have proper testing done. Sometimes they can drift lower, some times they drift higher, we never know what a pup will do.

[labblab]

Addy is definitely correct in that it is impossible to predict which dogs may have lasting issues with low cortisol. But for what it's worth, the majority of dogs who drop too low on trilostane will see a rebound in their cortisol level once the drug has been temporarily discontinued. As a result, ultimately most will need to resume the trilostane once again -- but at a lowered dose the next time around.

Marianne

[molly muffin]

How is Tara doing? No signs of too low of cortisol?
hope you are all well.

Sharlene and Molly Muffin

[thewickedpickett]

Tara is doing pretty good I think. I haven't noticed any signs of low cortisol. She is still hungry and not too stiff. The main issue now is getting her to sleep through the night! I've been reading on here and gather it can become an issue with older dogs with cushings.

I have a theory that she wakes when the second dose of trilostane wears off and her cortisol rises. She then gets up and i let her out to toilet and has a drink.

At the moment she is dosed at 7am and 7pm. Would I be better delaying the second dose to just before sleep (11pm). This would mean it should last through the night. Or at least longer than to 5am. Or would this affect the morning 7am dose ie there wouldn't be 12 hours between doses.

Also how much food needs to be given with each dose. I'm wondering if the meal I give her at her second dose is also making her get up at night.

[addy]

Hi,

Glad to hear Tara is good. You would want to keep that dose as close to 12 hours as possible. There have been some studies done on 3 times a day dosing and we did have one member try it, however, in my opinion stay as close to 12 hours consistently as you can. Zoe was getting up early , like 4am, so I started giving her a bigger snack a few hours after dinner and an hour before bed. That helped her along with the melatonin right before she wnet to bed.

Sometimes melatonin can help them settle for the night. You could try that, it may take a few weeks to see an effect.

[thewickedpickett]

Thanks I have started her on 3mg melatonin hopefully that will start to help.


Perhaps feeding her more in the evenings after dinner would help. I hadn't thought of that.

So there is definitely no logic to delaying her second dose to nearer bedtime?

[addy]

I dont think so unless you plan to delay the morning dose. Twice day dosing is still rather new and sometimes still a bit of a controversy. If it were me, I would be worried about the lesser time between doses if you did not delay the morning dose. She's at 2.5 post. I am a worry wart. If Tara were my dog, I would not want to chance it.

I feed Zoe a bit bigger snack than I used two one hour before bed. For Zoe, it took about 3 weeks for the melatonin to kick in so that she slept later on a regular basis. I also try to keep her a bit more active in the evening.

How is her drinking and peeing otherwise? Can you tell if she is concentrating her urine? Did they test for that when she went in for her acth?

hopefully others will come around as well with ideas.

[thewickedpickett]

Her drinking is fine always under a litre a day. Sometimes less. She has had no accidents in the house for a good while now. As for the Urine concentration I am not so sure. She still produces a lot of urine for the amount of water she drinks. Sometimes when I come home from work she has barely drank anything yet still does a big flood. The vet suggested some cushings pups always produce more urine even with good ACTH results.

[addy]

sounds good then, I hope the melatonin and extra snack help. Give it some time.:):):):)

[molly muffin]

Sounds like Tara is doing pretty good. Hopefully the melotonin will help.

hugs,
Sharlene and Molly Muffin

[thewickedpickett]

So yesterday evening I gave Tara her second vetoryl dose at exactly 12 hours from last one. Normally I leave it for an hour or so after. I was going out so only gave it with a bit of cheese rather than a smallish meal. She had 2 urinary accidents during the night. Do you think this is because I didn't give the dose with enough food ie it didnt get properly absorbed? Or is it the slightly different dosing timing?

Is there a chance it's Addisons or something that needs checked out?

[molly muffin]

Maybe not giving it with enough food. Having a urinary accident is not Addison symptom, that would be, vomiting, not eating, lethargic, diarrhea, etc.
Try tonight with some food as normal and give it as the time you normally gave it to her.

Sharlene and Molly Muffin

[addy]

so you have been doing 13-14 hours between morning and evening dose but then about 10 hours between evening dose and morning dose? It would not seem that shouldn't matter that much, I thought you wanted to do like 8-9 hours between the evening dose and morning dose which is why I voiced concern especially since Tara has not been on the drug that long so we dont have a history to guide us.

maybe the cheese was not enough food or she just had a bad night.
how is she otherwise?

2.5 is a good solid number but sometimes larger pups are sensitive to the drug, that is only why I sometimes voice concern :o:o Vetoryl can sometimes be unpredictable and we need to remember it is not the "safe" drug all these vets seem to think it is and respect it. Dont mean to make you worried or scared.

[thewickedpickett]

Thanks. I will put it back to normal tonight. I'm also beginning to wonder if too much dry food can cause incontinence. Seems some sources suggest it can. She had more dry than normal yesterday. It is so hard to know. I'm also obviously more worried now she's at 2.5.

Are there any thoughts on what type of food is best for trilostane absorption? I definitely agree that it is a very potent drug.

Otherwise she is fine. The only thing is the other night when I fed her a bit more before dinner she drank an awful lot more during night. But last night she drank very little so accidents weren't due to drinking too much.

[molly muffin]

I'm not sure what foods are best for absorption, I'm sure some of the others know though.

I did just see this on Dr. Petersson's blog and is probably what happened with Tara, the medicine was absorbed. This is in regards to the ACTH testing, but I'm sure that it is true for anytime that you give vetoryl.


When a dog ‘s food is withheld, the absorption of trilostane from the gastrointestinal tract is decreased. This leads to low circulating levels of trilostane, resulting in little to no inhibition of adrenocortical synthesis. Therefore, serum cortisol values will higher when the drug is given in a fasted state than when it is given with food.

Even though food wasn't withheld, it wasn't as much as she would normally get with her vetoryl, so probably didn't absorb enough to help her over night.

Sharlene and Molly Muffin

[addy]

the food thing would be my guess as well, if I had to guess. I went to check out an Addison's site and was suprised to see excessive drinking and peeing on the list of symptoms and immediately thought of my Zoe all these weeks after her surgery:eek: We dont normally think of those as signs of Addison's crisis. I did not post the link as I was not sure how reliable the source was and wanted to check it out.

Dry food can make a dog drink more water. Their cortisol and other hormones can flucuate too. Zoe had high estradiol and intermediate hormones which Vetoryl can increase. We are not sure how those other hormones can affect some dogs. So sometimes we may be seeing those come into play as well.

you are doing great, you will work it out.

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

[thewickedpickett]

Thanks. I think it was a mixture of giving it too early and with not enough food.

I too seen those symptoms listed for Addisons! It seemed like cushings symptoms can be very similar to Addisons if that is true. Off food I suppose is the big difference.

What worried me last night was that Tara was still licking and eating herself which is typically more a sign of low cortisol.

[thewickedpickett]

Has anyone any experience with tramadol and trilostane together? Tara takes tramadol for arthritis. 100mg twice a day. I was just wondering what opinions were on when to dose it ie before/with/after trilostane?

Another ACTH tomorrow for Tara.

She's doing good and is enjoying the better weather coming in here. She still gets up every night around 3/4am. I have not been able to Remedy that yet but everything else is fine.

[addy]

We do tramadol and trilostane. I usually try to wait a few hours between the Trilostane and the tramadol but that is just me. Zoe gets super tired from the tramadol and tired from the Trilostane so I usualy keep the dose apart by a few hours and mostly at night before bed if I am not doing Melatonin that night.

Good luck with your stim:D:D

[molly muffin]

Hi! Checking in to see how you and Tara are doing.
Hope you are getting some nice spring weather there.

Let us know when you get a chance.

hugs,
Sharlene and Molly Muffin

[thewickedpickett]

Tara is good. I'm waiting on a call today about the latest ACTH results

One thing I have found recently is that the type of food fed with trilostane affects things. You will recall I had trouble with Tara getting up in middle of night. This was after getting her second 30mg trilostane with soaked dry food and some ground beef. I changed this to the same as she gets in the morning which is some scrambled egg and white rice. She has now slept through the night since starting this. I'm not sure why this is, perhaps the soaked dry food was too much at 9pm?

Her ACTH results have always been after scrambled egg and rice in the mornings.

[thewickedpickett]

Tara ACTH up to 234 which I think is 8.7 in your money. We are getting good symptom control at the minute so vet is suggesting just leaving her be unless she starts to rebound. Plus I think the new nightly feeding routine is helping.

I discussed introducing an NSAID to help with her arthritis. Vet was cautious but suggested a new one on market called Onsior which is apparently the safest and newest. So we are going to try a low dose of it and monitor kidneys closely. My feeling are that I would love to give her some better mobility coming into the summer.

[Squirt's Mom]

Onsior is also an NSAID and with what Squirt and I are going through the last few weeks, I just cringe to hear you say Tara may take an NSAID. Tho now it seems Proin may be the prime culprit in Squirt's case. I can tell you that Squirt was on Metacam, also an NSAID, and her liver values shot up, way up, to the point her vet is thinking liver disease. We are in the process of trying to get a good blood sample to test them now that she has been off the NSAID for a few weeks.

Some things you can consider as alternatives -
*a good fish oil with the highest EPA and DHA that you can find

*Vit E (always give Vit E anytime you are giving an oil supplement to help prevent oxidation)

*Vit C at the highest dose she can take and not have diarrhea - you will start at the recommended dose and increase it slowly until you see her stools getting loose, then back it up just a tad so the stool is normal again

*GlycoFlex - a great supplement for arthritic issues that contains glucosamin, condroiton, green muscle lips, and many other ingredients that are beneficial for inflammation

Some links -
This is the fish oil we use -
http://www.onlynaturalpet.com/products/Only-Natural-Pet-Wild-Alaskan-Salmon-Oil/999147.aspx

GlycoFlex -
http://www.vetriscience.com/index.php?l=product_list&c=6

Squirt and Brick are on the GlycoFlex III, the strongest strength, but Tara can start with the GlycoFlex I and move up if needed. They come in tablets and chews - both apparently tasty. Brick LOVES his chews and gets very excited to get a "chew treat". ;)

We are struggling with pain issues at the moment as well and a friend reminded me of a product call Dog Gone Pain. I did some research on it as well as herbs I was considering and found this product, which I have ordered for Squirt -

http://www.onlynaturalpet.com/products/Only-Natural-Pet-Get-Up-Go/999163.aspx

Hope this helps!
Hugs,
Leslie and the gang

[thewickedpickett]

Thanks but I've tried all of the suggestions you've made. They help a little but not to any great degree. They also cause stomach upset in T. I am not sure about the NSAID either but I'd like Tara to have some more mobility even if just for the summer months. Vet is going to monitor kidneys 2 weeks after she starts. Tara was on metacam for a long one before the cushings diagnosis.

Incidentally the one safe drug I found that worked most was called Cortavet

[thewickedpickett]

Decided against introducing an NSAID.

Tara is up to 40mg twice a day now after the most recent ACTH result and some nighttime accidents. It seems to be after 5am the cortisol kicks back in and she's awake.

[thewickedpickett]

Tara had an accident this afternoon there which is unusual and it was foul smelling. Starting to wonder is it a UTI? She's had 2 doses of 40mg trilostane so far. Is it usual to have accidents when upping dose?

[Harley PoMMom]

If the urine has a foul smell chances are good that an UTI is present and an antibiotic is needed. Accidents are common with an UTI because the dog tends to drink and urinate more.

[thewickedpickett]

No obvious UTI present in Tara's urine. She had another big urinary accident this morning at 6am then went outside to pass more Urine immediately after.

Why is this happening with the increased trilostane dose? Is she just adjusting to the new dose? I guess she was starting to have them with the previous dose too. She is not drinking any more which makes me doubt the cushings is raging at current dose.

[labblab]

When you say "no obvious UTI," that leads me to think that only an immediate microscopic analysis was done, but the urine sample was not actually cultured to see whether or not abnormal bacteria are present. I hope that others here who are more familiar with UTIs will comment, but I think that when urine samples are dilute, it is hard to correctly diagnose UTIs on the basis of visual examination alone. Tara surely does sound like she has a UTI, so it's hard for me to give up on that notion yet. Increasing a trilostane dose definitely should not be associated with increased urine output.

Marianne

[addy]

If Tara's urine is dilute, a urine culture must be done to determine if an infection is present. Do you know what her last urine Sp Gr was?
Urine cultures are best done on sterile urine removed via needle from the dog's bladder rather than from a urine free catch.

[thewickedpickett]

The vet tested the urine with a strip. She said the ph was fine and there were no traces of any blood. However she proscribed antibiotics anyway. Hopefully it is still a UTI and the antibiotics will work. If not I fear we are into a whole different scenario.

[labblab]

Since your vet did not actually culture a urine sample, there is no way of knowing whether any infection would actually be sensitive to the particular antibiotic that has been selected. That's why performing a culture is the more informative route to go. So even though Tara does not respond to this antibiotic, that does not mean she doesn't have a UTI.

Marianne

[Harley PoMMom]

I totally agree with Marianne and Addy, when the urine is diluted it is imperative that when an UTI is suspected that an urine and sensitivity test be done.

[thewickedpickett]

Thanks ill say that to the vet if this continues. Tara having accidents regularly now around 10/11 hours after 40mg trilostane dose in morning and evening.

Could it be the extra trilostane is making her stiffer which is leading to incontinence?

[doxiesrock912]

Wickedpickett (that's too cute),

Trilostane leaves their systems by 8 hours so I doubt that the accidents are from that.

[Mel-Tia]

I would suspect as she had joint issues previously that she could be feeling more uncomfortable now as the cortisol can mask their pain

With my limited knowledge I believe she can't take NSAIDs with vetoryl or they don't encourage it but I do believe some of our other members have used tramadol and gabapentin for pain management

One of our more experienced members should be able to confirm or set me straight :D

Mel
Xxxxx

[doxiesrock912]

I forgot to mention that Daisy has arthritis in her back legs and she takes glucosamine chondroitin with MSM every morning. It helps!

[molly muffin]

Do they give the shots for arthritis there? If so that has been beneficial to some of our members. Is Tara still on the tramadol? She was on that when this whole thing with the cushings first started right? Do they have the swim therapy? Where they put the dogs in a water pool, it's small made just for therapy and then have them swim? Not sure if that would help with the joint problem or not and the pain.

I do hope that a could balance can be found for Tara and you.

hugs,
Sharlene and Molly Muffin

[thewickedpickett]

Tara is still on tramadol, water treadmill, acupuncture and laser treatment.

She is still having accidents every morning. I'm going to mention the Urine culture to the vet. But if its not a UTI what are the next steps? Presumably an ACTH to see what's happening with the cortisol?

[molly muffin]

Tara's post numbers have been up and down, if I remember correctly, we started at 26.89 and then it went to 7.8, 6.9 and now 8.9.
It is entirely possible that Tara is not one of those who control symptoms at a higher range, and needs to be more like 5.
I know you went from 60mg once a day to 30/30. The last ACTH test was in mid April and it was coming back up, so I'm not sure that you're seeing opitimal control at this point.
Can you only get vetoryl Brand trilostane there in Ireland or can you also get the compounded Trilostane?
I'd keep her here since the last test was the first on the 30/30 split for a bit, and then if the cortisol has continued to rise at the next ACTH test, or even just stay where you are with Tara still having accidents, then you might want to consider a very slight raise in the evening dose by say 5mg or so. (if you can get a compounded trilostane, because I think the smallest dose that Dechra makes is 10mg) However, lets rule out a UTI first. Then as I mentioned still give it a bit of time for the next ACTH test. All other other symptoms other than this morning accident is controlled correct?

Sharlene and Molly Muffin

[thewickedpickett]

That's what's worrying me though. We have increased dosage to 40mg twice each day. 30mg and 10mg. Since doing so the accidents have not gotten any better. I can see the extra working in that she's stiffer for the first few hours after dosage but it seems to me the cortisol still spikes after several hours causing the big floods of urine.

Most symptoms appear controlled. Not much drinking or restlessness. Just the urinary side of things really.

[thewickedpickett]

Tara had another urinary accident tonight at 2am which is a new time for her. 5 hours after receiving 40mg trilo. I really don't know what's going on.

[addy]

Is she drinking more water, has anything else changed?

When is her next ACTH test? If you just changed her dose, it should be about 14 days from the dose change.

[thewickedpickett]

She is drinking very little. Whilst the trilostane 40mg is working she is fine but when it wears off the problems start. I will give it another few days and go back to vet. Something not right.

[molly muffin]

If she isn't drinking very much water then I don't think it is the cushings causing it. I'd check for the UTI, maybe have a kidney panel done or even blood work to check Glucose and thyroid, as both of those can cause urination issues.

Hang in there!
hugs,
Sharlene and Molly Muffin

[thewickedpickett]

It may just be coincidence or the antibiotics curing a UTI but I did not give Tara any dry food mixed with wet yesterday and she had no accidents during night. I have often felt the trilostane does not work as well after eating soaked dry food. We will see over the next few days I guess.

[molly muffin]

Well that is good. I think that because every dog is different, sometimes you just have to tweak around with food, treats, medicine, timing to get it all just right. Once you do it's nice to be able to relax. Just have to find what works best for Tara. Maybe it wasn't a UTI, but it's one of the first things to check if urinating continues or starts while on the meds and the cortisol is controlled levels.

hugs,
Sharlene and Molly Muffin

[addy]

It is hard to know what is going on sometimes. I took Zoe in for her ACTH, she was post 4. I started her on a new probiotic about two weeks later and out of nowhere she starting having pee accidents in the morning about half an hour after going outside for her first pee of the day. I even googled if there could be a diuretic in the new probiotic. :confused: She had just had a UA and needle draw and urine culture which showed no urinary infection. Then after 4 days, the accidents just stopped as suddenly as they started.:confused:

Try to journal it for a week or two to see if you see a pattern.

[thewickedpickett]

Too true. I think it all just cycles perhaps. Here's hoping it was the soaked dry food but its a long shot! Still no accidents mind you..

[thewickedpickett]

Tara has had her latest ACTH test. The first on 40mg twice a day trilostane. She's at 78 now.

Also, we've had no accidents since stopping feeding any dry food.

[addy]

That is a really good number for Tara and I am so happy the accidents stopped. Vetoryl/Trilostane can sometimes be poorly absorbed so perhaps the new food helps Tara to better absorb the drug. Here's hoping that the new food and her great stim keeps working for you both.

Great job, Mom!

[thewickedpickett]

I think the trilostane is being poorly absorbed again. She has had a few urinary accidents again and I can just tell cortisol is high.

How much food do you typically give with trilostane? I've been giving it in a small ball of minced beef then immediately after some scrambled egg and rice. She also gets 2 tramadol at this time too. I've also started giving a sprinkling of montmorillonite clay to help firm poos up. Is there anything in here known to affect trilostane absorption?

Are there any studies on what helps/hinders absorption? The guidelines just state giving with food improves absorption but gives no detail on what foods or how much.

[labblab]

I would worry that the clay may be affecting the trilostane absorption if it is given at the same time. Fiber supplements usually contain a warning against being given at the same time as meds. And one of my dogs has an anti-diarrheal treatment made of clay and charcoal that my vet has instructed me not to give within one hour before or after any of her other medications. So I would alter the time that you are giving your dog the clay.

Marianne

[thewickedpickett]

Yeah I suspect that myself. Although she has been taking it for a while and it's just started again but I guess it could have taken time to develop. The clay is wonderful at keeping stomach good which I had thought was the key to good absorption. The clay is the same stuff in the tubes of anti diarrhoea stuff.

I could just give it at dinner time when no trilostane is involved. Problem with later is I've no way of giving her the clay unless I introduce another meal post trilostane.

[thewickedpickett]

Having some problems with Tara. Concerned it is the development of the pituitary rumour.

She spent a week with my parents whilst we were away 12-19 July and she has been off ever since. She is Very stiff. Won't go up stairs. And does not eat her dinner in evening though does mostly eat breakfast and night meal though with less enthusiasm than before.

I stopped vetoryl and took her to he vet. She did bloods and potassium levels and said there was nothing to indicate cortisol was too low but we'd need to do an ACTH test if it continued. After a few days of normal vetoryl it seems we are back at the same place.

She was also up panting a lot of last night though it has been very warm here. To complicate matters further I found a growth type thing on her face which is being biopsied on Monday. It does not look like a mast cell tumour but vet is being safe.

What do you think about the cushings side of things. There have been no urinary accidents or increased thirst.

[doxiesrock912]

Cushingoid dogs are heat intolerant. This could explain the panting and the not wanting to eat three meals a day.

I would do the ACTH to see where Tara is with that.

Did she get enough exercise with you parents? I ask because Daisy is less stiff when she has more exercise. She has arthritis.

[thewickedpickett]

If anything she would've got more exercise with my parents. However they have no stairs so perhaps she's just forgot how to go up them?? I think an ACTH next week is in order. She is on 40mg vetoryl twice a day but I'm wondering if the morning dose needs to be that high. I know both doses should be same but to me nighttime is when cushings really kicks in.

[doxiesrock912]

Is Tara any better?

[thewickedpickett]

She had a better night last night. So hopefully it was nothing too serious. She ate her breakfast this morning and seemed more mobile. ACTH later in week should tell the story.

[addy]

The stress of the change in her routine can sometimes cause problems for them. Hopefully now that she is back to her normal routine, she will continue to improve.

When Zoe had a vulva growth it was bothering her, we had it removed and her post dropped from appx 7 ug/dl to appx 4ug/dl with no change in her Vetoryl dose so the growth was bothering her and it showed up in her pre and post numbers.

Just mentioning it, every dog is different.

I hope Tara continues to improve.

[doxiesrock912]

How scary! Please keep us posted after the ACTH.

[thewickedpickett]

Hi guys. Sorry for the lack of updates. Internet access has been patchy lately. Tara has continued to have good ACTH results and symptoms are generally not too bad. She is old though as I'm sure most people here can appreciate.

The latest drama concerns our vet no longer being able to get the stuff used in an ACTH test. I don't know why this is as the practice is one of the top places in the country. Therefore they are just going to do one of the dexomethasone tests instead. I have no other options but just wondered if this was common? It worries me how we might decide on an increased dose and test subsequently etc.

[molly muffin]

Hi, so good to hear from you. I know that in the UK, they have had trouble getting the stuff for the ACTH testing too. No, the LDDS doesn't do you any good that I know of. You'd be just as good to do a resting cortisol test and at least see where the pre number is. The LDDS is not really worth doing once you start treatment. So, save yourself some money there.

Yes, they all get older on us, buy I'm glad that Tara is doing good over all.
I saw that you've been getting some flooding in various areas too this year, Yikes.

hugs,
Sharlene and Molly Muffin