9 Year Old Maltese with Cushings

[Roxee's Dad]

I am sure it is very overwhelming!! :( But hang in there. Maybe just have a conversation with your vet and ask why LDDS vs ACTH? See what she says. Either way, eventually you will have both test performed.

We will not let you start treatment without an ACTH to at least baseline Gracies treatment. Even if we have to jump through the computer monitor to reach you :p :D

[Squirt's Mom]

Educate yourself as much as possible on the conditions that Gracie faces - that you know she faces or have a pretty good idea she does.

Don't believe everything you read from any source but make sure your sources are reliable. Learn to be skeptical and questioning, doing your own research, making up your own mind.

Take time to be still and learn to listen to that small little voice inside - that is your gut and it will tell you the truth every time if you learn how to listen.

Unless it is a life and death situation in which minutes count, there is never a reason to let yourself feel pushed into anything for Gracie. Take a day or so if you need before making any decisions on her behalf and exercise your new-found research and critical thinking skills.

Above all else, remember that you know Gracie better than anyone else. Listen to your gut, learn to trust it.

You are going to be just fine, Kenny. You are never alone.

[KennyJ]

Dr Herring called to check on Gracie to see how she tolerated the meds she prescribed. I was very impressed by her once again. I asked her if Gracie's mucocele was related to her possibly having Cushings and she said most of the dogs she found mucocele in their gall bladder ended up having Cushings as well. She went on saying we didn't have to test Gracie for Cushings on her next visit if I didn't feel comfortable doing it but the long we put it off the problems could increase. ON another not Gracie drank 9 ounces of water yesterday.

[goldengirl88]

Kenny;
What if any symptoms did Gracie have from the mucocele in her gallbladder? Did it show up in the blood test? I am curious, and know you had a scan which it probably showed up on. I am just wondering if this caused any problems for Gracie, or you didn't know until they told you it was there? Blessings
Patti

[KennyJ]

Patti, Gracie showed absolutely no signs of having a mucocele. The ultrasound showed the kiwi appearance of the mucecele. It was very clear and when I researched the disease itself I was shocked that she had one. The concern is if it should rupture. It doesn't appear to have much data on it being treated medically. Most of the time surgery is required but she is showing no symptoms. I was hoping this was the reason her ALP was elevated and although that still is a possibility there is a link a lot times with Cushings. Gracie so far has been a trooper when it comes to her meds. So far she has not gotten sick. Valerie was telling me that her dog had a mucocele but it was on her salivary glands.

[KennyJ]

This article says surgery is still recommended.


http://www.google.com/imgres?imgurl=http://veterinarynews.dvm360.com/dvm/data/articlestandard//dvm/322009/616664/ACVIM-2.jpg&imgrefurl=http://veterinarynews.dvm360.com/dvm/Gastroenterology/Gallbladder-mucoceles-Surgery-still-recommended-du/ArticleStandard/Article/detail/616664&h=150&w=197&sz=21&tbnid=jHjGiccqAqKOeM:&tbnh=81&tbnw=107&zoom=1&usg=__At1fMhuJ8f5-XG0jZfi18CAHp2A=&sa=X&ei=BkncUdv5JYnB4AO_yIHQAw&ved=0CCkQ9QEwBQ

[Roxee's Dad]

Hi Kenny,

How is our Gracie doing today? :)

The question about surgery is a good question to discuss with your vet. You may want to ask why she choose not to do surgery.

[goldengirl88]

Kenny:
That is definitely a question I would want answered by the IMS. Maybe she feels she would try the meds first and then consider the surgery if no results from the meds. I would think that any Dr. would be hesitant on surgery with these dogs, since they have so many problems already. Maybe she feels it is not going to harm Gracie's health to leave it there?? I would be on the phone calling and asking her this. If you don't it will just eat away at you, and make you a nervous wreck. Blessings
Patti

[labblab]

Hi Kenny,

I, too, have found an article that also recommends surgical intervention over medication management. Do keep in mind that this article is on the website of the American College of Veterinary Surgeons, so there may be a bias there towards thinking that a surgical solution is the best one. But the article does raise questions that you probably want to discuss in more detail with your IMS. Everything else that she's said so far seems very reasonable to me, so there may be some specific considerations in Gracie's case that warrant the more conservative wait-and-see approach. But I do think it's worth discussing the surgery with her so you're both on the same page in terms of risks and benefits.

http://www.acvs.org/small-animal/gallbladder-mucocele

Marianne

[KennyJ]

I did call and ask, although Dr Herring wasn't there one of the other vets responded. I think since Gracie isn't showing any of the symptoms they believe they should try the medication first. I believe if I am correct the vet school here at Virginia Tech would have done the same thing. One thing I am proud of is that I have gotten Gracie to lose weight. It was very difficult but she is down to 11.8 lbs. The leg is still doing great. Like I said if I had never had her in for the leg issue I would have never known about any of the stuff going on inside her. She seems like a normal little dog. 13 ounces of water yesterday and a couple of days ago she only drank 9 ounces.

[KennyJ]

Marianne, after reading that article I hope Dr Herring knows what she is doing. Wow. :confused:

[labblab]

I really do think she sounds very competent, so I would think and hope that she will be very willing to discuss her recommendation in Gracie's case. As you have read, the surgery itself is not without risks. So you really do want your vet to be considering your own dog's specific situation when decisions such as this are made. And who knows, she may be privy to some research that is even more current than what you and I have found on the internet.

So by posting that link, I did not mean to raise doubts in your mind about Dr. Herring. Rather, I just wanted you to be armed with as much information as possible when you do have the chance to talk with her directly about Gracie's long-term treatment plan.

Marianne

[goldengirl88]

Kenny:
I am glad you called. Maybe you can talk to your regular IMS when she is in and question her further if you still feel uneasy. I agree with Leslie, educate yourself about her conditions. Find out what symptoms Gracie would exhibit if the gallbladder starts having problems because of this condition. You are doing a good job with her Kenny, just think things thru before making decisions. Blessings
Patti

[Budsters Mom]

Hi Kenny,:)
Just popping in to check on the two of you. Is Gracie keeping you out of trouble? Kenny we are here to help in any way we can. Try to take a deep breath now and then and just spend a few minutes enjoying Gracie. Big hugs,

[KennyJ]

I am totally exhausted every day because I stay on the Internet day and night researching. If I only had one thing to deal with maybe it would be easier. Never dreamed I would take Gracie for an injured leg and then find out she may have Cushings. Now mucocele??? What else?

[molly muffin]

No, what else. Gracie has maxed out her what else. :) That's my very nonprofessional opinion on the matter.

Kenny, you certainly have a good handle on all the different aspects of each situation from your reading but you do have to know when to turn off the internet, get plenty of rest and just enjoy Gracie.
Nothing about any of these individual situations is easy and put together I am sure they are overwhelming.
The best person though to take your worries to will be your IMS. If you have specific concerns about the treatments recommended then you should have a chat with her. Even if you need to just make an appointment and have a one on one talk.
Has it been one week that Gracie has been on the meds for her gall bladder? She has to do 6 weeks right to see if the medicine is working?
How is her leg and when is that reevaluated?

Sharlene and Molly Muffin

[KennyJ]

Gracie is supposed to go back for her 6 week check up with the orthopedic doc next Wednesday. Not sure how much more of this I can handle. She has 5 more weeks of meds for the mucocele. Not sure what the plans are after this. All I know is I am spending a lot of money and they just keep finding something else. Gracie has absolutely no symptoms of the mucocele so if they suggest surgery after the 6 weeks is up I am not sure which way I will go. Seriously, I am at wits end on all this. Take her in for leg injury and come back with multiple problems. I am upset that my regular vet never said anything during her yearly exam last year about her looking like she may have Cushings. I mean this is not something that just happens overnight. SMH

[goldengirl88]

Kenny:
I know just how you feel. When I took Tipper to the IMS and the first thing she said is this dog has a heart murmur. I thought to myself she is at my vets constantly, why did he not tell me this??? I am not so sure that old age caused it either, as I have seen other dogs on here with Cushings that have murmurs also. I am betting it is from the Cushings as your heart is a muscle. I feel for you and know what you are going thru. It seem every time you walk thru the vets door, it is a new problem, and more money. Try to hang in there Kenny. I know there are times it gets the best of and I end up sick. You are all Gracie has so take care of yourself she needs you now more than ever. She deserves the best and I know you will do that for her. We all manage somehow to keep going and to keep paying., and also to keep praying. Blessings
Patti

[KennyJ]

Patti, I am so concerned about the meds not working and then what? What if the IMS suggest surgery for the mucocele?? Why wasn't lab work ever suggested the whole 9 years when I take Gracie in for her yearly exam??

[goldengirl88]

Kenny:
You are one of those people like me that can't stop thinking ahead. In a way it is good, and in another way it is bad. I know how you feel that none of this was told to you on all the regular vet checks. I could choke my vet as much money as I have paid him, and he never mentioned many things to me. What happened to vet malpractice? It's a joke, there is no such thing, and that needs to change. They need to be held accountable too. I don't know if you caught it on my thread or not about asking him about Tippers eyes. I told him I noticed something funny , and they never looked that way before, and described it to him. He looked and said it's just old age. By this time I was much smarter to his crap and went straight to an eye specialist. Sure as anything she has calcium deposits form Cushings. When my vet got the report fro.m the specialist, he ignored it and acted like he knew nothing about it-he never brought it up. So Tipper gets checked again next month and if worse will go on drops. I do not trust these vets anymore. I have had far too many things like this happen, and no more. Do you think you would opt for an operation if Gracie needs one? Did the IMS say if need be she was in good enough shape to do the procedure. How long do they think she has had this? I feel for you as Cushings just opens the flood gates to many problems as far as I am concerned. I know many people on here say and believe the dog does not die from Cushings, it's things secondary to Cushings that takes their life. To me it is all the same thing as if the dog never started with Cushings it would in all probability never get these secondary issues. So I feel it does go back to the Cushings and that it the causative factor in the dog passing. I guess I just have a different way of looking at it. If it quacks it's a duck. Are you set financially in case this becomes an option to operate? If not try and apply for a Care Credit Card, it will help lessen the blow. Hang on, and pray for dear sweet Gracie. Blessings
Patti

[KennyJ]

Patti, I do have the Care Credit but I believe it comes at a very high interest rate and not sure if this clinic uses it. I am not sure what I will do at this point. Already over $2,000 and we still haven't tested for Cushings . This is really getting out of hand financially.

[KennyJ]

Gracie drank more water today than she ever has. 18 ounces. Could the antibiotic and Ursodiol cause that?

[frijole]

Yes sir without a doubt. Kim

[goldengirl88]

Kenny:
I do think these meds will make her drink more. About the financial end. You have come this far with Gracie, if you stop now can you handle what will happen, and live with that? That is the question I would ask myself. You have come a long way with her. I hate that the money situation always seems to govern what we do with our babies. It is a darn shame that all of this is so expensive. The money wasted on vets that do not know what they are doing is terrible. It could have been used for treatment where people know what they are doing. I wish I was very wealthy, and I would pay for all these babies to get help. I have had times with Tipper where I scraped the bottom of the barrel for money too. Every time I manage to get some more saved, we have an issue that has to be dealt with. Don't get me wrong I will give anything I have to help her if I have to. It's like it has become a lifestyle with me to ensure my Tipper's life. I don't do anything anymore, I save all the money for her. I just got a haircut at the salon yesterday, for the first time in like 4 months. I cut corners everywhere and have done without many things to have money to help her. A sacrifice I gladly do. I never ever leave her alone. My neighbor said to me "how can you stay in the house for months on end like that?" I said "I'd stay in for the next 100 years as long as I have my girl." My world revolves around finding the best way to enhance Tipper's life, and keep her out of pain, and danger. I constantly scour this site for any new information that I can use to help her. This has taken over my life. I feel this is what I am wanting to do, and that she is under my care, and her fate depends upon me. I never feel obligated to do this. I know it is my job as her caretaker.That is a heavy responsibility so I know first hand how you feel. Each one of us will make a different decision on what to do with our babies. You need to make a plan of what Kenny is going to do, so you are not flying by the seat of your pants. I know it is hard, but you can't keep going on wondering what to do. Find out if the IMS you go to takes the Care Credit you have. They basically set the time you have to pay it off- they can make it long or short, so talk to them about your situation. That is the only way to get help. Tell the IMS what you have spent, and that you need to know what has to be done next, the cost, the probability it will help Gracie, and just be honest. Tell them they need to formulate a plan of action with you so you are not in the dark wondering what to do and what it will cost. Have you asked the IMS if Gracie is a good candidate for surgery?? That is where I personally would start. If she is not a good candidate for surgery, then you have decisions to make. I would go and have a talk with them asap. God Bless You and Gracie
Patti

[KennyJ]

I may cancel my 6 week reevaluation with the orthopedic surgeon and save my money for the other tests. Dr Wilson just completed another laser therapy session and said her leg was doing great. She is concerned about the mucocele.

[goldengirl88]

Kenny:
Wouldn't cancel that unless I was 100% sure she is healed and is going to have no further issues with it. If you are certain that would be a way to save money for what is really needed. I do agree I would be worried more about the mucocele. Did the IMS say when and how they would recheck Gracie to if the medicine worked?Are you going to call and talk to the IMS? Blessings
Patti

[KennyJ]

Patti another ultrasound and lab work in 5 weeks for mucocele.

[goldengirl88]

Kenny:
Save, save and save some more!!! I pray the medicine helped your Gracie and she won't need surgery. Blessings
Patti

[Budsters Mom]

Yes Kenny, try to save wherever you can. Many of us struggle with the financial aspects of care. I am still paying off Buddy's vet bills and he is no longer with me.:o Hang in there Kenny. you're doing a great job with little Gracie.:) Please remember to occasionally stop and just enjoy her. We never get back the present moment. Xxxxx:D

[goldengirl88]

Kenny:
Thinking of you and Gracie, and hoping that Gracie is getting better on her meds. Blessings
Patti

[KennyJ]

Gracie is drinking so much more water now and the panting has gotten worse. She is almost drinking all the 20 ounces I put in her bowl now.

[goldengirl88]

Kenny:
Do you have an air conditioner on? The Cush dogs cannot cool their core down like they used to so heat and humidity really affect them. I am sure the excessive water is from the antibiotics right now. Can she pass the water bowl up without drinking anything? Is she cut down short enough for summer heat? When are you supposed to test for Cushings or did you I forget? Blessings
Patti

[frijole]

Is she still on the drugs you mentioned a couple days ago? If so I would bet that is causing it. We've seen it many times over the years. After they are off of it water consumption returns to normal. Kim

[KennyJ]

My house is always very cool. And yes she is on the meds for ar least another 4 weeks. I saw a vet friend at the baseball game and he said it could be the clavamox causing it. He said do NOT allow them to do surgery on the mucocele. Said 40% of dogs die from the surgery. She drank all 20 ounces of water and I had to give her more.

[Roxee's Dad]

Hang in there Kenny....
When you get a chance to discuss with your vet, she may have some answers as to why she chose meds over surgery.

[KennyJ]

John I believe its because she didn't have symptoms and I also believe thats what our vet school does as well. You would not believe the increase in water John. And the panting has increased as well.

[Roxee's Dad]

Mention it to your vet. See what she has to say.

[KennyJ]

I sure hope its the meds that's causing it. If not she is getting worse.

[Simba's Mom]

Sending hugs and prayers!

[KennyJ]

Ok guys, just got off the phone with my IMS vet. She said she did not think the clavamox or the ursodiol would cause Gracie to drink more water. Said it was most likely a symptom of the Cushings possibly progressing. I know she may be correct on this, however, I do find it extremely odd that it started after she had been on the meds for about a week. I could fill her bowl with 20 ounces of water and always empty 4-6 ounces water out at bedtime. Now Gracie drinks all the water and then some. I asked her what would happen after 6 weeks. She said she would do another ultrasound and check to see if her liver enzymes are going down. If not I am not sure what the next step would be. I asked her about the 40% deaths of dogs having surgery for the mucocele. She said most likely the dog was already gravely ill with the disease so you really can't lay the blame on the surgeons or surgery. She feels like the ACTH has to be performed if no improvement in her lab work. I also asked why some vets does the LSSD test vs ACTH. She said the LSSD does give more false positives that's why she prefers the ACTH. Ok have at it. Do you still think I am good hands with this IMS? Because I do not know after going back and reading some of the posts saying the antibiotic could be causing more water drinking and she says that should not be the problem.

[Roxee's Dad]

Hi Kenny :)

And how is Gracie today?

Just my opinion, but I think you are in good hands. Your IMS / vet has a plan that you are both carrying out. I have little doubt that Gracie may have cushings among her other issues. But cushings sometimes needs to take a back seat to more important and immediate issues.

[KennyJ]

John, I am in total agreement with you. My big concern is her being on all these meds at the same time. Once she starts treatment for Cushings that's some pretty potent meds going in her little body.

[Roxee's Dad]

That's good, you should be concerned. It will make you a better guardian and advocate for Gracie.:) It's when we don't care or don't learn that we run into trouble and issues.

If Gracie does have cushings, I think you will follow the conservative method of treatment, being sure she starts more at the lower end rather than higher end.

I am sure you will do fine. :D

[KennyJ]

John, I can't remember but I believe Dr Herring said she preferred giving the Cushings meds twice a day. I know some of the vets do it once daily. I want to trust this Dr since she is an internal medicine specialist. She used to be a Dr at the vet school here at Virginia Tech. Decided to work at Companion because she could go part time and stay with her kids and family more. I didn't realize she was part time until the other day.

[doxiesrock912]

Kenny,
we tried once a day for Daisy and it was too much medication at once. She takes Vetoryl (Trilostane) twice a day and is totally able to tolerate it.

Once you start the meds, keep a close watch for loss of appetite and lethergy. Sometimes it take a bit of tweaking to find the right dosage regardless of what the tests show.

Daisy's IMS had her starting at 10mg twice a day and it was just too much for her. So far, 7.5mg twice a day is doing the trick.

[frijole]

John, I can't remember but I believe Dr Herring said she preferred giving the Cushings meds twice a day. I know some of the vets do it once daily. I want to trust this Dr since she is an internal medicine specialist. She used to be a Dr at the vet school here at Virginia Tech. Decided to work at Companion because she could go part time and stay with her kids and family more. I didn't realize she was part time until the other day.

Kenny, Which drug does she use? That totally makes a difference in the approach. Just want to agree with John that she seems to be doing a good job on your case. Since you are focused on the dosing already - is there a reason you haven't done the ultrasound or acth test? If it's money - I get that.. always an issue. If not go ahead and get it over with so you can quit worrying about whether she has cushing's. Sorry you have so much to deal with. Hang in there, Kim

[KennyJ]

Kim, the ultrasound has already been completed. That's how she found the mucocele. She is being treated with clavamox and ursodiol. In 5 more weeks she gets another ultrasound and more lab work to check her liver enzymes. Dr Herring said most likely she will test her for Cushings if the meds failed to bring the enzymes down. I can tell by the way she talks that she thinks Gracie has Cushings.

[KennyJ]

Oh I'm sorry I read that incorrectly. She uses the Vetoryl.

[frijole]

Thanks - did you post the entire findings from the ultrasound? (I'll look thru the entire thread later tonight) I'm curious how the adrenals looked (you can sort of tell if cushing's is involved sometimes)

Re the vetoryl - I think that it is protocol to start out with dosing once a day and only switch to twice daily if it is necessary. (note diabetic dogs often will need twice daily for obvious reasons). Key is to start out on a low dose and slowly increase if you need it. Don't worry, we'll help you with all that stuff if you need it. Kim

[KennyJ]

Kim, she said her adrenals were plump. One was slightly larger than the other one I believe is what she wrote down. Her liver may have been slightly enlarged but not very much she said. The size of the adrenals including exact measurements were on the film.

[frijole]

Kim, she said her adrenals were plump. One was slightly larger than the other one I believe is what she wrote down. Her liver may have been slightly enlarged but not very much she said. The size of the adrenals including exact measurements were on the film.

Thanks - I'll look tonight!

[KennyJ]

Only 11 ounces of water today. Strange.

[frijole]

I remember measuring water intake and having those days also... and someone posted to me "Kim when we are talking excessive water intake we are talking BUCKETS not ounces. You would know if she is drinking excessively" And so I share those words with you. I do not find her water intake to be excessive in the least.

I read what you posted about the ultrasound and I would not call it conclusive. I think your vet's plan is a very sound one. While they say the mucocele goes hand in hand with cushing's I can say I don't ever recall a single member in my 8+ years here having dealt with one... could be my feeble memory... I saw where it's also related to other issues such as hypothyroidism and diabetes. Anyway... you will know more once you have the acth test.

Praying that the drugs work their magic on the mucocele. Kim

[KennyJ]

Thanks Kim, so do I. :)

[goldengirl88]

Kenny:
The only thing I can say to put your mind at rest is that when Tipper started with the heavy water consumption, we are talking bowl after bowl being emptied all day long!. So 11 ounces is not overly excessive at all. When she starts drinking many bowls of it, then there is a problem. You are doing a good job monitoring her Kenny. You are very good at watching for signs so you will know if something is starting, and that is a good thing. We all make it thru this one day at a time, and some days are harder than others. Blessings
Patti

[KennyJ]

Thanks Patti, according to Dr Hairfield because of Gracies size 16-20 ounces is considered excessive. Another friend of mine had a little dog that passed away with Cushings and other complications was told by her vet that 8 ounces was all her dog should be drinking during the day. Her dog weighed 9 lbs.

[goldengirl88]

Kenny:
I think sometimes these IMS's fall into the habit of being too rigid in their estimations, and thinking outside the box. They are by the book. I learned that with mine. I told her several things Tipper was doing and she said no it's not from Cushings, and several people on here have said the same about their dogs doing these things, so I know it is the Cushings causing it. If they didn't learn it in school, and are young and haven't seen a lot of cases they tend to go by the book. I have noticed mine has a very narrow minded opinion of how things should be, and she will not stray from that opinion, even gets argumentative if you question her findings. Everything is black and white to her, no grey areas. I still think Gracie is doing good on the water even at her small size. Blessings
Patti

[Squirt's Mom]

...according to Dr Hairfield because of Gracies size 16-20 ounces is considered excessive.

Once again, Dr. Hairfield is wrong.

[Roxee's Dad]

Hi Kenny,
I just realized your thread is 80 pages long, so I wanted to summarize Gracie's history and dateline so it will be easier to track as we move forward. :)



Gracie 9 yr old spayed Maltese, 13 lbs

May 16 -
Gracie taken to vet for leg/knee injury. Given rimadyl, but stopped due to ALP.
Discovered high ALP ( 3500 )
Vet suspects Cushings due to ALP, pot belly.

May 20
X-ray confirms torn ACL

July 1
Ultra Sound performed
nodule in her liver, but vet not concerned at this time.
Gall Bladder - mucocele
Adrenals - plump
Treating mucocele with antibiotics

Retest in 6 weeks

[Squirt's Mom]

Kenny,
we tried once a day for Daisy and it was too much medication at once. She takes Vetoryl (Trilostane) twice a day and is totally able to tolerate it.

Once you start the meds, keep a close watch for loss of appetite and lethergy. Sometimes it take a bit of tweaking to find the right dosage regardless of what the tests show.

Daisy's IMS had her starting at 10mg twice a day and it was just too much for her. So far, 7.5mg twice a day is doing the trick.

Kenny, please read Marianne's reply on Valarie's thread concerning her treatment approach. This post is a bit confusing and misleading so it would help you to read what Marianne had to say about the testing and dosing for Daisy. Not to mention you don't even have a diagnosis of Cushing's yet so talking about treatment is a bit premature in my mind. Who knows...if Gracie does have Cushing's she may end up on Lysodren not Trilostane so none of this Trilo info will mean squat in that case. ;) One step at a time, honey, one step at a time and you are doing a good job of that lately.

Hugs,
Leslie and the gang

[Roxee's Dad]

Hi Kenny,
Just checking on you and Gracie.

[goldengirl88]

Kenny:
What are you up to? Just seeing how Gracie is doing. Hope all is well. Blessings
Patti

[frijole]

Hi Kenny, It has been over a week so I'm starting to be worried about you guys. Hope you decided to take a vacation or something like that. Let us hear from you when you can. Kim

[goldengirl88]

Kenny:
I hope everything is ok and you are just taking a much needed break from all the Cushings crap. I have been concerned that we have not heard from you. Blessings
Patti

[Squirt's Mom]

YooHOOOOOOOO...any one home? You haven't stressed yourself into the hospital have you? Let us hear from you when you can!

[goldengirl88]

Kenny:
Where are you? Please just give us a few words to let us know you and Gracie are alright. I am worried as you usually answer us. Please just drop us a line. Blessings
Patti

[doxiesrock912]

Kenny,

has something happened? We're getting worried hon.

[goldengirl88]

Kenny:
Please we are worried about you and Gracie, I am praying you are on a vacation or something, but feel you would have mentioned that to us. Whatever is wrong we are here for you, please just type one word as in OK. Blessings
Patti

[goldengirl88]

Kenny:
PLEASE just one word to let us know what is going on. We are all highly concerned about you and Gracie. I don't know what else to say, but I feel something is really wrong. Blessings
Patti

[goldengirl88]

Kenny:
I am continuing to reach out to you in hopes you will answer me. I am getting suspicious that something has happened that is bad and you cannot talk to us because you are distraught. That is the only conclusion I can come to. If it were a vacation, you have been gone too long now. Please I beg you, just one word to let us know, as everyone is extremely worried. God Bless You and Gracie.
Patti

[Squirt's Mom]

Sometimes the vets don't like their clients participating in forums like this or researching online. His vet(s) may have encouraged him to stop talking to us for a while....I'm hoping that is what is going on anyway.

[Budsters Mom]

Well, I don't like it!! We are all worried about the both of them.:o

[goldengirl88]

Kenny:
Leslie may be right. Maybe your vet said to stop talking to us. If so please just say so and we won't keep bothering you. Blessings
Patti

[Squirt's Mom]

Just popping to let you know we haven't forgotten you nor Grace. I hope you both are well!
Hugs,
Leslie and the gang

[Budsters Mom]

Yes Kenny,
We do care about you and sweet little Gracie. Please let us know how you are. I miss you both.

[Frana12000]

Hello

You would think this was, my story although my Maltese is 12 exactly the same story except reading were not as high

[Squirt's Mom]

Hi Frana12000,

We would love to hear about your baby! It seems our friend Kenny here has disappeared for some reason, which makes us sad, so it is unlikely he will respond to your post any time soon. :(

However, please start a thread for your baby where you can tell us all about them and keep all their story in one place. Just go to the main discussion page - Canine Cushing's Questions and Discussions (hyperlink found at the top of this page) - then click the blue box that says "New Thread". A box will open and you will set the title for your thread then start typing in the box.

I look forward to hearing about your baby very soon!
Hugs,
Leslie and the gang

[KennyJ]

Wow, I was not getting any new messages from you guys. I was just coming on here to update you on Gracie. As you know Gracie was found to have a gallbladder mucocele. The IMS decided to treat Gracie with medical therapy. Well yesterday was her recheck, another ultrasound and more lab work. The ultrasound found the mucocele had decreased in size at about 50%. That's the good news. However, the vet just called me today and said they were very disappointed that her liver enzymes had not changed. This concerns all of us. If anyone has any advice please give. The thought is probably Cushings is also something that Gracie has but we have yet to test her. I take her back in two months with another ultrasound and more lab work. I have Gracie on Denamarin and ursodiol. Really not happy that her enzymes failed to decrease.

[Budsters Mom]

Kenny,
Welcome Back!!
We have missed you and Gracie. I personally thought that you dropped off the face of the earth or the aliens came and took away!:eek::eek::D I am so glad that you are back!:)

[KennyJ]

No, I was just getting ready to post and saw your messages. I don't know what to do at this point. The IMS and I both thought her liver enzymes would be a lot less since her treatment for the mucocele had decreased in size. Very upset about this.

[molly muffin]

Hi Kenny, so glad to see you again. I know that it is disappointing, but it can take time for the liver enzymes to go down. It is fantastic news that there has been a 50% decrease, but it can still be affecting the liver enzymes even with that. With the support it can take awhile to see that have an effect also. I was disappointed after 2 months not to notice a decrease, and only finally in May this year did we start to see a decrease in the Alkp numbers. That is after at least 7 months. So it is possible that it may take longer with Gracie, as her body is still working with getting the gall bladder sorted out. That makes the liver work harder and the support supplements is definitely beneficial with that. The numbers haven't gone up have they?

Again, so happy to see you online.

Sharlene and Molly Muffin

[Squirt's Mom]

Goodness! It's good to hear from you again! We were worried you had stroked out from stressing over all this. ~~whew~~

Glad to see you again!

[KennyJ]

Sharlene, Gracie's previous ALKP was almost 3500. This last test it was over 3200. I was so excited knowing that the mucocele had decreased in size and both the IMS and I were thinking her ALKP would also be a lot lower than this. I hope you are right about maybe it just takes more time.

[molly muffin]

300 points downward in 6 weeks is not bad. It's definitely the right direction. If it had continued to go up, then I'd say they need to be looking at the ultrasound a bit more carefully.
So, I'd say retest and see if it is continuing it's downward trend going forward, I have asked before to just test the ALKP and ALT to see where my Molly is.

Is her leg doing okay now? No more limping at all?

Sharlene and Molly Muffin

[KennyJ]

Sharlene, it's probably more like 8 weeks. Her leg is doing great!!!

[goldengirl88]

Kenny:
I am so glad you are back. I am glad Gracie is still doing well. I was really worried when we did not hear from you. Blessings
Patti

[frijole]

OMG Kenny you just can't disappear like that. We were worried sick about you and Gracie! Seriously.

Great news on her leg and it sounds like she's actually improving on the other front as well. Do keep us posted and don't make us worry like that again! We becoming 'vested'. :) Kim

[doxiesrock912]

Kenny,
hi! We were worried that something really traumatic had happened and I'm glad to see that it hasn't :)

One thing at a time sweetie, Gracie and you will get there. Now that the mucocele has been taken care of..how are her legs? I remember weakness and an ACL problem. Am I correct?

If the ACL is stable, now it's time to address the possible Cushings and time to test to be sure. Daisy is also on urisidol long term.

[KennyJ]

Valerie, they were really hoping and actually thinking that her ALKP would have been a lot lower than it was. That concerns them and does me as well. Mucocele reduced in size but still there.

[goldengirl88]

Kenny:
I can't tell you how glad I am to see you are posting again. I thought something had gone terribly wrong and we were all worried about you and sweet Gracie. Glad to hear the mucocele is smaller and she is doing well. Boy that was some break you took, scared me to death!!! Blessings
Patti

[KennyJ]

So since her liver enzymes didn't lower like they had hoped does that mean they will never decrease??

[goldengirl88]

Kenny:
Sometimes it takes a while to lower them.

[molly muffin]

No it doesn't and I wouldn't say never. It has taken a year for Molly's to come down some. They still aren't in normal range, but I'll take any drop I can get. That is just using a supplement.

Sharlene and Molly Muffin

[KennyJ]

Ok, Gracie has a ear infection so I took her back to my regular Vet. He also said Gracie has a pot belly and her fur is thin and looks like a dog that has Cushings. So once again I tell him that he says Gracie every year for her annual exam and not once did he ever mention that to me before. I told him about the gallbladder mucocele and even brought the film in case he wanted to take a look. However, he said he probably could not tell that much by looking at them because that was something he wasn't very well trained in. I didn't think that made much sense in all honesty. He asked if both adrenal glands were enlarged or just one. If it's just one it is most likely a tumor on the adrenal gland. He said that even if she did have Cushings that the meds would onlly be treating the symptoms and not the disease and that if he gave the the meds I took the chance of destroying her adrenal glands and that she would die from that. He said he is treating several dogs for Cushings and they are heavily monitored. I already knew that was a must. I guess my point is this. He didn't seem that excited about treating her even if she did have Cushings because he said no matter which way I go that Cushings would shorten her life even if treated and it's only if the symptoms are problematic to the owner that's the only reason to treat it.

[molly muffin]

I would suggest sticking with the doctor that is treating the gallbladder. They seem a bit more up to date on what is going on.
Is there a reason you decided not to go back to see her gallbladder specialist?
How is the ear infection doing? Is it clearing up? Molly had an ear infection I had to have treated.

hugs,
Sharlene and Molly Muffin

[KennyJ]

Only because he is near where I live. The IMS is near my work.

[Budsters Mom]

Hi Kenny,
It is terribly frustrating and confusing when different vets tell you different things. It is hard to know what to believe. I am glad to hear that Gracie is still hanging in there and that you're still up on things. It's best to get that ear infection cleared up first, then go from there.
Hugs to you and a belly rub for sweet Gracie.

[molly muffin]

Only because he is near where I live. The IMS is near my work.

Ahhh, okay. Proximity is important too. :) However, when it comes to doing the testing for cushings (how is that gallbladder doing?) then I'd go with the one who is doing the treatment for the gallbladder. Once that is better and she feels it won't affect the ACTH testing, then you could proceed with that.

How is her ACL doing? Is that all healed up now? You certainly did have a heck of a summer. I hope the fall is going to be much better for you and Gracie.

hmm, are we going to get some new Gracie pictures??!!! :D:D

hugs
Sharlene and Molly Muffin

[KennyJ]

Her leg is much better. You would never know she injured it looking at her now. Question. Gracie's constant licking and biting her legs are getting worse. It has driven me crazy and I am sure it's driving her crazy. Could this be caused by Cushings?? Treating her for a severe ear infection now. This has been so frustrating and very expensive.

[Squirt's Mom]

The leg biting and licking sounds like an allergy to me. Do you know when it started - like when the grasses started growing or any other plant she comes in contact with outside that may not be in bloom or leaf during the fall and winter? You might try wiping her legs down real well when she comes in from outside to see if that helps. You might also try some Benedryl. Has the vet said anything about this itching?

What is she taking for the ear infection? Any possibility the itching is a side effect of the med?

[goldengirl88]

Kenny:
I would try the Benadryl. Since Tipper got Cushings she does lick herself a lot also. I read somewhere it is one of the things that comes with it. Some dogs lick furniture etc. If the Benadryl does not work, I bought some dog socks that work well, let me know and I will tell you where to get them, they stay on with a harness that comes with them. They were cheap also. Blessings
Patti

[Budsters Mom]

Hi Kenny,
The scratching and leg biting could definitely be allergies. I am on my second allergic fur baby! Benadryl's dosage is 1mg. Per pound up to 3 X daily. It is considered safe, but does cause drowsiness. Night dosing is best because of this. Benadryl should be dosed with food as it may irritate the stomach. Since Gracie has other issues, please check with her vet before starting any new medication.

Could the scratching and leg biting be due to fleas or flea allergy dermatitis? A single flea bite can make an allergic dog scratch intensely for months. It is the flea saliva that they are allergic to. You mentioned that Gracie had an ear infection. They are common in allergic small dogs. Allergies cause a build-up of fluid, which easily become infected. Bathe Gracie carefully to minimize getting water in ears. You might also want to trim the hair around her ears so that more air gets into her ear canals, thus drying them out. Ear fluid and water can make a nasty infection. I wash my dog's head with a wash cloth, to avoid getting water in the ears. Xxxxx

[KennyJ]

I also noticed her water consumption has increased. She really urinates likes crazy as well. Trying to get the gallbladder mucocele under control first but I am seeing more and more symptoms of Cushings.

[molly muffin]

When do you go back to have the gallbladder progress checked Kenny?

Sharlene and Molly Muffin

[Harley PoMMom]

From my research on ursodiol, one of the side effects can be itching.


Skin rash or itching over the entire body http://www.mayoclinic.com/health/drug-information/DR601407/DSECTION=side-effects

[KennyJ]

Wow, I was just about to research that and just like that I came to the forum and found you had already done it. The itching is driving me and Gracie crazy. She also urinated in the bed the other night.

[doxiesrock912]

Poor thing.
Daisy has been on urisidol for months without itching. Ask the vet about Benadryl. It might make her sleepy though.

[goldengirl88]

Kenny:
Tipper is also on it and I haven't noticed her itching either. What mg is she on? Blessings
Patti

[molly muffin]

Kenny :) How are things going with Gracie? did you go back and see how the gall bladder is doing? Hope all is well with you and Gracie both.

Sharlene and Molly Muffin

[KennyJ]

Sharlene, I need to make another appointment to have another ultrasound and lab work. Gracie is drinking more water and she had another accident in my bed last night. She has gotten worse. Her leg seems to be ok although tonight coming up the steps she stopped and I had to carry her the rest of the way.

[molly muffin]

If the ultrasound shows that the gall bladder has responded to the medicine and no more blockage, sludge decreased to acceptable levels, then you could probably have a chat with the vet about doing a full blood panel and an ldds test or acth test to check for cushings.

It depends on how that gall bladder looks whether it would mess with the test results or not.

How as she when you put her down after bringing her inside? Molly will sometimes not want to go up the steps and stop for a "lift".

Sharlene and Molly Muffin

[Squirt's Mom]

Any chance this is an UTI?

[KennyJ]

Sharlene, Gracie was motoring up the stairs after I had complete rest for a couple of months. Now she sometimes stops and I have to carry her the rest of the way. I don't notice her limping but she has chewed and licked her front leg until it is red. It actually feels like there is a place on her leg. I am not sure if that is from all the biting but it's driving her and myself crazy because she can't stop biting it. I take her back for another ultrasound and lab work on Monday. I bought some shampoo with aloe thinking that may help her itching and biting and wow, her undercoat is almost gone completely. You don't notice it as much when her hair is fully dried. Her last ultrasound showed her mucocele had decreased in size but still sludge present. I see more and more symptoms of Cushings now.

[Squirt's Mom]

NOT saying this is what is going on with her leg but it something you need to be aware of since this has gone on for sooooo long - it's called Lick Granuloma

http://www.petmd.com/dog/general-health/evr_dg_acral_lick_granuloma_a_dermatology_nightmar e#.Un_WquIlikw

http://healthypets.mercola.com/sites/healthypets/archive/2012/08/31/dogs-lick-granuloma-disorder.aspx

http://pets.webmd.com/dogs/lick-granuloma-licking-sore-dogs


Is she still having accidents?

[Budsters Mom]

Hi Kenny,
Biting at the wound only makes it worse and increases the risk of infection. I'm not sure where on her front leg this is occurring. If it's a foot, you can try putting on a baby sock and taping it down. Be sure to tape to the sock, not to the leg, because the tape will stick to her hair.:eek: if it is not a foot, you can try wrapping it. If she continues to chew at it, then you will probably need to cone her. They make soft collars now that might work, instead of the hard, yucky, cones. Since you are taking her to the vet tomorrow, ask them what they suggest and see if they have anything that might help. Hugs,

Kathy

[goldengirl88]

Kenny:
You can also get a pair of baby tights and put all the way up the leg. Tipper had that problem a while back and I put Derma Paw on it which was great, and the socks I bought online that have a halter on them to keep them up. Blessings
Patti

[KennyJ]

I didn't notice just how thin her hair was until I gave her a bath trying to soothe her itchy front leg. Wow, hardly no undercoat at all now. Has to be Cushings. She is the Vet's office right now getting another ultrasound and more lab work. I feel so sorry for my little girl. Breaks my heart. I know one day I will have to say my goodbyes but I am just ready for that right now. And my regular Vet said unless I just wanted to treat the symptoms he didn't see a need to treat the Cushings at all because it would not prolong her life and that Cushings does cut down on the lifespan. She is at the internal medicine Vet right now getting her ultrasound. What do you guys think?? Go ahead and test her for Cushings and start treatment? And her biting and itching is on her upper left front leg.

[Roxee's Dad]

Hi Kenny,
Let's wait until we see the results of the Ultra sound and hope they get a good look at the adrenal glands.

But your vet is WRONG!!! Many here are proof that Gracie may live a normal lifespan if diagnosed and treated properly for cushings.

Not treating will definitely shorten her lifespan.

[KennyJ]

John, all the internal medicine Vet says is that her adrenal glands are plump. Nothing else. The last time I didn't even get the view graphs. I think I remember one of them being slightly larger than the other one. I would let this Vet do the Cushings test since she has done all the other stuff including the ultrasound. Right now I am still just numb to it all. Another thing John. I remember discussing treatment options with this vet and she said she would treat with meds twice a day. Gracie weighed in this morning at 10.7 lbs. Is that normal protocol for treatment and what is the dosage for a dog this small??

[lulusmom]

Hi Kenny,

If you get a confirmed cushing's diagnosis and choose to treat with Vetoryl (Trilostane), recommended dosing is 1mg per pound of body weight. If your vet chooses to go with twice daily dosing, you would have to split that dose in half, so to start, you would be giving Gracie 5mg in the am and pm. Vetoryl does not have that dose available so you would have to have it compounded. One of the most reliable, trusted source for this is Diamondback Drugs in Scottsdale, AZ. I've been using them for eight years. Your vet may want you to start at a higher dose but do not do that. While not reflected in the Dechra's (manufacturer) packaging insert, they verbally told one of our admins, Marianne, that they recommend starting at the lowest end of the range shown by weight. UC Davis established their own protocol, based on their extensive experience with the drug, and their much more conservative dosing recommendations addressed the disparity in Dechra's dosing recommendations, which if followed to the letter, can place a dog at great risk of being overdosed. Unfortunately, a good number of gp vets, who take on the responsibility of diagnosing and safely treating a cushdog, don't feel compelled to attend continuing education courses to further their knowledge of the disease or its treatment. They simply pull out the packaging insert and read the instructions. That makes perfect sense and you should be able to rely on the fact that these recommendations are safe but they are not! The manufacturer has chosen to do nothing about revising the dosing recommendations because they would have to jump through a lot of hoops in order to alter any of the written material that was submitted to the FDA for approval. That is exactly what Dechra told Marianne and I find that infuriating.

Glynda

P.S. We have lots of reference material on Vetoryl (Trilostane) in our Helpful Resources subforum. I heartily recommend that you take a look when you have the time.

[KennyJ]

So the makers of this drug tells one of our administrators not to exceed l mg per lb but will not change it on their package??

[Budsters Mom]

Kenny,

Believe what you want, but this information comes from more than one administrator. One who knows more than many of us put together, I might add.;) Even my GP vet who had many things wrong regarding Cushings treatment, knew the amended recommended guideline of the 1 mg. per pound starting point when dosing Vetoryl ( Trilostane) The lower starting dosage allows the dog to adjust to the meds. with hopefully less severe side effects. Stomach upset is very common when starting Vetoryl. Larger doses can cause a sudden drop in cortisol level, which can be life threatening. That can even occur with smaller doses, so monitoring is the key. You are free to call Dechra (the manufacturer) yourself. I did.

[Trixie]

Isn't it crazy that they don't update the package!!?? My dog was about 16 pounds and we started treating-- 12mg (6mg 2x a day). Diamondback can compound the doses that aren't made by Dechra. Their prices are good too.
You definitely want to go in low and slow with Vetoryl/Trilostane.
It was slower to see results starting with a low dose, and we did gradually increase along the way, but I think it was worth it to avoid side effects and get the dog conditioned to the med.
My dog has done quite well on this medication. Her symptoms are controlled and she's got plenty of energy and spunk in her and she's 9 and a half.
Hope Gracie will feel better soon!

Barbara

[Squirt's Mom]

From that Helpful Resource section Glynda directed you to -


http://veterinarynews.dvm360.com/dvm...date=&pageID=1

The UC-Davis current recommendation is to initiate trilostane therapy at 1 mg/kg once daily. That dose is continued for about one week until a veterinary re-check can be completed.

UC-Davis (Uni. of CA - Davis campus) has done studies on Vetoryl (Trilostane) since it was approved for use in the US and their findings do NOT support the starting dose recommended by the manufacturer, Dechra. And several members here as well as "one admin" along with several vets of the pups here have been told the exact same thing.

Your best best move at this point is to finally start educating yourself on this disease and the treatments available so you can educate your vet since he insists on telling you incorrect info. ;)

[KennyJ]

Oh I believe you, I was just shocked the manufacturer would not change the dosing on their package. I printed this information off because Gracie is showing more and more symptoms of Cushings. Now, if she is closer to 11 lbs than she is 10 will they adjust that or still go with the 5mg twice a day? Also, the internal medicine Vet uses Wedgewood for their meds. I couldn't get the link to work on the above post. Barbara, they really went low with your dog didn't they? If she weighs 16lbs why didn't they do the 8mg twice a day??

[Trixie]

If I were you even at 11 pounds I would not go for more than 5mg 2x a day to start with. We started below 1mg per pound for the first go around. Better safe than sorry. My vet was pretty conservative about the dosing and from reading this board I was pretty nervous about starting too high, the idea that my dog would react badly to the med had me on edge...so I was fine testing the waters below the standard. We did a lot of dose tweaking. My dog is now on 14mg 2x a day...but we got to this dose without any adverse effects.
The symptoms won't disappear overnight but when they finally do it's a relief for both you and your dog.
Barbara

[Trixie]

Check out the prices...you can go with the pharmacy your vet uses for the first script...if it's cheaper online you can order it from wherever you like.

[labblab]

Kenny, if your IMS wishes to proceed with twice daily dosing, my guess is that she'll opt for 5 mg. twice daily. Even though Gracie weighs 11 pounds, you don't have to fine-tune the dosing formula that exactly.

There is nothing wrong with starting with twice daily dosing. Some clinicians prefer once daily to begin with -- others prefer twice daily. After Gracie has been taking the drug for awhile, she will be re-evaluated and her dose altered if that seems desirable.

As far as compounding pharmacies, if Gracie were my dog, I believe I would feel more comfortable using a pharmacy that has not received inspection citations from the FDA. FDA issued a report on Wedgewood last spring -- you can find the report on the list here if you want to look at it:

http://www.fda.gov/AboutFDA/CentersOffices/OfficeofGlobalRegulatoryOperationsandPolicy/ORA/ORAElectronicREadingRoom/ucm340853.htm

You can discuss this inspection report with your vet, but I would feel more comfortable using a compounder that is not on this list. Many of our members use Diamondback Drugs in Arizona. I'm sure folks can give you additional recommendations.

Marianne

[Squirt's Mom]

Here ya go - it works from the page in the Helpful Resource section -

http://www.k9cushings.com/forum/showthread.php?t=185

[Roxee's Dad]

Hi Kenny,
One step at a time, let's get her US done, check out the gall Bladder, another look at the adrenals and Cushings testing. You have been given some great advice... start low and slow.

Keeping all fingers and paws crossed that Gracie's Gall Bladder is all cleared up and we can move on in this journey.

Let us know what testing your vet plans on doing. Have confidence in yourself, you have learned so much I am confident you will be the best guardian Gracie could ever ask for. ;) Your cush family will always be here to help, listen or just to let you bounce your ideas and thoughts.

[KennyJ]

Wow, Gracie has a bacterial skin infection all over her body. Both ears have an infection. She is now on antibiotics, a medicated shampoo, more ear drops, and still on ursodiol. This is all very strange. The IMS says she needs to be tested for Cushings. I expressed my concern on the dosage and she said she would always start on the lower end. She also said she thought they had changed that on the package. Her mucocele was about the same as the second ultrasound. The only positive was the bile seemed to be flowing better. Depressed!!!:(

[molly muffin]

oh dear, poor little Gracie. Did they do a skin scrapping to see if it is caliconosis cutis?
If so maybe it would help to get the cushings testing done. If it's cc, then there is a likely hood that high cortisol is contributing to it and if she has cushings, then she is going to be prone to infections.
What test are they recommending they do, the LDDS or the ACTH? Is her liver/adrenal glands enlarged at all? If you don't know, you can ask the vet that has the ultrasound results if they are or not.

Sharlene and Molly Muffin

[KennyJ]

Sharlene, the ultrasound shows her adrenal glands as being plump. This IMS uses the ACTH test and that's what she will perform. She didn't say what kind of skin infection, just that it was a bacterial skin infection. The poor little girl also has an ear infection in both ears. So bad she said you could not see the ear canal. I can't believe all this just started happening the last several months. Makes no sense.

[doxiesrock912]

Kenny,
A bacterial skin infection is what lead us to test Daisy for Cushings. She also received antibiotics and medicated shampoo. It will clear up quickly though. Test for Cushings because the skins problems will continue without treating for Cushings.

Until this time, Daisy never had a skin problem so it was definitely related to the Cushings.

[goldengirl88]

Kenny:
Forget the tights you may have to get Gracie a baby onesy to wear so she does not scratch herself and make it worse all over. Blessings
Patti

[KennyJ]

Is there anything I can get besides this Ecollar she was given?? Just what do these vets think when they give her this? They told me to never take it off. Ok so in other words she can't drink or eat her food with this thing on. Sorry I had to take it off. Is there anything else I can place on her front leg to keep her from biting and licking? Also, I just got the lab work back and her ALP has come down from 3272 to now in the 2000 range. Still very high but in the right direction. Does this matter at all when it comes to the liver enzymes?

[goldengirl88]

Kenny:
Did you look into the baby tights, that would eliminate the leg chewing. The baby onesie would not allow her to scratch her body. You could put them both on her and she would not have to be wearing that horrible E collar. Blessings
Patti

[Roxee's Dad]

Hi Kenny,
Was Gracie professionally groomed before this skin infection happened?

[molly muffin]

There are some soft collars, that sort of do the same thing but are more easy for them to maneuver with.
They have to learn to put the collar over their food and water bowls to eat and drink, but usually when you are watching them carefully you can have it off. Maybe because Gracie's is such a bad infection, they don't want to take any chances?

I think the gall bladder was causing the ALP to be so very high and that now that is getting better that number is coming down a bit. If cushings is in the picture too, it will probably remain a bit on the high side, but not in the 3000's at least.

Actually the baby onsies is not a bad idea. We have had members use these before, with great success. Also good for keeping doggie diapers on when they are having accidents all the time.

Sharlene and Molly Muffin

[Trixie]

I once used the sleeve from a soft cotton long sleeve T shirt for Trixie because the e-collar freaked her out! It dragged when she walked and spooked her. I took the sleeve, cut it to her size and it kind of fit over her body like a sausage casing. I did have to keep my eyes on her but she couldn't really get at anything when she had it on.
They also make a soft donut --like this one, which seems a little kinder and certainly less uncomfortable.

http://www.chewy.com/dog/kong-cloud-collar-dogs-cats-large/dp/47474?utm_source=google-product&utm_medium=cpc&utm_term=&utm_content=pla&gclid=CNa-g-XR4LoCFVRnOgodnVMAZg

Looks like someone has made a dog onesie...found this online
http://www.tulanescloset.com/magento/

hope you can find something that works for Gracie...I hate those e collars!!

Barbara

[KennyJ]

Yeah, her ALP actually dropped over a 1,000. Still way too high and most likely will never be in the normal range again. Hey Thyroid and everything else was pretty normal.

[Squirt's Mom]

"Pretty normal"....are there any values that are too high or too low other than the ALP?

[KennyJ]

Everything was normal on Gracie's lab with the exception of the following. Results on the left, reference range on the right.

ALP 2305 10-150 U/L H

TCO2 25 17-24 mEq/L H

Monocytes 12.6 3-10% H

Eosinophil 0.5 2-10% L

Platelet 572 164-510 K/uL H

Absolute Eosinophil 49 100-1250 ul L


On a side note I was not a happy camper when I picked up her lab work. They attached someone else's dog on the back of Gracies report that indicated this dog had lymphoma.

[KennyJ]

John, not sure how I missed your message but yes this started right after she was professionally groomed. That was the first thing I thought about when they gave me the news. Barbara, my Vet said you couldn't break the capsules up and she never mentioned that the drug could be compounded. So if its not compounded how on earth can she give the meds twice a day for a 10.7 dog?

[Roxee's Dad]

but yes this started right after she was professionally groomed

Back when I was a very active groomer, I like most all groomers would purchase shampoo's and conditioners in concentrated gallon containers and mix our own.

What I learned was that the shelf life of the mixed shampoo's was dependent on the quality of the water used when it was mixed. Tap water, chlorine content, well water etc... Shampoo (the kind we pre mix) will develop bacteria if left in the bottle too long. So I wanted to know how long was too long as their is nothing stated on the labels.

I wrote to the manufacturers of these various shampoo's and asked about this. They recommended that the unused mix be disposed of after 3 days, one day if using well water. The ones that didn't respond to my inquire, I didn't purchase anymore. Cleaning of the bottles used should consist of a vinegar and water solution before the bottles are reused again to kill any bacteria.

I am not saying that this is what happened but it could be the cause of her skin infection. You may want to check out your groomer and see if he or she is using concentrated shampoo and mixing it themselves. Especially vulnerable are the natural shampoo's as they contain no preservatives.

[lulusmom]

Hi Kenny,

I believe all of those lab abnormalities can be attributed to cushing's.

Glynda

[goldengirl88]

Kenny:
That is a very interesting thought that John brought up. It could be a possibility. Blessings
Patti

[Budsters Mom]

Thread hijack!!! Sorry Kenny

Hey John,
I've always mixed my own pup shampoo/conditioner. What's left always sits mixed until the next bath a few weeks later. I NEVER thought about the possibility of bacteria forming in the mix. :eek: it's time to throw out EVERYTHING that has been premixed! Ugggg! Thank you for cluing me in! ;):p

Kathy

[molly muffin]

Well I certainly hope you get this cleared up Kenny. I'm sure Gracie feels miserable too.

hugs,
Sharlene and Molly Muffin

[KennyJ]

Glynda, I believe you are right. Even the low eosiophil count mentions Cushings when I google it. Her water consumption has increased and it's nothing to see her urinate on the floors now. :( One more thing, the IMS that I am seeing did not mention that this drug can be compounded. Matter of fact she was talking about trying to get the dosage as low as possible but said you couldn't break the capsules up in smaller dosages.

[Squirt's Mom]

Vetoryl can be compounded into any size dose that Dechra does not make. ie, you cannot compound a 10mg dose but you can a 9mg, 5mg, 3mg, etc. Diamondback Drugs is a good compounding pharmacy that many here use for Trilostane.

[goldengirl88]

Kenny:
Never open the capsules as that is hazardous, Dechra says don't even let your dog puncture them. Like Leslie said many on here use Diamondback Drugs. What mg were they thinking of starting her on? You know the best start is 1mg per lb. If you start higher you are looking for problems, especially with a small dog like Gracie. Blessings
Patti

[molly muffin]

Well you are going to just have to Tell your IMS about compounded Trilostane. :)
sometimes we end up educating them too. LOL

hugs,
Sharlene and Molly Muffin

[doxiesrock912]

Kenny, we use Diamondback Pharmacy online for Daisy's Trilostane. Our IMS vet is familiar with them as are others here on the forum.

[KennyJ]

Hey guys, just got off the phone with the IMS. She is going to test Gracie on Monday for Cushings. I did ask about the compounded version and she says they do not recommend this for this particular medication. So what should I do?? I don't want to make her angry but at the same time I want what's best for my little friend. Also, not sure if its the meds they are treating her for the ear infection or the infection itself but Gracie is having a very difficult time hearing me now. Ok guys I need your help!!!!

[Squirt's Mom]

Is the medication for her ears a "mycin / micin" drug? Does it contain those letters in the name something like Gentamicin? Drugs in this class have the potential to cause deafness....even tho they use this class drug for ears, etc. It isn't a common reaction but it does happen. How is the infection?

As for the compounding, YOU are the boss, not the IMS. If you want to use a lower dose, if you believe a lower dose is what Gracie needs, then demand she prescribe a compounded Trilostane or find another vet who will work with you. Bear in mind, you do not have to use Trilo - Lysodren is also an option and again YOU are the boss as to which one you prefer. Let the vets guide you but learn to think for yourself and do your own research, because YOU know Gracie best of all. ;)

Hugs,
Leslie and the gang

[KennyJ]

Leslie, I don't believe those are the meds used for her ear infection. If we don't use the compounded version, the smallest dosage is 10mg. That is way too high. She only weighs 10.7 lbs.

[Squirt's Mom]

Just to make sure we're on the same page, this comment is the one I was responding to concerning the "mycin / micin" class of drugs....not the compounded Trilostane.


Also, not sure if its the meds they are treating her for the ear infection or the infection itself but Gracie is having a very difficult time hearing me now.

The current recommended starting dose for Vetoryl is 1mg/kg/day. At 10.7 lbs, Gracie weighs 4.86 grs (10.7 / 2.2 = 4.8636363...64 rounded to 4.86 gr). So her starting dose would ideally be around 5mg per day. The Dechra brochure, as you know, states a higher starting dose and that is more than likely what the IMS is basing her dosing on. Have you shown her the study from UC Davis about the lower starting dose?

[KennyJ]

She said she would not put Gracie on the recommended dosage, that it would be lower than that. If that's the case how on earth can she do that without using a compounded version of this drug?? And she preferred to do it twice a day vs once a day. So you would have to divide the 5 mg. into half.

[doxiesrock912]

2.5mg twice a day is what we started Daisy on. She was 11lbs.
I don't understand why the IMS is reluctant to use compounded Trilostane.

You can't break up the 10mg capsules
. That is dangerous and not recommended by Dechra (the manufacturer).

Our IMS used Diamondback Pharmacy for pets online without a problem when she lived in California.

If the IMS doesn't cooperate, I would get another opinion.

[KennyJ]

Valerie, this concerns me a great deal since she does not recommend the compounded version. It just so happens she is the only IMS in the area unless I took Gracie to the Vet school. However, Dr Leib has already said they would not treat her for Cushings that my regular vet could do that.

[molly muffin]

Check and see what medication you are giving Gracie for her ear infection please and let us know. We are looking for anything with mycin, micin, in the name.

Thanks,

Sharlene and molly muffin

[KennyJ]

Sharlene, here is the medication I am using for her ear infection.

http://www.vetapprovedrx.com/shop.asp?item_id=1770#.Uo6RmSeSETA

[molly muffin]

Kenny, taken from the website you just provided the link to:


The use of Otibiotic Ointment gentamicin-betamethasone-clotrimazole ointment has been associated with deafness or partial hearing loss in a small number of sensitive dogs eg. geriatric. The hearing deficit is usually temporary. If hearing or vestibular dysfunction is noted during the course of treatment, discontinue use of Otibiotic Ointment gentamicin-betamethasone-clotrimazole ointment immediately and flush the ear canal thoroughly with a non-ototoxic solution.

It is not always temporary. I believe Johns dog was permanently deaf as a result.

I would not use this any more and would call the vet and let her know what has happened.

Now, back to the trilostane/vetroyl deal. I thought it was 1mg/1lb recommendation, with U of Davis recommending 1mg/1kg. The lowest is 10mg made of vetroyl which would have to be given once a day, as you can't split the medication and if your IMS ever says you can, then you know that they aren't familiar at all with this drug or protocols for using it.

I don't know where your IMS is getting the information to not use compounded trilostane, when U of Davis, one of the top vet schools and doing research with cushings, uses Diamondback drugs for compounding. Obviously you have to have a good compounding pharmacy, and many of our members use Diamondback, or other compounding pharmacies.

Could be that your vet is using the insert brochure from Dechra which has incorrect dosage directions (since it would be an awful imposition for them to change the insert after using those guidelines to get approval to administer in the US) it is however, not what they currently recommend.

I think I'm having a frustration moment right along with you.

hugs,
Sharlene and Molly Muffin

[Roxee's Dad]

Yes, Our Rozee went deaf very shortly after the vet administered Gentamicin. Unfortunately for Rozee, it wasn't temporary. :(

I use nothing else but Zymox now. It works great! they have a prescription version and an over the counter version. I also use Zymox for my customers dogs that the ear canals look irritated or possibly infected.

Look in her ears, are they swollen inside, a dark red instead of a pretty light pink?

It seems to me that the ear infection and skin infection started right after the grooming, you may want to take a tour of that grooming shop and take a good look around. Many groomers squirt ear cleaner in the ears, and sometimes if they squirt it into a dog with an ear infection, there is suck back, when the groomer stops squeezing the bottle, it will suck back some of the ear cleaner liquid that was in the infected ear, thus contaminating the ear cleaner still left in the bottle.

As far as the Vetoryl, Sometimes a sit down heart to heart talk with your vet/ IMS may help.

[labblab]

Hi Kenny,

I just wanted to add a few thoughts as to why some vets may have a legitimate preference for using brandname Vetoryl over a compounded version of trilostane that is prepared from raw ingredients. It is important to know that compounded drugs are not the same thing as generic equivalents of brandname drugs. And I believe that more vets have become cautious about prescribing compounded trilostane subsequent to news of this 2012 study conducted by Dr. Audrey Cook of Texas A & M University. This study was funded by Dechra, so that may raise the eyebrows of those who are cynical. But Dr. Cook is highly respected internationally both as a researcher and a clinician. And these are the study results:


Compounded trilostane capsules (15 mg, 45 mg, or 100 mg) were purchased from eight pharmacies and assayed for content and dissolution characteristics. Capsules made in-house containing either inert material or 15 mg of the licensed product and proprietary capsules (30 mg and 60 mg) served as controls. Findings were compared with regulatory specifications for the licensed product. Altogether, 96 batches of compounded trilostane and 16 control batches underwent analysis. In total, 36 of 96 (38%) compounded batches were below the acceptance criteria for content. The average percentage label claim (% LC) for each batch ranged from 39% to 152.6% (mean, 97.0%). The range of average % LC for the controls was 96.1–99.6% (mean, 97.7%). The variance in content of the purchased compounded products was substantially greater than for the controls (234.65 versus 1.27; P<0.0001). All control batches exceeded the acceptance criteria for dissolution, but 19 of 96 batches (20%) of purchased compounded products did not. Mean percent dissolution for the purchased compounded products was lower than for controls (75.96% versus 85.12%; P=0.013). These findings indicate that trilostane content of compounded capsules may vary from the prescribed strength, and dissolution characteristics may not match those of the licensed product. The use of compounded trilostane products may therefore negatively impact the management of dogs with hyperadrenocorticism.

Here's the link for the abstract of this article published in the Journal of the American Animal Hospital Association:

http://www.jaaha.org/content/early/2012/05/18/JAAHA-MS-5763.abstract

The compounding pharmacies that were sampled in the study were not named. So on the face of it, there's no way to know from this study whether any individual compounding pharmacy was problematic in the past, or will be in the future. Historically, there has been no mechanism in place to validate the testing of any compounding pharmacies in terms of efficacy or contents. Validation has not been performed by the FDA, state pharmacy boards (other than Missouri), nor any other regulatory body. This issue has been the focus of congressional concern during this past year, and just this week some new legislation has been passed by Congress that will affect the regulation of certain large-scale compounders of drugs for human use in the U.S., but not the entire compounding profession.

There are definitely circumstances when there is simply not an available dose of brandname Vetoryl that is suitable given the size or needs of the dog. For instance, if your vet wants to dose Gracie twice a day, it is true that you will likely need to turn to a compounder to either obtain the brandname product to package into alternative capsule strengths (which is what the UC Davis researchers did in their most recent trilostane dosing research study), or else rely on the raw chemical trilostane that the compounder has obtained on their own.

However, given the results of Dr. Cook's research study, my own personal opinion is this: if I could not afford brandname Vetoryl to treat my dog, or he/she needed a dose or form (liquid) for which Vetoryl is not available, then I would definitely go the compounded route rather than not treat at all. But if I could afford to pay the price for the brandname drug, I would buy it. In the long run, that might save money anyway, because I wouldn't run the risk of scratching my head and performing multiple ACTH tests because I couldn't figure out why my dog was having rebounding symptoms or suddenly crashing while supposedly being maintained on the same dose of compounded drug.

Marianne

[molly muffin]

I just want to clarify, that Dr. Feldman has said that U of Davis uses brand name.
However, we had a member who said that from their studies they were impressed with Diamondbacks accuracy of dosage and they will write a prescription to them and work with Diamondback. This if from our member Bonnie's thread for her beloved Pia.


The vet was, once again, not our regular vet, but it was the one who saw Pia when our vet was on vacation, so she's becoming more familiar with Pia. An interesting aside was that she did a study on compounding pharmacies and trilostane, and when I mentioned Diamondback, she quietly told me that they were quite good (like you all didn't already know that). She also said that in her study of compounded trilostane from various pharmacies they found that the strength ranged from 100% to 150% of what it was supposed to be. Until we get Pia stabilized I've decided to stick with branded Vetoryl, but once we have a steadily good result, I'd like to switch to compounded. I agreed to do a little extra testing when we make the switch and she was pretty ok with that, especially if I use Diamondback.
http://www.k9cushings.com/forum/showpost.php?p=114229&postcount=255

Just so you'll know where I was getting my information from and any others who are also curious.
I do think they prefer to use the name brand though if possible.
You do have to be careful and not just go to any ole pharmacy and do your research. Then the IMS's have to be flexible too.

Hope that helps to clarify.

Sharlene and Molly Muffin

[KennyJ]

Sharlene, the problem is with the name brand they only come in 10mgs. That is way too much for Gracie. So I dont' understand how this IMS can prescribe a dosage that high.

[goldengirl88]

Kenny:
I forget how much does Gracie weigh?

[Squirt's Mom]

Sharlene, the problem is with the name brand they only come in 10mgs. That is way too much for Gracie. So I dont' understand how this IMS can prescribe a dosage that high.


Not Sharlene but here is the answer to your question. As you know, what the Dechra brochure that your vet is probably reading is different from what subsequent studies have shown for a starting dose of Vetoryl. Here is what the brochure says -


The starting dose for the treatment of hyperadrenocorticism in dogs is 1.0-3.0 mg/lb (2.2-6.7 mg/kg) once a day based on body weight and capsule size (see Table 1).

1 to 3 mg per POUND.

UC Davis has found that a starting dose of 1mg per KILOGRAM of body weight per day is a safer starting dose.

So the answer to your questions is the IMS is following what Dechra says in their drug insert (brochure) and NOT what UC Davis recommends.

Here is where you can see the chart she is more than likely looking at -

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

[labblab]

Kenny, just to add another "voice" to this conversation -- I would not say that the UC Davis recommendation of 1 mg. per kg. is "newer" than Dechra's -- it is an alternative recommendation based on their own experience with the drug that was referenced in a 2007 article that we have included on our Trilostane resources thread. Dechra has both a published dosing chart and also a published dosing range. The chart is the outdated information. The published dosing range of 1-3 mg. per pound is their current recommendation, but with a preference for starting at the lower end of the range. Some clinicians prefer starting even lower than that (such as is referenced in that 2007 article re: UC Davis' protocol at that time). But many others are currently dosing at the lower end of Dechra's recommended range: 1 mg. per pound. I am honestly not sure what initial dosing range the vets at UC Davis are currently using with their new patients, and that is something we'd love to find out for certain.

But based on Dechra's current formula, a starting dose of 10 mg. would be right at the lower end of their range recommended for Gracie. The problem with brandname Vetoryl is that this would require dosing her once a day (which may clinicians do recommend) as opposed to splitting the dose into two halves given daily (which is recommended by others). In my opinion, this is the piece you really need to sort out with your vet -- does she want to dose once daily with the 10 mg. Vetoryl capsule, or does she want to dose twice daily with a compounded product.

Marianne

[KennyJ]

Marianne, that's just it. When she and I talked about the dosage the first time she said she liked to do it twice daily. So if she did that there is no way she can use the brand name. Gracie only weighs 10.7 lbs. What are the numbers to look for when they do the ACTH test on Monday so I can be prepared when she calls me with the results? Any help you guys can offer before Monday I would greatly appreciate it. If she tells me Monday she wants Gracie on the 10mg, what do I say?

[labblab]

So Kenny, you're afraid she is going to want to start Gracie at 10 mg. of Vetoryl twice a day? One thing you could do is print out this page published by Dechra:

http://www.dechra-us.com/Cushings-Syndrome/Veterinarians/Prescribing-VETORYL-1.aspx

It was published relatively recently and clearly recommends beginning dogs at the lower end of the 1-3 mg. per pound -- total per day --dosing range. You can tell her that if she wants Gracie to start out taking brandname Vetoryl, you prefer that she begin at no more than a total of 10 mg. daily, and that will necessitate a single morning dose. After you both evaluate how she is doing on that dose during her first month of treatment, then you can decide whether and how her dose needs to be changed.

As far as the diagnostic ACTH test on Monday, it will be all about the numbers. There will be two blood draws, one before and one after the injection of a stimulating agent. What we all will be looking at is the second number: whether or not it is high enough to be diagnostic of Cushing's. When your vet calls you with the results, she will tell you the cut-off value for the lab she is using. Pretty simple, huh? But a number we'll all be interested in seeing!

Marianne

[KennyJ]

Marianne, is 10mg even low enough?? I want to make sure they give her the lowest dosage possible. I am really dreading Monday, I just know she has Cushings. Her symptoms have drastically gotten worse. Is there anything that can give the ACTH test a false positive?

[labblab]

Hi Kenny,

Yes, just like with the LDDS, it is possible for a dog to test "positive" on the ACTH even if it does not have Cushing's but instead is suffering from some other illness or injury that is causing the cortisol level to elevate. However, the ACTH is less likely than the LDDS to give a false positive result if Cushing's isn't really the culprit. This is the reason, though, why it is so important to consider a dog's symptoms in conjunction with the testing. If a dog is suffering from a profile of symptoms that can all be caused by Cushing's, "positive" blood test results are then much more trustworthy. And it sounds to me as though that is where we are with Gracie: she is exhibiting a number of symptoms that would all be explained by Cushing's, and therefore the IMS is wanting to see if the ACTH is consistent, as well. The frosting on the cake, as it were.

As far as the dosing, there is no way to know in advance what dose will end up being optimal for any dog. You make an initial guess based on weight, but that initial dose may need to be adjusted either upward or downward (and usually is). Starting Gracie at 10 mg. would be considered a reasonable starting dose by many clinicians, as I've explained above. You'll be watching her very closely, and she'll have follow-up blooding testing after 10-14 days. If either her behavior or her monitoring testing indicates that dose is too high, then it will be lowered. And on any day that she seems unwell to you, you can simply withhold the drug altogether. If she were my own dog, I would feel comfortable with starting at 10 mg.

However, if you would feel less worried beginning on a smaller dose, then you can certainly talk to your vet about the UC Davis protocol that Leslie told you about, and you can tell her that you'd rather start Gracie at that 1 mg. per kg. level. This will require getting compounded trilostane capsules, however, which your vet may or may not feel is in Gracie's best interest right at the beginning of treatment. So in that sense, there may be a trade-off.

The thing I want to stress to you, though, is that the initial dosing is a bit of a craps-shoot for every dog. You are making a guess as to what you think will be the right amount, based solely on weight. However, there is a huge variability in the amount that different dogs need, sometimes with little dogs even needing much bigger doses than large dogs -- It all depends on how each dog individually metabolizes the drug. So you are not making a permanent commitment to any given dosing level. You are picking a dose to start out with, and then you are monitoring your dog very carefully. If Gracie were to seem unwell on whatever dose you start with, you'd stop the drug immediately and revise the dose accordingly. So no matter what dose you start with, there is always the chance it will be too high (or too low). But the dosing can, and should, be revised accordingly.

I hope you can find a way to ease your worry about tomorrow's testing. The testing itself should not be a problem for Gracie. And if the result points towards beginning treatment, this is actually a good thing for her, because it means that there is a mechanism by which all of these problems may be eased for her, too.

Marianne

[KennyJ]

Marianne, wouldn't the 1mg per pound put Gracie right at the 10mg of the name brand?? Also can the gallbladder mucocele cause a false positive on the ACTH test? And I see vets using different tests. Most have said the ACTH test is what they use. I certainly hope this IMS knows what she is doing. Hey has anyone tried the liquid form?

[KennyJ]

Ok everyone. Getting ready to drop Gracie off and I need your support more than ever. I am still confused as to why the IMS does not recommend the compounded version of this drug.

[labblab]

Kenny, good luck with the testing! Yes, 10 mg. of brandname Vetoryl is what the manufacturer would recommend for a dog of Gracie's weight. I can't say whether the mucocele might have any effect on the test results. But remember, we are looking for a diagnosis that would explain all of Gracie's symptoms, which the mucocele does not. So a positive result on the ACTH would correspond with Cushing's being the cause of all her problems taken all together. We are looking at the big picture here.

You may have missed the reply I posted a couple days ago, but your vet may prefer not to use compounded trilostane because a recent study showed that some compounded products don't actually contain the right dose of medication in each pill or capsule.

I know you will be very nervous awaiting Gracie's test results, but I do think this is a step in the right direction.

Marianne

[KennyJ]

Well isn't this wonderful. The IMS decided to hold off on the ACTH test because she did some research over the weekend and found the eardrops had some form of steroids. Have to wait another 3 weeks.

[labblab]

Kenny, I know this is disappointing but it is the right decision if the eardrops contained steroids. The steroids could artificially elevate the ACTH result and give an inaccurate picture of Gracie's own natural cortisol level. So it is better to go ahead and wait.

Marianne

[KennyJ]

Change of plans. They want to clear up the infection in her ears and skin. Two more weeks of antibiotics and more ear drops. Wait 3 weeks and then test her for Cushings.

[molly muffin]

So in 5 weeks they expect to test for the cushings.

Did you mention the hearing problem to the vet?

Hang in there. You've come this far. If you need to look into diapers for Gracie, several of our members have used various means to keep them dry, cutting holes in a baby diaper, using a diaper with onsies over them etc.

hugs,
Sharlene and Molly Muffin

[doxiesrock912]

That's the best way to do it Kenny since any kind of infection can throw off the Cushing's test.

[KennyJ]

Valerie she was concerned that the ear drops contained some form of steroids in it and could affect the ACTH test.

[molly muffin]

Happy Thanksgiving Kenny and Gracie.
Hope things are going well.
hugs,
Sharlene and Molly Muffin

[KennyJ]

Thanks again everyone!!!

[KennyJ]

Gracie's water consumption and urinating has drastically increased. She will be tested for Cushings on December 30th. Her skin infection in my opinion hasn't gotten much better.

[Roxee's Dad]

Infection clearing up .... that's great news Kenny.

[molly muffin]

Nope, John, he doesn't think the infection is clearing up :(

I'm sorry to hear that Kenny. Poor Gracie has just been through so much this year.

I do hope that this cushing issue can be settled once and for all and maybe the cushing meds, if that is what comes of this, will help with the skin infection too.

How is her hearing doing?

Sharlene and Molly muffin

[Roxee's Dad]

Ooops. I read that wrong!! Hmmm.. I wonder if it could be the early stages of CC ?

[Budsters Mom]

That thought crossed my mind too, John. A bacterial skin infection that hasn't improved after many weeks of treatment and antibiotics? It could be a real stubborn infection, but CC is also a possibility if Gracie tests positive for Cushings.

I am so sorry that this has taken so long to sort out.:o
(((((HUGS)))))

[KennyJ]

Gracie goes for her ACTH on January 17th now. Her water consumption and frequent urination has increased drastically.

[Squirt's Mom]

Kenny, I would think hard about getting Gracie in to see a Derm vet asap.

[doxiesrock912]

Hi Kenny,
I agree. A dermatology vet is in order. Can you post pictures so that we can see her skin issues?

[molly muffin]

Hi Kenny, I hope that you can get some answers finally. It's been a long journey so far.
I hope you had Gracie had a good Christmas.
hugs,
Sharlene and Molly Muffin

[KennyJ]

The internal medicine vet said to try benadryl 3 times a day in addition to this medicated shampoo.

[doxiesrock912]

Kenny,
Benadryl is used to treat allergic reactions. Please be sure that Gracie doesn't have CC. Did the vet test for that?

[KennyJ]

ACTH test on January 17th.

[doxiesrock912]

Kenny, did the vet rule out CC with the skin issue? It's very different than a bacterial infection or allergy.

Here is a link to more information. http://www.vcahospitals.com/main/pet-health-information/article/animal-health/skin-calcinosis-circumscripta-and-cutis/590

[KennyJ]

No we both think it's Cushing related. Her symptoms have gotten worse. Urinates like crazy and her hair has gotten very thin.

[doxiesrock912]

Right, CC is common in Cushingoid dogs. If the meds don't work, this might be what is going on. Several on this forum have dogs with CC.

Of course, I hope that the meds work for Gracie :)

[molly muffin]

At this point, the sooner to get the ACTH test the better. The symptoms are piling up it seems.
Cushing dogs are prone to infections, they are also prone to cc, and the cc can become infected and be very resistant to get rid of. If this is part of what is going on, then lowering her cortisol should help. The only way to determine is if when they do the skin scraping they check for the calcinosis cutis. (cc)

Sharlene and Molly Muffin

[KennyJ]

OK this is starting to drive me crazy. She drinks until she is almost choking. And then urinates constantly. She's chewing all my shoes and that's something she never did. I also noticed she sleeps a lot more with less energy.

[molly muffin]

You have an ACTH test coming up though right. You could always ask them to do it sooner if possible?

Sharlene and Molly Muffin

[Roxee's Dad]

I'm with Sharlene... get an earlier appointment. and keep us posted.

[KennyJ]

It's scheduled January 17th. I can't move it up because they want her to be off the ear drops for at least 3 weeks.

[Roxee's Dad]

Today is the day... I guess it will take a few days to get the results but let us know.

[molly muffin]

checking in to see how things went at the vets

Sharlene and Molly muffin

[KennyJ]

Sorry guys, it was pushed back until Wednesday Jan. 22. Will keep you posted. So the test results will take several days???

[Budsters Mom]

No, just a day or two working days. Possibly three at the most. Hang in there Kenny. It will happen soon now.

Hugs,

[doxiesrock912]

Good luck Kenny!!!!

[KennyJ]

Ok everyone, Gracie had the ACTH test today. Dr Herring said the results would be back in a day or two. I already know she has it. There is no doubt in my mind. Drinking water like crazy, hair very thin, urinating all over the place. Even peed on my blanket again today that she was riding on. But this is my question. I would like to know this before the Vet calls me. What will be the normal range for the ACTH and then the High range that indicates Cushings?? Thanks as always.

[Roxee's Dad]

Normal: Pre-ACTH: 2–6 µg/dL - Post-ACTH: 6–18 µg/dL

cushings possible: - Post-ACTH 18–22 µg/dL

Consistent with Cushngs: - Post-ACTH >22 µg/dL

This is when not on treatment.

[doxiesrock912]

Hi Kenny,

I'm so glad that you finally got Gracie tested! I don't know the ranges, but if you ask the vet to email you the full report and what he recommends, then post it here, there are others who are really good at deciphering those things.

Don't be alarmed if something else is going on with Gracie, because Cushings wreaks havoc on the immune system, Cushpups are prone to skin infections and UTIs. If he prescribes antibiotics you'll want a retest once any other health issues are cleared up because an infection can throw the test results off.

Keep us posted :)

[KennyJ]

Even without the results back yet, I am positive she has Cushings. The symptoms have gotten worse. I hear people say you need to put gloves on when giving her the capsules, is that true?

[Roxee's Dad]

Human Warnings:
Keep out of reach of children. Not for human use.
Wash hands after use. Do not empty
capsule contents and do not attempt
to divide the capsules. Do not handle
the capsules if pregnant or if trying
to conceive. Trilostane is associated
with teratogenic effects and early
pregnancy loss in laboratory animals.
In the event of accidental ingestion/
overdose, seek medical advice
immediately and take the labeled
container with you

[KennyJ]

Good lord, and I am putting this stuff down Gracie's body?? I am not sure what is worse, the disease or the medication.

[KennyJ]

Vet just called. Gracie came in right above the normal range at 22.9 which she said was consistent with Cushings. She will be given a compounded version from Wedgewood Pharmacy at roughly 2.3 milligrams twice a day. She is also going to prescribe prednisone just in case. She didn't think I would need it since Gracie would be on such a low dosage but just being on the safe side. Ok guys, what do you think?? Does this sound like a good plan?

[labblab]

Kenny, if it were me, I would talk with your vet about using a compounding pharmacy that is included on this list:

http://www.nabp.net/programs/accreditation/vet-vipps/find-a-vet-vipps-online-pharmacy

This is an explanation as to the credentialing associated with this list:

http://www.nabp.net/programs/accreditation/vet-vipps

You will see that Wedgewood is not on the list. Additionally, the FDA noted a number of irregularities in an inspection report they issued for Wedgewood last February. I don't know how many of the internet pharmacies on this list can compound trilostane in the dose that Gracie needs, but I know there is at least one -- Diamondback Drugs in Arizona -- because a number of our members currently use them. I would talk with your vet about getting Gracie's medication from one of these pharmacies.

In terms of dosage, can you remind us what Gracie weighs?

Marianne

[doxiesrock912]

Kenny,
We also use Diamondback. Please call your vet and insist that they call in the prescription a
1-866-578-4420. Someone from Diamondbacks will then call you for payment information, mailing address etc.

Starting low is great and your vet is being proactive by giving you then Prednisone just in case.

Other than their choice in pharmacies, you're off to a good start.

[KennyJ]

Wow, thanks guys. They use Wedgewood for Gracie's other med, the Ursodiol. I called and told them to please use Diamondback for the Cushings.

[KennyJ]

But I have to ask, according to this statement on the Wedgewood site it sounds like they meet the highest standards.


Wedgewood Pharmacy has earned the Pharmacy Compounding Accreditation Board’s (PCAB®) Seal of Accreditation, demonstrating that it meets the highest standards of quality and safety in its profession. It was the first pharmacy in the Philadelphia area to earn PCAB Accreditation, on January 31, 2012.

[labblab]

Yes, you would hope that the accreditation would be meaningful, but here's the FDA's actual report for Wedgewood issued last February of 2013 (based on inspections conducted during the preceding three months). Several infractions are quite worrisome. Here is one example that seems especially troubling to me:



Raw materials such as bulk active ingredients are not routinely tested for identity, and raw materials being used in sterile compounded drugs are not evaluated for routine bioburden [microbial contamination]. Although quality agreements are maintained with suppliers of active ingredients, sampling and testing has never been performed for any active or inactive ingredients. There are no identity tests performed for any materials.

http://www.fda.gov/downloads/AboutFDA/CentersOffices/OfficeofGlobalRegulatoryOperationsandPolicy/ORA/ORAElectronicReadingRoom/UCM342543.pdf

Your vet may be unaware of this inspection report and might wish to read it herself.

Marianne

[KennyJ]

Thanks again Marianne. This is the same company that we use for Gracie's Ursodiol. I will most likely switch that over to Diamondback as well. Do you happen to know if they are open on Saturday? My Vet called in Gracie's meds yesterday and I have not hear back from Diamondback. They told me once they receive my prescription from my Vet they would call me to get my credit card and billing address. So far nothing.

[labblab]

Kenny, I have never used them myself, but I would think they will answer the phone on Saturday if you go ahead and give them a call. At least you can give it a try. Here's their contact page:

http://www.diamondbackdrugs.com/contact-us/

[KennyJ]

Marianne, your dog doesn't have Cushings, correct? And can someone answer me does it matter that Gracie's results just came in slightly above normal?

[KennyJ]

Totally confused, my vet called in 1 milligram capsules for Gracie. Two in the morning and two in the evening. Total of 4 miligrams. However, Diamondback makes a 2 miligram capsules and it's also much cheaper that way. Why would my Vet break it down into 1 miligram capsules?

[lulusmom]

Hi Kenny,

The beautiful white Lab you see as Marianne's avatar, is Barkis, her beloved cushdog, who passed from an enlarging macroadenoma. All of us admins have lost our cushdogs over the years but we remain here to help others who need us. Marianne is a prolific researcher and is one of our most knowledgable staffers and in my opinion, the most knowledgable of Vetoryl (trilostane).

To answer your question, I'd say that if Gracie didn't have any symptoms consistent with cushing's I would be hesitant to start treatment with what could be considered a borderline post stimulated cortisol of 22.9 ug/dl but it appears that Gracie has a number of symptoms consistent with cushing's. I believe those are excessive drinking and peeing, panting, thinning coat and a pot bellied appearance. I believe Gracie also had a cruciate ligament injury and gall bladder mucoceles. Cushdogs are at much higher risk for both. Given Gracie's medical history and current symptoms, I think there is much evidence that supports a cushing's diagnosis.

I highly recommend Diamondback Drugs. They compounded all of my tiny cushdogs' medications, including Trilostane and Mitotane.

Glynda

[molly muffin]

It could be that your vet called in 1mg pills because of the anticipation that you might need to adjust Gracie's dosage, either AM or PM up or down and you'd want 1mg to do that. There isn't anywhere to go with 2mg, other than having to then buy 1mg. So, this is probably to start until you have a stable dosage.

As for her being just out of normal range, I think the vet is also going on symptoms of drinking, urination, hair loss, skin problems, etc in conjuncture with the results of the ACTH tests. It might be that Gracie won't need a lot of medication to get in a normal range. Although the range for being on medication is not the same range as when you are not on medication.

I would go with the 1mg, starting out.

Sharlene and Molly Muffin

[lulusmom]

Totally confused, my vet called in 1 milligram capsules for Gracie. Two in the morning and two in the evening. Total of 4 miligrams. However, Diamondback makes a 2 miligram capsules and it's also much cheaper that way. Why would my Vet break it down into 1 miligram capsules?

That is a very, very low dose and I can see why you are asking the question. The only reason I can see for the 1mg capsules is so she can increase the dose very slightly, if needed. Honestly, I don't think either dose is going to be adequate. Can you tell me how much Gracie weighs now?

[KennyJ]

Glynda, thank you so much for your post. Gracie does have the symptoms you mentioned and Diamondback called my vet this morning at my request and asked why I couldn't use the 2 mgs capsule instead. Would mean one in the morning and one in the evening. My vet agreed. Not sure why that wasn't asked when the prescription was called in. Makes it easier on me and about $20 cheaper.

[KennyJ]

Gracie weighs around 10.2 lbs at her last weigh in. What do you guys think? A total of 4 milligrams per day.

[molly muffin]

I just want to add and second what Glynda has said, all of our administrators, especially, have extensive personal knowledge of cushings and have had dogs with cushings at one point or another. They have stayed, out of the goodness of their hearts to help others. Without them, this forum would not exist and we would all be lost.

You can trust that what they tell you is coming from personal experience and even if Marianne didn't use Diamondback, Glynda has and so have many others on here. We don't recommend something without having a reason to back it up. We combine what we have and all our other members through the years have gone through, experienced and put that together to help others who are new to this to benefit from their experiences.

Just a note on how the forum works and part of where we get out information from, along with extensive amounts of research . Hope that helps you to feel comfortable with us.

Sharlene and Molly Muffin

[lulusmom]

Gracie weighs around 10.2 lbs at her last weigh in. What do you guys think? A total of 4 milligrams per day.

I think your vet is being very conservative in her dosing based on a few things; one may be the borderline acth result but if you have expressed the same fear of the drug with your vet as you have here, I think that might be a bigger driving factor for her conservative dosing. I certainly appreciate a vet who is conservative in dosing over one who simply follows outdated packaging insert recommendations, which can be very risky. The good news is that with conservative dosing, the odds are that it'll either prove to be adequate or you'll need to increase the dose. Go with it, Kenny, and know that we're here to help you and Gracie along with way.

Glynda

[labblab]

Thanks for the kind words, Sharlene, and for all your tremendous help here!

And Glynda, here's a lotta love coming right back at you, because, AHEM...you are not exactly a slouch yourself when it comes to the research and knowledge department!!! ;) :)

Kenny, I know you didn't mean anything negative when you asked about me having a Cushing's dog. Right now, you are trying to get direct and personal feedback from others in the same boat, and I totally get that.

[KennyJ]

Oh no way did I mean anything negative. Hope you didn't take it that way?? By the way, Gracie took her first capsule tonight.

[labblab]

Good luck to you and Gracie!! :) :) :)

We'll be really anxious for updates! ;)

Marianne

[molly muffin]

Okay, we're marking it down, tonight is the first capsule. You are giving twice a day yes?

Sharlene and Molly Muffin

[KennyJ]

Ok, Gracie goes back on Monday for her 14 day retest. So far she has had no side affects from the drugs but I haven't noticed any change in her water consumption or wanting to urinate.

[Harley PoMMom]

Is Gracie's dose of Trilostane 2mg given BID for a total of 4mg daily?

[KennyJ]

Yes 2 mg, twice a day.

[Harley PoMMom]

She's on a pretty low Trilostane dose, which is a good start, but it may take longer to see any improvements in symptoms.

Will be looking forward to seeing her ACTH stimulation results. ;)

[KennyJ]

I hope someone can respond to this extremely fast. Gracie needs her meds twice a day. However, I need to leave here shortly so can I go ahead and give her evening dose right now?? I gave her morning meds around 7 am. I won't be home until around 10:30 pm tonight.

[Harley PoMMom]

Since she is on a very low dose of Trilostane, I think it would be fine to give her evening dose now; however, if you would feel more comfortable not giving it to her that would be ok too.

[KennyJ]

Ok, dropped Gracie off for her second ACTH. What kind of numbers should I be looking for after 14 days?

[lulusmom]

The goal of treatment is to get the pre and post stimulated cortisol within the therapeutic range established by Dechra which is 1.5 ug/dl - 5/5 ug/dl. If all symptoms have resolved, a post stimulated cortisol as high as 9.1 ug/dl is okay. Are you seeing improvements in symptoms?

[KennyJ]

No improvement at all.

[lulusmom]

If you haven't seen any improvement, cortisol is probably still too high. You'll find out soon enough when the results are back.

[KennyJ]

Ok, just got the results from her second ACTH. 14.2, not where they want her to be but for right now she wants to leave the dosage as is and retest in one month.

[labblab]

Kenny, that is actually a very safe route to take. We have learned that cortisol levels can continue to drop throughout the first month of treatment even when the dose remains unchanged. So by the time of the next test, Gracie's results may have gone lower all on their own. At any rate, your specialist will have a better idea at that time as to the amount by which to increase the dose in the hope of achieving the optimal response.

Marianne