suspected Cushings

[Jan W.]

My tale starts over 2 years ago. My lab mix Cinder has had some hypothyroid symptoms for years along with low normal T4 level. Then 2 years ago I finally talked my vet into trying thyroid medication and for almost 1 year she was like a new dog. Ear and skin inflammations cleared up, weight gain reversed, energy went up (was still participating in agility and improved!!). Then she slowed down again not wanting to go for walks with us. She started panting and became more heat intolerant and thirsty. Of course increased urination came along. I had a T4 level again done and it was higher normal so we reduced it. this happened again a few months later and T4 now more than normal. Reduced again. 6 months later, her symptoms are becoming more exagerated and she now increase appetite, has weak back legs with one paw staying turned over. My vet thought this was from possible pinched nerve and at almost 13 years old labrador, I did not want to persue major orthopedic/neuro testing and surgery. So opted to give her pain medications for a week and see how she does. She became worse (weaker in hind legs) and I realized there was something more going one here. I called the vet and I stopped her very low dose thyroid medication as I felt she was in thyroidtoxicosis and in two days time her loose stools stopped and her paw knuckling improved but still weak in legs. Her panting, thirst, urination improved slightly. So after more than a month I decided she might have Cushings symptoms. Went to Endocrinology specialized vet some distance from us. He did not feel she was cushionoid looking, but her liver enzymes were elevated and she had +1 protein in her urine. He decided I might know what I was talking about and ran an ACTH test on her. This came back positive 24.2 (normal high is 17). Not high for cushings though. So he felt we should see an internal medicine endocrinologist. "Tests done the way we did because of the lateness of the day and the distance I have to drive. Urine culture negative - urine creat. ratio negative, endogenous ACTH not available yet, ultrasound liver appeared normal except for nodule which they felt was hyperplasia ( this can elevate liver enzymes), spleen with lipomas (she had external lipomas all over her back, legs, chest, hips etc. everywhere) - , probably benign bladder polyp, alk phos 865(normal is 212) ALT 350 (normal 100) Cholesterol 406 (normal 320). Amylase 515 (normal 500-1500) My understanding that normal Cushings Alk phos is much higher than Cinder has. She has never had abnormal labs in the past. She lost 6 lbs while on thyroid and now has gained 5 of it back and all in her belly.
I can't imagine what else would give you all this if it wasn't Cushings. I will let you know the results of her endogenous ACTH results and where the vet wants to go from here. She did mention that she would use Trilostane if she decides Cinder is a candidate. She felt that her kidneys and liver were able to handle it. Jan W.

[spdd]

Welcome to the group. Someone with way more experience then myself will be along to help you shortly. This forum is a wealth of information, and I don't know what I'd do if I hadn't happened across this.

Sorry about your baby, but I'm sure soon with the help here you'll get answers.

Judi & Keesh

[Budsters Mom]

Hello and welcome from me too:)
I am sorry for the reason that brought you here, but so glad you found us. You have come to the right place! There are many K9Cushing's angels standing by to help and stay with you every step of the way. They love details, test results, any information you can get your hands on. The more the better. We will do all we can to help. Others will be popping in shortly to welcome you also. So again welcome Jan and Cinder.:) Hugs,

[Jan W.]

Thanks for all concerns - I feel that the first vet didn't feel Cinder looked like the typical Cushings due to her just coming off thyroid medications which made her coat improved and she wasn't full of belly. Have call into Vet for endogenous ACTH report and probably won't her until tonight. Thanks for being there. Jan

[Roxee's Dad]

Hi and welcome to you and Cinder,

The ALP is elevated and and although not off the charts, it is plenty high enough to investigate the possibility of cushings.

Was there any mention of the adrenal glands in the results of the Ultra sound?


urine creat. ratio negative,

Is a very good indicator that cushings is not present. While it can often give a false positive, it is very reliable to rule out cushings.

When you say she has increased appetite and thirst... is it extreme, like always searching for food, stealing food from places she never would normally steal or take food?

We could be dealing with Atypical cushings. I am sure some of our other members will stop by to welcome you and share in their experiences with typical and Atypical cushings. I assume that's what the endogenous ACTH test is for and was sent to the University of Tenn Knoxville?

[lulusmom]

We could be dealing with Atypical cushings. I am sure some of our other members will stop by to welcome you and share in their experiences with typical and Atypical cushings. I assume that's what the endogenous ACTH test is for and was sent to the University of Tenn Knoxville?

John, since the ACTH stim test is consistent with cushing's, I believe the vet did an endogenous ACTH to differentiate between PDH and ADH. This is not a stimulation test but rather measures ACTH levels in the blood. Dogs with pituitary dependent disease (PDH) can have normal ACTH levels but most often they are elevated. This is because at some point the pituitary gland goes haywire and the feedback loop between the pituitary and the adrenal glands is lost. The pituitary just keeps releasing ACTH no matter how much cortisol is in the system. Dogs with an adrenal tumor (ADH) have a healthy pituitary gland so these dogs have lower ACTH levels because the adrenal tumors secrete cortisol independent of the pituitary gland. The pituitary gland does exactly as it should and detects sufficient cortisol so it doesn't over produce ACTH. I hope that makes sense.

[Roxee's Dad]

Makes perfect sense :) Thank you, :) Oh wait, that sounded like an AT&T commercial.

but I guess I am a bit confused by the negative
urine creat. ratio negative

[Jan W.]

I forgot what the vet said about the protein/creatinine ratio except that it was within normal limits I believe. I called the vet today to see about the endogenous ACTH test results and she said that they had to redo them so it will be awhile before we hear and she is on vacation next week so we will talk on her return on the 30th. Hopefully we will hear by then.
Cinder I think would eat a whole cow if it was put in front of her. She will finish her food then go over to our other dogs' bowl to see if she missed anything and makes sure they are cleaned. She has never done this before. If we even open the fridge, she is there. She even finishes before the other dog which has never happened. But I'm not sure she is constantly on the hunt for food. She makes sure she is not left out of treats. I even have been able to get her to go on a walk with us by tempting her with treats. And she has not been real crazy about going on our daily walks.
Her adrenal glands appeared to have no problems noted on the ultra sound. So the Vet said she may have pituitary envolvement which is more common. Jan W.

[Jan W.]

You can get some supplements in liquid form and give by eyedropper. I have questions about supplements liquid or otherwise- I have been giving my dog supplements for years - the usual joint complexes, probiotics, etc. (my dogs were involved in performance (competition obedience and agility etc) during most of their life. But since Cinder probably had thyroidtoxicosis, I have changed my regime and added a few extra supplements. My neighbor is an elderly retired veterinarian and had his dog on some of these supplements so did some research and feel that they would be beneficial and cause no further harm. Once I found out that Cinder's liver enzymes were also elevated, I then started her on milk thistle concoction. I give these in liquid form as possibly better absorbed and less pills to give.
I do not give all the supplements I use every day and they are in very low doses most of them. My question is what is everyones opinion on milk thistle, dandelion, burdock, sam E for liver support. Also if we start my dog on trilostane - this might exacerbate my dogs arthritis experience due to a decrease in cortisol -is this correct?
Jan W.

[Squirt's Mom]

All those herbs are excellent and work well for dogs....the possible exception is the Dandelion. One of Dandelion's actions is as a diuretic. Since excess peeing is one of the signs of Cushing's, using Dandelion can confuse the picture by increasing the urination. It does have good cleansing actions for the liver, kidneys and other areas, tho. I have used the Burdock root, SAMe, and Milk Thistle (among others) with Squirt. She is allergic to the MT and can't take it unfortunately but it is a great herb for the liver and combined with the SAMe it works well. As far as using them with Trilo, I don't think it would be an issue but I'd do some deep research to make sure. We use Lysodren and they work differently. ;)

[Squirt's Mom]

Yes, lowering the cortisol can cause inflammatory conditions like arthritis to come to the forefront sadly. Most of us use some sort of supplements or herbs to counter this as best we can. Salmon oil (high in EPA and DHA), Adequan, Dasuquin, glucosamine, MSM, condroiton, as well as herbs.

[Jan W.]

Cinder had increased urination before using the dandelion and the amount I'm using isn't much so may not be very effective at the low dose. I'm just wanting to support her liver until we get all final test results back.
Her "pot belly" seems to be leveling out. She isn't looking like it is getting worse anyway. She gained 5 lbs in 1 month after I took her off the thyroid medication and all in her belly. She has no weighty areas anywhere else. She looks way too thin otherwise.
Someone asked just how hungry she is --- well, when taking a walk yesterday she stopped to chow down on fresh cow pies 3 times and wasn't going to quit until I used more enthusiastic reprimands. She also chowed down on a few dead grub worms from my compost pile that I pulled out and left in a bucket. So she's not very picky about what she eats these days. Jan W.

[Jan W.]

Yes, lowering the cortisol can cause inflammatory conditions like arthritis to come to the forefront sadly. Most of us use some sort of supplements or herbs to counter this as best we can. Salmon oil (high in EPA and DHA), Adequan, Dasuquin, glucosamine, MSM, condroiton, as well as herbs.

My dogs have been on joint supplements for years and fish oil. I recently increased the fish oil and Vit E. The vet wanted me to put her on Hills science diets mobility kibble, well I won't go into my beliefs about kibble but I did look at ingredients and they have major omega 3's with flax seed and fish oil. I tried some extra flax seed and Cinder has never been able to tolerate any of the grains etc. even with digestive enzymes. So had to back off the flax again. She get gas and loose stools badly.
At present she doesn't seem like she is in pain much so stopped all the tramadol he gave her - But if we start her on trilostane - then I may have to rethink the whole pain issue. I should have thought about the extra cortizol depressing any pain issues she had. I would not have kept her in agility as long as I did but she wasn't showing any signs of pain she just got weaker in the back legs and that's when I stopped her in agility and obedience as they have to jump over higher jumps than in agility. Jan W.

[addy]

I use Tramadol with my pup for her leg pain. I have a hard time finding the right balance with it. I read it can affect them neurologically especially along their spine. It definitely makes my pup off balance if I use it too frequently but it does help her back leg pain.

Our GP did not think my Zoe would be good for acupuncture, she gets too stressed but he thought I could try the lazer treatments. One of our members did underwater treadmill treatments for her pup which really helped the pups' mobility.

[Jan W.]

What did you read about tramadol effecting them neurologically along the spine? I would like to know more about this as my regular vet thought my dog had a pinched nerve in her spine and put her on tramadol. I felt there was more to what was going on with her hence looking at all the problems she was having that led me to the possible cushings. She may still have neurological problems but I think that is only part of the big picture here. This why I am seeing an endocrinologist. Jan W.

[frijole]

About the arthritis becoming unmasked as cortisol is controlled - it will happen no doubt. You might take a look at adequan injections - that's what I did for my gal and she lived to be 16 1/2. (4+ yrs using lysodren for cushings) I gave her tramadol once (cannot remember why) and it was the scariest night of my life... she was loopy - the dose was the recommended amount but when I compared notes with everyone else on the board at the time they had all had the same experience... we all ended up using 1/2 the recommended amount with success. (we suspect it had to do with them all being elderly dogs with compromised systems due to cushings)

Anyway- take a look at adequan. I'm glad I went that route. My other girl had other issues (a rare adrenal tumor but not cushings) and we ended up doing acupuncture and it worked wonders on her.

Kim

[Jan W.]

I believe my regular vet mentioned adequin at one point but he wanted to see how she did on the tramadol for a week. That's when I decided there was something else going on beside problems in the hind legs. I also thought the dose he gave was a bit much so did not give that much to her and then weened her off it when I felt she wasn't really in that much pain. My neighbor that is a retired vet also felt that Cinder didn't seem to be in a lot of pain either. I'm sure the pain can wax and wane with the amount of cortisol being excreted. Will keep the adequin in mind if we do prove she has cushings.
I had a fellow obedience classmate that had their dog on tramadol and it caused kidney problems big time. I know that it can also cause liver enzymes to be elevated and I spoke to the Internal Med vet and she didn't think Cinder's elevated enzymes was from the tramadol nor did she think it was from the excess thyroid she had been on.
But when you combine all the things going on at once here, I wonder?? Soloxine, heart worm medications, tramadol. I can't imagine that any of these helped lowering the liver enzymes. But we did redo her liver enzymes and they remained about the same after all was stopped or held.
Thanks for the info Jan W

[addy]

The (-) enantiomer is five- to tenfold more potent in NE uptake inhibition and has less affinity for mu receptor binding than for 5-HT uptake {05}. Electrophysiological studies show that tramadol, like morphine, depresses motor and sensory responses of the spinal nociceptive system by a spinal and a supraspinal action {18}. Some opioid activity is derived from low-affinity binding of the parent compound and higher-affinity binding of the mono- O-desmethyltramadol (M1) metabolite to the opioid receptors {01}. The analgesic potency of M1 is about six times greater than that of tramadol in animal models and 200 times more potent in mu-opioid receptor binding {01}.
__________________


I finally found the quote so I may have explained it wrong originally.

Sorry it took me awhile, I am sometimes not the best at organizing all my research:o:o

[Jan W.]

Wow --- I'm going to have to sort the tramadol reactions on the body piece by piece - It has been a very long time for me to know what all this means and I'm not sure I ever understood all this to begin with but will take a few extra wild blueberries and other brain supplements I have on hand and see if I can understand it. Thanks for the stimulation - I probably need to do these kinds of things more often to keep the dementia away. I kinda understand the first couple of lines but then my synapes go awry. Jan W.

[Jan W.]

I just received test results on Cinder for endogenous ACTH which was "low" indicating adrenal involvement rather than pituitary. So the vet said that we may need to repeat the abdominal ultrasound to have another look at her adrenals as the first one didn't show anything abnormal on her adrenals. At the same time we could look again at the bladder "polyp" . This could help us determine whether we should do surgery to remove the bad adrenal gland. I am not in favor of surgery in her present condition. OR
She felt that she did have cushings and we could just go ahead and start the trilostane because she would have used it with either adrenal or pituitary involvement.
I am concerned about starting trilostane if we don't have a definitive abnormal adrenal gland. The other problem I have is the distance to the vet if an emergency arises. My regular vet is 1/2 hour away with the emergency 45 min to 1 hour away. The Endocrinologist vet is 1.5 hours away at her emergency hospital. She said we would be understand if I wanted to do all this at my regular vet's place. Any suggestions. I know you are all out there giving hugs and they help believe me. I just worry about delaying the medication any longer. I know it is a slow progressive disease, but it's really hard to just sit here without doing anything and seeing her deteriorate slowly. Jan W.

[spdd]

My dog has normal adrenal glands, which they can't give me an answer as to why, however he is on Trilostane. He isn't adrenal cushings though, it's pituitary so it's a little different. I have heard also that Trilostane is used for both types, but regardless his adrenal glands aren't supposed to be normal from what I understand.
I have the same issues in regard to travel time with his regular vet, the college and emergency, so I have switched vets to have one a little closer, I've actually had to educate him a little, but as long as the dog is stable, then I'm happy.
I wish you luck with all of this. It's time consuming and extremely worrisome, but we love our babies, and they love us back for it.

[Squirt's Mom]

I just received test results on Cinder for endogenous ACTH which was "low" indicating adrenal involvement rather than pituitary. So the vet said that we may need to repeat the abdominal ultrasound to have another look at her adrenals as the first one didn't show anything abnormal on her adrenals. At the same time we could look again at the bladder "polyp" . This could help us determine whether we should do surgery to remove the bad adrenal gland. I am not in favor of surgery in her present condition.

I'm very confused here. First they say the adrenal glands are both normal then say he may need surgery to take out the bad adrenal? If both are normal, there is no "bad adrenal". :confused::confused::confused:

OR
She felt that she did have cushings and we could just go ahead and start the trilostane because she would have used it with either adrenal or pituitary involvement.

I am concerned about starting trilostane if we don't have a definitive abnormal adrenal gland.

It makes no difference if it is adrenal based or pituitary based, Trilostane works for both. Conventional Cushing's always means a tumor - either on one or both adrenal glands (ADH), which sit on top of the kidneys, or a tumor on the pituitary gland (PDH), which sits in the skull.


The other problem I have is the distance to the vet if an emergency arises. My regular vet is 1/2 hour away with the emergency 45 min to 1 hour away. The Endocrinologist vet is 1.5 hours away at her emergency hospital. She said we would be understand if I wanted to do all this at my regular vet's place. Any suggestions.

Some folks need to have a specialist handle their babies case because it is a bit more complicated than the norm, and some folks just don't have access to a GP vet who will treat Cushing's that they feel comfortable with. The flip side is that many specialists will NOT treat your baby on a regular basis but prefer the GP vet handle things unless there is a problem - then the IMS would step in.

As for the distance to the specialist, that would not normally be an issue. The key here is to make sure they give you prednisone and tell you when and how to use it in case of a crisis. ;) And, of course, you have your family here 24/7 should you need us....not the same as having a vet close by but we can sure tell you if you need to use the pred and/or take him to the vet. ;)

I know you are all out there giving hugs and they help believe me. I just worry about delaying the medication any longer. I know it is a slow progressive disease, but it's really hard to just sit here without doing anything and seeing her deteriorate slowly. Jan W.

I hope others will be along soon to share their thoughts.
Hugs,
Leslie and the gang

[Jan W.]

My Int. Med Vet wants another ultrasound to have another look at her adrenal glands for any abnormalities which was missed the first time because her endogenous ACTH was listed as low (indicator of adremal involvement - but they looked fairly normal. Then they want to revisit the bladder "polyp" they found at same time. I'm the one that was hesitant to start trilostane when adrenals appear normal. I understand that the trilostane is for both types - I guess I am worried we have the correct diagnosis yet. My gut says yes.
It was suggested that if they find an abnormality in one adrenal then we could possibly do surgery if I wanted/needed or we could just go ahead with the trilostane. I've seen some on this site that say their adrenals were normal on their furry child. And I guess there is a possibility of problems in both adrenals and pituitary.
The inter. med vet is very willing to let our regular vet handle all this from afar. I have not told him yet about my running to an endocrinologist and he knows nothing about my thoughts that Cinder has Cushings. He only zoned in on her hind leg weakness and felt she needed a neurological assessment. I sat home 1 week and decided there was something else going on and I took her off the very low dose of thyroid meds which I think gave her thyroidtoxicosis and watched her a while longer noting some improvement but then it leveled off. I never told him anything after I told him I was taking her off the thyroid meds. So I need to have a sit down with him to see if he would be willing to take this all on.
We never had an 8 hour dexameth. test so I thought this might be a good idea instead of the repeat ultrasound. Not sure how expensive this is either but this could be done at regular vet's office. I'm not sure that going to expense of another ultrasound will be worth it. If they find cancer, Then there is her back problems and we are looking at thousands of dollars here and she is 13 - I was hoping the cushing's treatment would give her a better quality of life for a couple years. I'm not wanting to torture her with multiple surgeries/procedures. I'm just so confused and sorrwful. Yet she is a bright spot in my life that will not disappear. I was gone all day and she still got those back legs moving fast and jumped up to greet me. I love her spunk!! Any thoughts about the 8 hour test vs repeat ultrasound?? It is a blessing to have somewhere to express our frustration. Jan W.

[frijole]

I had one dog that had cushings and we did the LDDS test and then acth tests - never an ultrasound. We treated successfully end of story.

My other dog was tested for cushings with the LDDS test and it came back positive, acth test positive so we started treating....it didn't work so I had an ultrasound done at a specialists (2 hr drive) and they found nothing.... I ended up having 2 false positives on the LDDS test and like 5 false positives on the acth test.... After a year of total anguish I finally drove five hours one way to KS State Univ Teaching Hospital and they did an ultrasound and found an adrenal tumor - but not the kind that causes cushings.

I share this not to depress you but to point out just how every dog is different and how fluky cushings testing can be. I had 4 years experience treating cushings and figured dog 2 would be a breeze. Boy was I wrong!

You have had 2 endogenous acth tests - one came back high (cushings) and the other low (not cushings) [by the way please get us the exact number because I don't trust anyone who says high or low or normal because errors are made this way] An ultrasound that showed nothing abnormal with the adrenals.... I understand why you are confused.

LDDS vs ultrasound - based on my experience and being here 8+ years without a doubt I'd go ultrasound route. It is the biggest bang for the buck. That said it's only as good as the person running the eqpt and reading the film. The eqpt has to be high resolution and they have to get both adrenals on film. (they missed the adrenal with the tumor on my first one!) Most vet offices don't have high resolution machine - most specialists do.

The reason why I don't trust the LDDS in your case is that other illnesses can cause false positives and I'd be afraid it would happen based on what you have shared.

Kim

[lulusmom]

You have had 2 endogenous acth tests - one came back high (cushings) and the other low (not cushings)

Kim, I believe the first endogenous acth test was no good so they had to redo it. The new test results show that ACTH levels are low, which is indicative of an adrenal tumor. Dog with PDH have normal but more often high levels of ACTH. Since the first ab ultrasound showed normal adrenal glands, the IMS wants to do another one to make sure nothing was missed. I personally would opt for the ultrasound for many reasons but primarily because a specialist is more likely to have state of the art ultrasound equipment and are usually backed up by board certified radiologists.

[Jan W.]

The ultrasound was done at one of the leading vet hospitals in Colorado so you would think they have state of the art resolution and a very experienced radiologist reading the results. Just because they had a national TV show for years doesn't mean they are up to date. And to have my local vet do another ultrasound that he reads himself without an experienced radiologist - I'm thinking that would not be a good idea and a waste of time/money. If we do another ultrasound - they won't have to shave her again as her hair hasn't grown back in much. HAHA Another sign of Cushings!!?? You have to have little humor in your life here!!
I suppose I could drive up to Ft.Collins to the vet school for an ultrasound (2.5 hour drive)- I'll ask my neighbor when he comes over as he graduated from that school. I'm sure his feelings on this whole thing is that I'm spending way too much money already. He is very very old school. I think I just need to break down and have a good cry and probably when he comes over here today I probably will just do it. He and his wife are very very good people and very caring.
I feel that the int. med vet (which specializes in endocrinology) is fairly sure that Cinder has Cushings - but I also think she would like another ultrasound to make us all feel better about starting the trilostane. I like her and think she knows what she is doing and trying to be respectful of my money at the same time. She is walking a fine line. My husband and I have medical/vet bills amounting to around $20,000 this year so far that isn't paid by medicare or insurance. What little retirement I will get from my last job is all but gone now. I thought I was going to get to travel some. Guess again.
I guess what I need to ask her - if we have nothing showing on the ultrasound again = what then - do we just start the trilostane? If that is what she plans - why do a repeat ultrasound in the first place.
You know you guys following this site should charge for your psych. care - this really helps!!! If the vet told me this was something more tangible I would be able to deal better with an exact diagnosis, but this is so up and down. I'm probably putting too much cortisol through my system - I'll be next on the Cushings train myself.
I'll keep you posted. Thanks Jan W.

[Jan W.]

I almost forgot - the endogenous test had to be redone due to some error on their part and final came back "low. She had this one rechecked and called yesterday when I was gone. She did not give my husband the exact results only that it was correct and was low. When I call her back after my neighbor comes over I will get the exact figure. Jan W.

[frijole]

Jan, Re the psych care... as they say "it takes one to know one"... :D:D:D We have all been there and some of us still are. Keep the faith.

Wow those are some hefty med bills. Bless your heart. Sounds to me like your best bet is to trust the IMS doc on this. I wouldn't waste any time talking to a vet that thinks you already spent too much money on a dog. You already know what his answer would be.

You are doing a great job even though you might feel lost - you really are doing everything right. Kim

[Jan W.]

The other vet is my neighbor - He just came over and we talked. He understands my situation, but he is looking at it from a practical point of view. He and his wife asked important questions - like what am I expecting out of the medication treatment for Cushings?? I said I hope to give her a better quality of life for whatever life she has left. Hopefully, she will not progress further with her hind leg problems or maybe improve. But on the other hand - the drop in cortisol will probably cause her more pain if she does have true spinal problems. We would have to treat that if and when it comes along.
I am not thinking that I want to put her through surgery and/or biopsies or aspirations. Not at her age and in her present condition. After talking to my neighbor - I probably would do an ultrasound again and will talk to the internal med. vet about whether their ultrasound is high resolution or not. If not I might talk to the Vets at Ft. Collins Vet school. He said they have a state of the art ultrasound for horses he knows for sure. (He is a large animal vet). So probably has a good one for small animals. He felt the price may be about the same price as a vet office.
I think I will call the vet now and get things rolling as I feel we are dragging our feet and her paws. Thanks for remarks Jan.W.

[frijole]

FWIW I paid $500 for the ultrasound at the specialists office in Omaha where they missed the tumor and $150 at K State Vet Hospital. Go figure. :D Kim

[Jan W.]

I spoke to the vet a while ago and have decided to redo the ultrasound at her hospital. They do have a high resolution ultrasound. She wants to have another look at the bladder "thing" to see if there is any change and another look at her adrenals. I hope they get a better look this time. I asked her if there is no change or again nothing different noted with the adrenals, what is next - she said we start her on the trilostane. she is to call me back with a time for the ultrasound. While I was on the phone with the vet, Cinder got some liver treats out of my coat pocket. She never has gone into my pockets for food until this all came about.

I had time today to read some of the articles posted in the site here and it started making some sense to me. Most helpful!!!!
The thing that scares me is we just found a lipoma on our other 9 year old lab. I hope this isn't the start of all this again. Although Cinder had lipomas long before she was 9 years old plus other skin problems. Chamois has had none so far until now.
Again thanks to all who respond to this site for information. I helped me make a decision. Jan W.

[Jan W.]

I think these tests are only as good as the person running the tests. No matter how much you pay for them. I have an appointment for the ultrasound at the vet hospital tomorrow and hope the radiologist is on his game. It's at eleven in the morning so he might not be over worked yet. I just pray they find what they need to move on here. I need to have my dog fasting so digestive system will be empty and not get in the way. Boy is my dog going to be mad at me. Jan W.

[frijole]

Boy is my dog going to be mad at me. Jan W.

OH yeah. Promise him extra treats when it's done. :D Kim

[goldengirl88]

Jan:
Just reading your thread and I wanted to tell you I hope all works out for the ultra sound. Those things aren't cheap, and to have to repeat it is costly. Hoping all goes well for your baby. Blessings
Patti

[Jan W.]

It's early morning and I fed my other dog and Cinder is wondering why she doesn't get anything. So she drank another gallon of water. She has had loose stools the last couple days with some blood in them, so guess she has a little bowel problems. Maybe it's just as well that she be fasting anyway for a few hours. I'll give her a bland diet when we get home so this hopefully clears up. Who knows what she has gotten into when we go for a walk out here. I live out in the middle of the country so all kinds of critters roaming around. She isn't left outside without supervision, but when you are hungry you can grab a bite of something and keep walking. Her stool specimen a couple months ago was negative for parasites and she had loose stools when she was on too much thyroid medication (side effect), but that eased up when we stopped that medication until now.
I'm sure the blood is from irritation or hemorrhoids from a harder stool and the vet gave her a finger check when we first went in to see her. liver treats can give her the runs and she did get them out of my pocket. I'll hopefully be glad when we can get the trilostane started to see if some of these things ease up.
I'll keep you informed of test results. Again thanks for kind remarks and they help decompress the anxiety we all go through with these things. I will never have any grandchildren as my son is a priest so my fur babies are my grandchildren. I feel more like my own children - I won't tell him this, but I think we treat the fur babies better than we treated him growing. Maybe it's because they love us unconditionally and human kids are more needy. Jan W.

[Jan W.]

Well the vet tricked me - she told me if we didn't find any change in the ultrasound - we would go ahead and start the trilostane. She changed her mind - the ultrasound showed no change and they can't find the tumor. Someone asked what the endogenous ACTH was and the report says Less than 10. Which indicates adrenal but they can't find the tumor. The vet still feels that Cinder is Cushinoid but she wants more indicators. I can't blame her there as I don't want to start a medication for a poor diagnosis. She did say that the bladder polyp or whatever has also not changed, but if she does have Cushings then she may be subject to frequent bladder infections because of the placement of it. So we need to follow up on that frequently. Now I almost wish I had gone to Colorado State University for the ultrasound. Of course they want to redo an ultrasound a few months down the road to watch for the bladder "thing".
So we now are scheduled on Monday for the LDDS test at my regular Vet office. I admit it --- I let the vet talk me into the ultrasound. I will let you know the results. Jan W.

[Jan W.]

I have a question for Squirt's mom - you say your dog had a tumor on the spleen? What type of tumor as my dog is showing a couple of lipomas on her spleen. And we all know that most lipomas are benign. Could a lipoma on the spleen cause the same problems you had with your little Squirt?? The Internal Med. vet didn't seem too interested in the spleen thing. I found this on Magic's file. Jan W.

[Jan W.]

I have the LDDS test today, but my dog now has had diarrhea as of yesterday several times and wonder if this will effect the test. I'm taking her in anyway and see if I can talk to the Dr. and give them a stool sample to test. She has not had anything to eat since last evening at 6 PM as they wanted her fasting for the test. She isn't vomiting and still looking for food and still drinking without problems.
I'm pretty sure they won't want to do the test. So will have to put this off. JanW.

[frijole]

I would not LET them do it even if they wanted to. Keep us posted. Kim

[addy]

Jan -per Peterson and Kaplan:

more than 50% of dogs will test positive on the LDDS if they have a non adrenal illness. It is recommended the dog be allowed to recover from the illness before conducting the test

http://www.delawarevalleyacademyvm.org/pdfs/jun11/8cushings.pdf

[Jan W.]

I thank you for the quick reply - I read something about this about 1AM when I took her out for the latest donation. As much as I want this test done and over with - I feel you guys are right - it would not be a good test. So will just take my sample in to the vet and see if I can talk to him or her. Thanks Jan W.

[Squirt's Mom]

I have a question for Squirt's mom - you say your dog had a tumor on the spleen? What type of tumor as my dog is showing a couple of lipomas on her spleen. And we all know that most lipomas are benign. Could a lipoma on the spleen cause the same problems you had with your little Squirt?? The Internal Med. vet didn't seem too interested in the spleen thing. I found this on Magic's file. Jan W.

Hi Jan,

I don't remember what kind of tumor Squirt had on her spleen...if they even told me a type. What I do remember being told is that it was the kind that could easily be Hemangiosarcoma so it had to come out asap. So I feel like if they felt this presented a danger to Cinder, they would have recommended it come out. Lipomas are fatty deposits, not really tumors to my understanding. Squirt is now covered in lipomas and none of her vets are the least bit concerned about them...tho there is one on the top of her head that is changing and is concerning *me* a bit! ;)

Hope this helps!
Hugs,
Leslie and the gang

[Jan W.]

Most lipomas are benign and only cause problems by their growth in areas that can cause problems. But some are infiltrative and grow into muscle etc. and then rare ones called liposarcomas are not good. But all my vet said was that these were lipomas. Cinder does have one on her left hip that is under the muscle and her vet was not anxious about removing it. She has had close to 20 removed from the outside. Now I'm wondering if there aren't more somewhere else internally causing problems. Some feel that lipomas are an indication of imbalance in the dogs endocrine system (hence cushings - thyroid ). Some say no so I get really confused. My regular vet mentioned the possiblity of cushings just before we removed 18 lipomas and started her on thyroid. I think there is no clear cut knowledge of lipomas.
In my research of lipomas - I found a new way to reduce the size with an injection of an enzyme. So for those that have one in a place that is causing problems and not good candidate for surgery - this would be a good thought. But the medication is extremely expensive. I also found out that the same medication is a new procedure for people with Dupuytren's disease which my husband has and has had injections. So some good came out my research. But the cost is $3600 for a vial of the enzyme not very cost effective way to reduce size of lipomas. I'm glad you were able to remove the tumor from your dog and things turned out good. I know of three people in our agility world that have had dogs recently die with hemangiosarcoma and one was a veterinarian and had no idea it came on so fast. So be glad you got this quick.
I'm just wondering if lipomas can be on my dogs pituitary - It's just a thought. Jan W.

[goldengirl88]

My Tipper has had many fatty lumps on her. She has had dozens removed when she was well. I am wondering about all this now??? My last dog died of hemangiosarcoma, it came on all of a sudden out of nowhere. She was a Soft Coated Wheaten Terrier, and afterwards I had been told there was a problem with the breed genetically being predisposed to this. It broke my heart. This medicine you're talking about to reduce the lumps isn't expensive it is outrageous!! How could the normal person afford that?? Yikes I can't . Blessings
Patti

[addy]

Hi Jan,

You had asked on another thread about feeding raw- my Zoe was on 100% raw commercial meat diet when she was first diagnosed with Cushings- for her inflammatory bowel disease. I have cut back on her raw diet, supplementing it with Honest Kitchen-which is not a raw diet- as it is the only other food she could tolerate. I cut back on her raw meat because:

1- her ultra sound showed irregularities in her pancreas and her turkey patties are too high in fat

2- she was throwing protein in her urine so I needed to cut more protein out of her diet to improve her kidney numbers.

She still gets about 2 ounces a day of her raw turkey patty only because I cannot replace the calories with more of her Zeal Honest Kitchen- her IBD cannot handle that much.

[Jan W.]

A lot of commercial raw does have too much fat in it, but according to the raw people if the fat is from animals that are not commercially grown the fat content isn't an issue (like grass fed beef). I don't feel that way - to me fat is fat and if you have a dog with fat metabolism problems, then it is too much fat.
I started my dogs on a raw diet because they both had problems with things that seemed to be related to that type of diet. My one dog does not tolerate kibble for the most part as it give her elevated urine pH and I have to give her Vit. C to counteract. Once I put her on raw most of the time, she has not had a urinary infection nor does she need to pee all the time.
Cinder does not tolerate the dry as she has slow bowels and she gets a lot of gas. I've tried most of the brands on the market and all kinds of digestive enzymes, probiotics etc. Once on raw - she straighten right out until now.
We just got back from the vet and he put her on flagyl for now and sent in the specimen - but found no coccidia on quick exam. So he felt that she should be good to go with the LDDS test if no more diarrhea by the end of the week. Does anyone see that as a problem? He also has history of giving Trilostane to a couple of his patients with no problems so far. I may be getting ahead of myself here - need the positive test results first. Jan W.

[Jan W.]

The medication for the lipomas is an injection and all it does is reduce the size - all that for over $3000. It's an enzyme and not sure how it works exactly, but yeaah!! some expense. I don't know if it can begin to grow again. It does have some serious side effects too, but it appears someone is trying to do something about these fat globules for dogs. A few more years and they will come up with something.
Fortunately my husband's injections are for another purpose and medicare pays for it. Jan W.

[Jan W.]

The IMS vet on Friday noticed that Cinder's eyes were blood shot. I noticed them some time ago, but kept forgetting to ask about this problem as we get so involved in everything else. I do know from experience that dry eyes in older dogs can be from thyroid problems. Now that she is no longer on thyroid medication, maybe this is another sign that she has cushings. This can lead to blindness and cause pain. They wanted to do a tear study on her, but I didn't want to spend any more money at present, so just started putting artificial tears in twice a day and bingo!! They look like she used to look. If it didn't make a difference, I would have the tear study done.
One of my agility friends fosters terriers and one had blindness from dry eyes. I asked him if they had checked her thyroid level and they had not so they did and indeed she had thyroid problems. This decreased the amount of very expensive eye drops they needed to use. Unfortunately, she already had some permanent blindness.
I guess I better read about more problems that may be forthcoming. You don't think about the little things because we are too busy looking at the bigger picture.
She has had no BM's so far today and only a little "gas" so the flagyl and lomotil is working or she got over her little bout. I only gave her 1 lomotil yesterday and hasn't needed any since. I probably will make the appointment for the LDDS on Friday and get that done. Jan W.

[addy]

Zoe developed quite a few eye issues last year, some caused by allergies, some contributed to Cushings. At one time she was on 12 different eye drops and we thought we would not be able to save her eyes. She has maintained quite well now for a year with Tacrilomus, Cyclosporin, Fluriprofen, EDTA and over the counter Gentle Gel. Yes, it is expensive but we got a 50% off card from Walgreens for the Fluriprofen and we use a compounding pharmacy our ophthalmologist recommended.

If you don't control the dry eye disease, they will lose the ability to produce their own tears completely and they are also prone to corneal ulcers which will sometimes be deep and not heal without an operation.

I know it is scary about how much money everything costs but if you don't measure the tear production you wont know how well the medicine is working. Zoe has a follow up about every four months and we have had to adjust medications.

[Jan W.]

Right now the artificial tears are working pretty well. And she doesn't mind them. Once I'm sure of what I have - I'll see what they say about the eyes. What's next?? I suppose I will have to go back in to see the IMS vet as I know they can check the tear production as she said they could. If not I'll probably have to find an ophthalmologist because I doubt that my regular vet can do this. I'll ask on Thursday.
I guess I better start a list and check off when I have addressed the issues.
Poor babies - I have had dry eyes myself and know what that feels like. One of you guys on this site mentioned that dandelion has some diuretic properties, This may contribute to the dry eyes. I have been holding off on her supplements until after we get the LDDS done. So will keep eye on it all. Thanks Jan W.

[addy]

Melatonin also bothers Zoe's dry eye disease. Some of this is trail and error it seems:):)

I dont mean to be pushy about the eye issues. It was just that Zoe started off with a very minor eye ulcer from the early stages of dry eye disease, then the dry eye disease got worse, she got a new ulcer that was worse than the first, then she developed secondary glaucoma, gosh it just escalated into such a mess so very quickly. Every dog is different but I worry now when I hear "dry eye" disease with a Cush pup.:o:o:o:o:o

Hugs

[Jan W.]

I just read about how they do the test for dry eyes - it is simple and my regular vet can probably do it if he has the test strips. She has her LDDS tomorrow and I will ask while I'm there. I just don't want to do anything to cause stress while they are doing the LDDS. I don't want any false positives and this girl can get pretty stressed quickly. And steroid type eye drops might cause problems.
The artificial tears are really clearing her eyes. But that doesn't mean that she doesn't have more involved problems. I used to work for an eye Dr. (human) in my first life. But all these things associated with Cushings is creeping up on me.
My 95 year old Mother also had dry eyes and and she is on steroid eye drops because of the corneal problems involved plus glaucoma drops.
I don't think you are being pushy!! Just concerned and I am also. I just don't know what else to be watching for. Some things just don't have neon lights pointing to the problems. Jan W.

[Jan W.]

I took Cinder in for her LDDS test today and guess what happened? They gave her the wrong Dexamethasone so the whole test had to be canceled for today. But they did do the Schirmer eye test and she has plenty of tears. I didn't want to tell them that they were probably tears from being subjected to so many tests and she just wanted to go home and eat. HAHA I guess God just doesn't want me to get this test done this week. AT least they found out that there was an error because we could have had false results.
Anyway I will now put this off until next week. If she doesn't have Cushings now, she may by the time we get done injecting her with all these medications. Jan W.

[Trixie]

Oh no...well like you said at least you didn't end up with a test result that would have been screwed up! Poor Cinder...hope she enjoyed a good meal after her morning at the vet!

Barbara

[Jan W.]

I just got Cinder's LDDS results - pre dose 5.7

4 hours - 6.0

8 hours - 6.2
Our regular vet is sending the results to the IMS vet so am waiting for a call back from her.
I am confused about the results but I guess it will get ironed out soon.
ACTH stim test was 24.2 endogenous ATCH was less than 10, ultrasounds x 2 showed no adrenal tumor and difference in size. And she has most of the clinical signs of cushings. Jan W.

[lulusmom]

Cinders definitely did not suppress on the LDDS and this pattern is more consistent with an adrenal tumor vs pituitary dependent disease. Usually an endogenous acth test or an abdominal ultrasound is done to differentiate between the two. Cinders has had both of these done and results are conflicting. The endogenous acth is consistent with an adrenal tumor but the abdominal ultrasound didn't detect any adrenal tumors. I'll be very interested to hear what the IMS has to say.

[Jan W.]

I'm waiting - I suspect she will ask for a high dose dex test. The reg vet thought it was indicative of pituitary. Go figure. Jan W.

[lulusmom]

Everything I've read says that the endogenous acth test is considered more reliable than the high dose dex suppresseion (hdds) test in differentiating between pituitary and adrenal dependent disease. The reason being is that if a dog with pituitary dependent disease fails to suppress on the ldds, there is a possibility they will also fail to suppress on the hdds.

[Jan W.]

I don't know if she sees it that way. She wants neon signs with pointers and she's not getting them. I guess I don't blame her. No one wants to make a mistake. I just don't understand why her levels remained so close to the same or slightly elevated for the entire 8 hours. If you have outside stressors such as illness or just feeling left alone in the cruel world, your cortisol would elevate more. I think not being fed for 8 hours when you are starving is a stress in itself. Jan W.

[Jan W.]

I received a call back from the IMS vet and she feels that Cinder does have adrenal cushings and we are going on with the Trilostane medication but we are starting with a low dose (1mg/kg). It will be mailed to me since I live so far out and I am to call her when it comes for instructions. Then we will get a ACTH stim test in 7-10 days I believe she said but will find out for sure when I speak to her again. After we get her stabliized, then I can work through our regular vet out here.
So I'm scared and at the same time relieved that we are moving forward finally. If it doesn't work, I will be OK with it at least I tried. I do not want to put her through surgery so if there is an adrenal tumor hopefully it will grow slowly and she will have a little time that may be more normal.
I will have you guys following when I need some help and so glad you are all there. If I had not plugged into this site, I not have made some decisions that I made. I had two vets with conflicting views as to which type it was. So this site helped me get through this---God bless all of you. Jan W.

[frijole]

Wow so the ultrasound shows normal adrenal glands and no tumors and every single test came back negative for cushings and she wants to treat? She could be right but if I were you, since you live 'far out' I would ask for a prescription for prednisone and have that on hand. You give it if the cortisol goes too low (ie if it really isn't cushings). You don't want to be without it if you can't get to the vets office in a hurry in an emergency. They are very cheap pills and have saved dogs lives when doses were too high. Not to scare you but the reality is you are treating a dog without a definitive cushings diagnosis.

That dose is low but it is what alot of vets are giving to dogs with solid diagnosis so I don't want you to have a false security about it. Its a serious drug and you simply need to watch like a hawk for diarrhea, vomiting or lethargy (extreme). You see it you cease giving the trilo ok?

I will sleep better for having shared that - better safe than sorry. Kim

[Jan W.]

Cinder's ACTH stim test was positive, the endogenous test was positive for adrenal, LDDS was consistant for adrenal, she had positive leukogram, elevated liver enzymes, +1 protein in urine, dilute urine, plus all the normal signs of cushings. Just no positive ultrasound. This is an internal medical vet with endocrinology as her specialty. She has treated a lot of cushings dogs in her past and felt strongly that she was cushinoid.
I do have prednisone at my home. I would like to have had a neon sign pointing to the tumor on the adrenals. But that didn't happen. She was very thorough and cautious. I understand that sometimes there are irregularities (tumor) on the adrenals that are difficult to find and only found when the adrenal gland was removed. Don't know if this is what we have going on here.
I am a nurse so hopefully will be able to see any signs of addison's but I am too close to this whole thing so will rely on my husband and neighbors (two vets) to help me recognize any adverse signs. I live within 45 minutes of an emergency hospital, but not the one where my internal med vet is.
I'll keep you posted. Jan W.

[Jan W.]

PS -- Yes - this site is really good about letting me know what to look for and what I need to do. I feel it's sorta like taking a CPR course. And I am getting old so need reinforcement.
I will D/C the medication if I see adverse signs. And I will make sure that we do the ACTH stim test correct. Again thanks for your concerns and I feel they are well founded. I have God watching of me also. Jan W.

[frijole]

Awesome Jan. You will be fine. Glad you have prednisone. Keep us posted - we are here if you need us but you sound on top of things. Keep up the good work. Kim

[addy]

Hey Jan,

I justed wanted to add although not the norm- there have been occassions when adrenal glands are normal and a dog still has Cushings as well as adrenal glands being enlarged from a non adrenal illness- not from Cushings.

There really is no test that is 100% accurate which is why history and symptoms play such a big role in diagnosis.

[Jan W.]

I'm glad you brought this out - I feel better that you have knowledge of normal adrenals. My vet feels this is the case also, but I will be ever watchful.
If my IMS vet is correct and Cinder responds to the treatment, I will have to bring her a gift of some sort. She has not charged me for any of the other office visits or consultations so far. And she agreed to start Cinder out on the medication until she is stable. This makes me feel better also. It's not that I don't trust my regular vet, he just doesn't have the experience that the IMS does. However, my regular vet thought about Cushings two years ago - when we had no major symptoms then so I didn't pursue it.
You guys are angels. You have the knowledge that helps us all make decisions. Life is not 100 % - this little girl has worked hard for me all these years and I need to try and make life easier for her if I can. My other concern now as was pointed out to me --- will she have increased pain when the cortisol is reduced. This may be the reason I was able to have her in agility at 11 years old because the cortisol was masking her discomfort. I still have some ultram and rimadyl handy. I just need to let the vet know what is going on. But I am kinda curious how her hind leg problems will change if at all.
I have been pretty careful to get her to go on walks - I use treats and she will do a lot for treats. But she won't go far - at least she gets some exercise and keeps her muscles in a little better shape.
I won't get the medications in the mail for a few days but when I start and have some indication of what is going on I will let you all know. Thanks again for all you do Jan W.

[Jan W.]

Just to let you all know -Cinder has a bowel infection going again and currently have her on antibiotics. She had yellow stools and no vomiting - remained starving all the time. Now concerned about bacterial overgrowth or something more sinister. I refused to start the trilostane until I have a clear picture here - did the bowels cause tests to be positive? Won't know until I get it cleared up - I plan on re-running one or more of the cushings tests after she is good and clear- She has had all the cushings symptoms for over a year and some several years and no bowel problems then, but I am still concerned that something is amiss here. Did the cushings cause her to get a bowel infection or was it here all along. Which came first the chicken or the egg!!! I need to know that she is clear for a longer amount of time. Again thanks for all you concern --- I will keep in touch. Jan W.

[addy]

Im not sure which came first. Cush pups are prone to infections. It is possible that Cushings caused the infection. However, dogs having non adrenal illnesses can cause false positives on many of the tests.
If she were my pup I would want to try to get the bowels straight first, which is exactly what I did with Zoe. I debated that a lot with our IMS in the early days as she would point out that it was possible Zoe's Cushings was causing the repeated infections for her IBD and that possibly bringing her cortisol down would help that. In our case, Zoe's "colitis' we called it back then before she had endescopy, was causing me more problems and worry than her Cushing symptoms.

[Simba's Mom]

Hope Cinder gets better soon, I would wait to treat her too until her bowels get better, cuz the trilo can be hard on the tummy too, hugs

[molly muffin]

Oh poor Cinder and poor you. It's hard to know what is going on when there is any kind of infection that could affect testing results. I think it's a good call to retest once everything is cleared up so you'll have a more accurate picture.

Hang in there. It can be a rough road getting through the diagnosis phase.

Sharlene and Molly Muffin

[Jan W.]

Simba's mom wrote that the trilostane could be hard on the tummy also - and that is another reason I told the vet I wanted her cleared up - How can you know if the trilostane is causing problems or the bowel issue is again. Cinder has never had major bowel problems like this - She has always had slow motility as diagnosed by lower GI done when she was about 1 years old. We managed to get her to this point without major bowel issues. So if we can just get her clear then we can redo some of the blood work. I am wondering about doing a UC:CR urine test as we never did this one. We did a protein creat. ratio test because of the +1 protein in the urine. Any thoughts on this urine test at this point? Jan W.

[addy]

The UC:CR urine test can have false readings as well and can tell you if you should look further into testing, it cannot confirm Cushings but it can rule it out as long as you dont get a false reading.

Trilostane can cause diahrrea and tummy upset. Some give Pepcid 30-60 minutes prior to the dose.

We started Zoe on a very low dose of Trilostane and her IBD flared right away -for 3 weeks actually for me to get to back under control and she had been doing really well prior.

It is a call you and your vet have to make and the vet will make it based on other symptoms your pup may be showing, whether to continue the drug or to stop it should loose stools become a problem.

[Jan W.]

Have you heard of many false negatives with the urine test? I understand how you can get a false positive. I was hoping that if we got a negative, then we could probably rule out the Cushings and figure the other tests were false positive??
How did you handle the recurrence of IBD while starting the cushings meds. Jan W.

[addy]

http://www.antechdiagnostics.com/Main/ANTECHInsights/October-2012-12.aspx

This is a good reference article summing up testing. If a dog tests negative on the UC:CR it is unlikely the dog has Cushings but cortisol can vary from day to day so they they recommend a 3 day pool or urine collected at home.

No one test is perfect and this article states a dog should not be tested during a non adrenal illness.

We started Zoe on a very low dose of Vetoryl, her IBD immediately flared. We withheld medication for one day. Her other behavior seemed normal and since Zoe had a history of bowel issues we went by her other behavior and tested her cortisol in 10 days. I had to with hold food, cut back on food, up her doses of metronidazole to regain control. It took 3 weeks. Every time I upped her Vetoryl she flared in these early days. After she was on the drug for six months her body adjusted and it was no longer a problem as long as I used conservative increases. I chose Vetoryl over Lysodren because I could start and stop the medicine as needed.

[Jan W.]

I can understand not doing a test with non adrenal illnesses are present, but when can you do the test if your dog has IBD. It seems to me that this can be an ongoing problem. I thought Cinder was clear after being on antibiotics (normal formed stool and color normal and very little gas) so test was done. Then she had a relapse 3 weeks later so not sure it was cleared up at all.
Thanks for the Antech article. It reiterates what other vets are saying, but there are some areas that are better covered here. I will do more reading when I have time. I did note that the medications may not work as well with adrenal cushings. I'm still trouble shooting after seeing on this site that one dog had a spleen tumor that was removed and the cushings was ruled out. And since my dog has lipomas on her spleen - I'm just keeping an open mind here. But there are invasive type lipomas that involve the spleen, adrenals, and spine. I don't think I have this problem, but it is in the back of my mind.
I thank you for sharing your solution to the flaring of the IBD. I will keep this handy if I run into this situation. I like the idea of being able to stop the vetoryl if needed without problems.
Again - You guys have the experience and really help me with the decision making department. I may not always make the right decision, but at least I have this knowledge as back up and can move in another direction. You are ANGELS!! Jan W.

[doxiesrock912]

Jan,
we had a similar situation with Daisy and the IMS specialist said that sometimes they can have a low level systemic infection like ecoli that doesn't show up on tests. She prescribed Tylan (Tylosin) powder. We sprinkle 1/8 teaspoon on her food twice a day and she has not had diarrhea since then.

Some also use Tylan to treat IBD.

[Trixie]

We had a major chlostridium overgrowth a year prior to a Cushings's diagnosis. Which went on for a few months...bloody diarrhea, vomiting...the works. This particular bacteria can produce symptoms of colitis, which it did in my dog. Finally, it was put under control with Tylan powder along with Metronidazole, though once the bacteria was gone we stopped those meds.
My dog had tummy trouble a couple times each year...so now that she's on Trilo/Vetoryl it can be worrisome when she all of a sudden has a bad poop...I have to wonder if it's too much vetoryl or just a gastro upset?
Last week after a bad night time poop and another one in the morning I withheld her medication for a day, and I did give her metronidazole for two days. My gut feeling was that her tummy issue was not due to the medication but just a typical gastro upset since she didn't have other symptoms of cortisol dropping too low...lethargy, weakness etc. but just to be safe I stopped the medication anyway until poops were back to normal the next day.
I do use Pepcid a/c every night...one half a tab for my dog who weighs about 17 pounds even though so far she does not seem to get any upset from the Vetoryl.

Barbara

[Jan W.]

Just to let you all know - After being clear of bowel problems for well over a month, I finally got my little girl a urine C:CR and it was 29.8!! I'm not sure where that sends me but it shows she is normal. Normal is less than 34 according to my lab values. Any thoughts on this? So the Trilostane is on hold forever I think. Jan W.

[molly muffin]

That is wonderful. :) It seems that the high cortisol was in fact a reaction to everything else going on. Which is entirely normal and why we say to not bother getting spendy tests if the results might not be accurate.
This is just so good! I'm thrilled for you and hope that everything now moves along nicely, and no more infections!

hugs,
Sharlene and Molly Muffin

[Jan W.]

I think I am misreading the lab results - I have not spoken to the dr. yet as they e-mailed results --- urine cortisol is 29.8 urine creatinine is 43.8 and urine cortisol/creatinine ratio is 212.

[Squirt's Mom]

Is there a normal range given for the cortisol/creatinine ratio?

[Jan W.]

Urine Cortisol 29.8 ug/dl

Urine Creatinine 43.8 mg/dl

Urine Cortisol/Creatinine a 212

----------------------------------------------------------------------------

a <34 hyperadrenocorticism
unlikely

>or=34 hyperadrenocorticism is
possible
The letter (a) was so small I didn't notice it at first. Jan W.

[Jan W.]

I forgot - this is how the lab was sent to me. I assume the small letter (a) next to the 212 indicates the sub title (a) below the dotted line which tells me that 34 is the point of fulcrum. So she is elevated quite a bit. I got this urine first thing in the morning so she was not under stress at the time. So I think we are on the roller coaster ride again with the Cushings.
I just looked at all the pictures of the guys that left us in the past - I wasn't sure I wanted to go there, but glad I did. I was getting pretty teary eyed at first,then some of the pictures made me smile. One dog still had a shaved belly probably from an ultrasound. I had to smile at that one as my Cinder's belly is still bare from hers and it's been since July.
I don't know any of you on this list, but just seeing the pictures gave me the feeling of warmth from others that have gone there. I feel less anxious because I feel that whatever path we take, it will be the right path for us - this group has helped me see the choices I have
Now I have to decide if I want any more labs done or just dive in. Do you think it would be beneficial to get another Acth stim test prior to start of Trilostane then of course a repeat after I start it. Jan W.

[molly muffin]

Oh so it does seem to be that cushings is still in the picture. Drat!

Well, depending on cost and if it is financially feasible, I always like to know what the ACTH levels are at before starting medication again. Just so you know how much you should be giving. I think though that with Cinders history and the concern arthritic symptoms if you drop too much, that you are going to want to start low and work up as needed. Tweaking dosage to get it just right for what she needs and what keeps her comfortable. Also, you want to lessen the chance of any gastro upset from the medications (IBD flare up). Make sure you give it with a bit of food in the am, some cream cheese or something with a small amount of fat content, not too much, but enough for easy digestion. That would probably help too.

Sharlene and Molly Muffin

[Jan W.]

I will sit down today and make out a pro/con list as to the benefits of medicating Cinder with the Trilostane or not. I am very likely to go ahead and at least try it but need to make me feel more comfortable in trying it. My neighbor - which I mentioned is a retired,large animal veterinarian, doesn't think I should go ahead and do this. He thinks that I should just let nature take it's course and keep her as comfortable as I can as he feels she isn't doing to badly as she is right now. So I have to weigh all that he is saying. If the medication causes her major problems, would it be worth trying!!?? Well --- you guys have all been there and no one can make your mind up for you, but I need to just weigh it all out.
I'm glad you mentioned again to give the medication with something like cream cheese and to make sure I feed her before the ACTH tests. I have taken a xerox copy of the protocol for giving the Trilostane so I can show this to my vet if he is not following correct procedures. I plan on seeing him this week and will discuss the procedures before I even think about starting the Trilostane. I live in a country setting and the vet is in a small town so worry about his experience with this. He told me he has only 2 patients that he has treated with Trilostane. He preferred the other one (lysodren -spelling?) as I'm sure he has more experience with it.
I agree with getting another ACTH test before starting and I assume you mean not just a pre dose level. So --- if I go ahead and try this - I read something about saving money by using the cortrosyn vials more than once or something like that. Can you enlighten me on this? I also have the first months Trilostane doses from the Internal Medical vet that I never started and she wanted to start with 22mg every 12 hours for a dog that weighs approx 48.5 lbs. I wonder about 1 tablet once a day for a few days then if no problems increase to twice a day - but wonder if this would throw the ACTH stim test off if done too soon after starting twice a day. I have not discussed this with the vet yet so don't know how he will want this done. The internal med vet felt this would be a low dose to start with. But I'm not sure it is low enough. Jan W.

[doxiesrock912]

Jan, that dose sounds quite reasonable. Daisy weighs 13 lbs and takes 12mg twice a day.

[goldengirl88]

You are doing the right thing. Get another ACTH before testing and see the numbers. If you start low chances are you have little to worry about on the trilostane. I cannot help you decide what to do, as I am sure by now you know the consequences of not treating. I cannot help you with your decision, but can offer this advise. My precious Tipper would not be here if not for Vetoryl. She had such severe symptoms I would have had to let her go. She had too much life in her to do that so I chose to treat her and started on the lowest dose possible. She is allergic to everything, and has had no adverse side effects so far and we are past the 1 year mark. All I can say is pray on it and ask God what to do. I hope all goes well for you and your baby. Blessings
Patti

[Jan W.]

I have an "in" with God (just kidding!!) - My son is a priest -- I have discussed this case with God many times and I think I have received my answer by getting a positive urine cortisol:creatinine on top of the other positive tests. It's just so hard to give medications that could have bad effects when I see her just sleeping at my feet so peacefully. (snoring) but peaceful. You are right - I will never know if things will work out for the better unless I move forward with this. I went over all the complications yesterday and showed my husband the list as he was leaning more along the lines with my vet neighbor. He seemed a little more understanding after reading about all the complications. Everyone sees her as being "not too bad off" "she seems fairly happy"-- They are right but as things progress down the road---- One vet told us that dogs live in the moment -- they don't seem to wonder why they can't get up the steps anymore- they just look for alternatives. God brought her to me for a reason - many reasons. She is my first puppy ever. She has given us so much all these years and all she asks in return is to be with us and some treats.
Thanks to all who are involved and belong to this site. It really helps. Jan W.

[goldengirl88]

I am glad to hear that you are at least considering treating your baby. This cortisol does such bad things to them it is a shame. A pastor friend of mine gave me a prayer cloth for Tipper. The whole church prayed over it for her. That is nice your son is a priest, I am hoping he is praying for your baby and asking God for mercy. I hope it all works out, as I know you love your baby. Blessings
Patti

[goldengirl88]

Jan:
I just got Lourdes water for Tipper yesterday in the mail I am a great believer of this. When my father was dying our friends wanted to pay to take him to Lourdes for a healing, but he was too fragile to make the trip. I am putting some on Tipper every day in hopes she may have a miracle. Blessings
Patti

[Jan W.]

I live in Colorado and about 2 hours away is Mother Cabrini's shrine which has holy water. I have been there years ago. Wonder if it is still there. It might be worth it to check and see. I'm sure my son would know. I don't think Cinder could make it up the 200 or however many steps they have, but the water is down at the bottom. Interesting thought. Thanks -
I have an appointment with the my regular vet tomorrow and will discuss the meal with the trilostane, but I don't find anything in the drugs literature about feeding with the pill prior to ACTH test other than to say they need food with the pill. I have the article that Dr. Peterson wrote and will take that with me but I was hopeful there was something more so I could be armed when I walk in the door as I suspect they believe in a fasting test. I never even talked with the IMS vet about this so don't know her stance. Is there articles where other Vets are in agreement with Dr. Peterson? Jan W.

[goldengirl88]

If you fast the dog before the ACTH test the results will be skewed and the dog can be over dosed. I talked to Dr. Peterson, he is the consultant to my vet. This will absolutely ruin the test results. Think of it in this way, the trilostane needs food with fat to absorb, it is fat soluble so if you do not give the food it will not be absorbed properly therefore skewing the test. Dr. Peterson is the only Endocrinologist in the world with a clinic for this, he knows what he is talking about. Hope all goes well. Blessings
Patti

[Jan W.]

Here goes - I will take the Dr. Peterson article with me and have her/him read it. If they still have problems they can call Dechra I guess. And if they still have problems, I guess I will have to look for someone else to do the tests. Like I said I still don't know the Medical Specialists stance on this as I never got around to asking. We are just having the extra stim test this morning for a currant base line and to see if I still have a positive. One last attempt to tell me I am on the right road. Thanks for the info and I think it is a big help. Jan W.

[goldengirl88]

Not sure what you mean about the extra stim test for a base line. Is your dog currently on trilostane? If this is a first baseline test you will not feed the dog. I am confused on what you are doing, please clarify. If you dog is currently on trilostane feed him and give the trilostane before going. Blessings
Patti

[goldengirl88]

Jan:
I would get the holy water for my baby, it can't hurt. I believe in these things so God works in mysterious ways. Blessings
Patti

[labblab]

Hi Jan, just wanted to "second" Patti in that it is OK to fast before a diagnostic or baseline ACTH (which it sounds as though you are having performed today), but that you will want to give the trilostane along with breakfast each morning once treatment begins, and also on the days when subsequent monitoring ACTHs are performed. We earlier had an extensive discussion of this issue on the thread of one of our Forum Hosts, Kathy. The discussion started here and continued for a couple more pages:

http://www.k9cushings.com/forum/showthread.php?t=5121&page=2

Kathy took it upon herself to contact Dechra directly, and this is what she was told:


Marianne,
THANK YOU!!!!! I followed your device and called Dechra. They were very helpful. Not only were my all of my questions answered, they were also explained. They told me that Vetroyl was fairly new in the United States and a lot of vets are not familiar with it's protocol.

1. Trilostane must be administered with food for proper absorption.
2. ATCH testing - No fast- Meal with medication - a smaller meal is warranted if the animal tends to get carsick. Test must be
started within a 4-6 hours, but doesn't have to be completed by
then.
Vets often want to do several tests at once therefore requiring a
Fast. In that case it is advisable to do the ACTH test at a different time.
3. Benadryl - Benadryl shouldn't in any way affect the ACTH test results.

So there is your verification once more! I wish my vet would call!
There are other Cush parents who are going to be getting the same instructions that I was given and won't know enough to look further.:(

Kathy and Buddy:)
Hopefully the info in this discussion will be helpful for you as you discuss the future testing protocol with your vet. We'll surely be anxious to hear how this first baseline test turns out, though!

Marianne

[Jan W.]

thanks for the info. I'm just praying I am able to remain calm while talking to the vet and win them over to our side on this. This info is a big help. I think it is self-explanatory. I know the the one vet is definitely more into the Lysodren as he said he only has treated with Trilostane with 2 animals and prefers the monitoring of Lysodren. Maybe the reasons he doesn't prefer the Trilosane is due to his lack of experience and knowledge - maybe I will give them a boost here. If her test comes back elevated again - I just hope it is more than last time so I won't feel so uneasy about this. Because 24 is elevated but really on the low end according to Dr. Peterson's charts. Again Thanks - I have to get ready to go now - Jan W.

[Squirt's Mom]

Monitoring with Lyso is typically much easier and less expensive because it rarely requires tweaking while Trilo often does. Every time the dose is changed, you have to start the monitoring testing schedule all over at 2 weeks, 30 days, etc. just as if you were starting brand new each time. On Lyso, once the load is achieved and maintenance working to hold the load, dose changes are much more rare than with Trilo (Vetoryl). From the vet's, dog's, and parent's perspective fewer tests are usually a good thing. ;)

[Jan W.]

I agree less tests are better for everyone -but I am also having a B-12 and folate run on her at the same time I hope. I asked the tech about it and she said she would ask. I see the vet this afternoon when I pick Cinder up. I'm just trying to rule out damage from her bowel problems she had a while back. Cinder still isn't having bowel problems now, just being nutsy I guess.
Everything I read about Trilostane says there are some possible pluses over the Lysodren so there are pluses both ways. I can see why the vet might want to use Lysodren more now. I really had not looked up the differences as the IMS vet determined that she wanted to use Trilostane. I do see that Trilostane is supposed to clear out faster if you have problems. So that to me is a big plus. Well, when I talk to the regular vet I'll bring this up. Jan W.

[Squirt's Mom]

Yes, Trilostane (Vetoryl) is leaving the body within 2-12 hours while Lysodren is just reaching its peak performance at 48 hours. In an overdose situation, this is a very positive point for Trilostane. ;)

[Jan W.]

I just returned from the regular vet and she was very receptive to Dr. Peterson's article and she wanted to keep it and read it more at her leisure. She was not aware of this routine. She has no problems with following those guidelines and she was comfortable with compounding pharmacies and wrote down all the information from my trilostane bottle so she could have the information for Diamondback. They have used compounding pharmacies and had not heard of Diamondback.
We discussed possible other health problems and she did not feel the things I mentioned could be a possible cause of false positives for Cushings and I was pretty sure she would feel that way but just wanted another opinion. One of the things I brought up was the lipomas they found on her spleen and she felt that they were able to distinguish between a lipoma vs a tumor and the lipomas would not cause the cortisol issues.
She was in agreement with my wanting a B-12 and folate level done and understood why I wanted it - I don't anticipate any problems but will relieve my mind. I will feel good if her bowels have no malabsorption issues. So I am awaiting those results and the ACTH results. If ACTH is positive then we will begin the trilostane on Monday. She wanted to wait until Monday so she would be available. We discussed the prednisone issues and dosage if I determine we are in trouble.
I think she will work with me well. I left the clinic feeling up. If the trilostane doesn't work out for us, we could try the other or just let it go. One step at a time!! I will let you know the outcome. Jan W.

[Squirt's Mom]

I'm so glad you had a good chat with the vet! :cool: That feeling goes a long way in helping us become more comfortable with all of this. We had a great vet when we started this journey and I couldn't be more grateful to her. ;)

You done GOOD, Mom! :):cool::)

[Jan W.]

I think you guys done good!!! You guys have been a big help. I think a lot of people don't know about this site. I am so fortunate that I did. Although, I just about choked when I got my bill yesterday - Not a good time to run out of your blood pressure medications. Fortunately they give me a senior discount. My bill included their senior 6 month check ups etc.
The vet told me yesterday that they don't see a lot of Cushing's but I"m not sure people are really aware of what is going on and just consider it aging problems and they don't really have the money to help their pets so don't go to a vet unless they have to.
I will let you know what happens in the next few days. Jan W.

[goldengirl88]

Jan:
So glad to hear your vet is willing to learn form all this and work with you on it. It is so much better to know your vet is on your side and willing to get caught up to speed on things. This forum is a life saver and I literally mean that. Blessings
Patti

[Jan W.]

I just got a call from the vet and Cinder's b-12 level was elevated so we do not have bowel disease causing malabsorption- I can quit giving her the oral B-12 and her ACTH was almost double of the last one - last one was 24 and this one is 47 with anything over 22 being probable cushing. So we are even more elevated - I will start the trilostane on Monday and if we have no problems I will get another ACTH test 1-2 weeks out. The IMS vet talked about 10 days so I'm not sure - I guess I will just see how she does and if I feel uncomfortable it will be done sooner. I'm not one to sit and wonder - I feel it is worth doing the labs sooner than too late especially on the first go around. I'm still not sure if I want 1 dose the first day or go to the Q12 hour dosing right away. I guess you get less side effects with the Q 12 hour dosing.
Keep your fingers crossed - my son is saying prayers and will be out here visiting on Monday and will pray with us. My prayers are there for all of those going through the same thing. And bless all of you involved with this site - Jan W.

[molly muffin]

I like the first test around 10 - 12 days from starting. That gives it enough time to show what it will do. Too soon and you won't see where the range might settle at, too late and you get the risk if the cortisol is dropping too much.

It depends on the dog, everyone is different in how they react, but if you notice a lot of symptoms at night, then twice might be the way to go. If more in the morning, then it could be that a once daily will work fine. It is for those that don't maintain control throughout the entire day and night that double dosing works best. This is something you'll know better what should be tried as you see how she is during the day and night.

Drat that she doubled almost in that time.

hugs,
Sharlene and Molly Muffin

[Jan W.]

I was just wanting to give the trilostane the first day once just in case I saw a reaction - but the vet had ordered twice a day dosing. Cinder really doesn't have much problem during the night as their beds are in our bathroom and she doesn't drink water and need to run outside during the night. She has not been incontinent yet, but when she goes -- well lets just say she has a bladder large enough that my husband actually stands there and counts the seconds off. And sometimes her legs won't hold her up so she has to stand up and is still peeing or she will walk around a little then go at it again. She will head for the water first thing before she goes outside also.
I'm not sure how much longer it will be that she would be able to keep good bladder control. She doesn't get stressed during the night and sleeps good (doesn't whine or act like she is in trouble) - but she snores and gags sometimes. Which we have discussed with the vet. Lately her gagging is more after she drinks water rather than at night.
Speaking of it - she just got up and went to the water bucket. I must have given her the idea with mental telepathy!!
Jan W.

[Jan W.]

I want to be sure about my first ACTH test - I feed my dog in the morning and give her the trilostane say at 5AM then I take her to the vets and they can start the pre-dose and ACTH dosing at 9 AM but no earlier than 4 hours? But we are ok if started between 9 AM and 11 AM.--- If this is correct - I may have to adjust my feeding time if the vet office wants to start earlier. I'm ok with that, I just want things to be correct. Jan W.

[molly muffin]

You want to start to finish in the 4 - 6 hour period after giving the trilostane. Optimally, you feed her and give the trilstane and they take the first draw 4 hours later, and the second draw an hour after that at 5 hour mark. That should give the most accurate result.

Sharlene and Molly Muffin

[addy]

Dechra states 4-6 hours after dosing, UC Davis says 3-4 hours after dosing.

Whatever you do this time is what you want to do ALL the time when the ACTH test is done so you know the test was done with consistency. I make sure the test is started 4 -4 1/2 hours after dosing, I always have to calculate about 30 minutes of them doing other things before they do the first draw. I never want Zoe's second draw at six or more hours.

So if possible try to time it so that first draw is 4 hours always. Zoe too gets fed around 5:30am so I try to push it as close to six as I can which usually means 5:45:rolleyes::rolleyes: She's a hungry girl in the morning!!!

Always give food with the dose, I usualy just give her normal breakfast or a tad less and then no more food until after the test.

I would schedule the test for about 10 -12 days out the first time. Keep in mind you can always reschedule if you think there is a problem and do it sooner. If in doubt about possible side effects you may see withhold the pill. Usually starting at a lower dose split twice a day minimizes side effects but every dog is different.

Zoe was about 45 post ug/dl when she started on only 10 mgs and she was about 20 pounds. Her cortisol dropped like a ton of bricks that first week. Sometimes we see them having cortisol withdrawal and they dont feel all that great.

Just check in with us and you will be fine.

[Jan W.]

My dose is 22mg twice a day for a dog that is approx. 48lbs. Is that too much to start with?? I was under the impression that this would be a low starting dose. Was your dog's 10mg starting dose once a day or twice?? I worry about the cortisol level dropping too fast if my total daily dose is too high.
I am very comfortable with the explanation of the ACTH draws and will make my needs known when I make the appointment with the office in about 10 days. I will also make sure that the same vet will be there in case there are problems as she agreed that we would follow Dr. Peterson's guidelines - she may not have informed the front office gals yet.
Jan W.

[molly muffin]

No 22mg twice a day is not too much. Optimally I guess if you follow the 1mg/1lb, you'd be at 24 twice a day, so hopefully you won't have any issues with going too low. I wouldn't expect you to have any issues with that, but every dog can potentially react differently to any drug.

Addy will tell you what Zoe was started at.

Sharlene and Molly Muffin

[addy]

Dr Peterson thought Zoe should start at 15mgs. She has inflammatory bowel disease so we were trying to prevent it flaring when we dropped her cortisol. Her IMS was nervous so she dropped the starting dose down to 10mgs once per day. I was fine with the 15.

She did flare though and had loose stools, it took me 3 weeks to get control again of her IBD. Every time we changed her dose, she flared then finally adjusted to the medication and lower cortisol.

I dont think you have to worry about your starting dose. Keep in mind too, my Zoe had very few symptoms, mostly skin/coat issues originally. We waited a year to start treating her as I had to fix her IBS first.

Every dog is different and you just dont know how they will respond so when in doubt withhold the dose.:)

You will do just fine.

[Jan W.]

I guess I am reading more into this stuff than necessary which is my usual!!! I guess it sounds right. It doesn't help much when I'm out of my blood pressure medication. I still have the other one I can take until they come in. My mailbox was found open 2 days in a row so worry. It's coming from Canada and is kinda late.
I will quit panicking and leave you guys alone for awhile --- Thanks -I read all this stuff then I forget where I saw it and try to find it and never quite understand the search then I get off reading something else and never do find what I'm looking for.
- One person wrote that they were wondering about the daylight savings time adjustment with the dogs - and yes my dogs are out of sorts --- I always thought they could read the clock, but they are an hour early looking for meals. So much for reading the clock!!
For fun yesterday - I took my dogs out and did some AKC obedience training which I have given up but they were so used to that kind of stimulus for years that they are totally bored. It was actually fun because Cinder thought she knew what I wanted and ran Chamois off trying to get to the treats first. I realized why we never worked with them together before. But it was fun - I had a good laugh. Cinder can be such a clown when she is trying so hard to do what I say and I think her mind isn't clear either so she gets confused.
It was amazing how much they remember and how much they want to forget!!! Again Thanks Jan W.

[goldengirl88]

Jan:
If it were me, my preference would be 30 mg to start off with. I am an advocate of starting low. It may cost a little more, but you are surely saving that in worry. I believe in being cautious with this drug, as I have seen my share of problems happen on here form people starting dogs too high. I truly believe it is the safest method to try and ensure you have no problems. I would rather be safe than sorry. The choice however is yours, that is my preference as it gives the dogs body time to adjust to the drug. Remember these dogs have never had this in their system before. For example when I was first put on thyroid medicine I thought the top of my head was going to explode from a really bad pressure headache. It would not go away and I could hardly function. I told the Dr. and of course she said it was impossible and was not coming from the drug. I left and went to another Dr. her immediately told me you have to start at a low dose on these meds to get used to them and that won't happen. Sure as God made green apples he put me on a lower dose and I steadily increased it and no problem. These are powerful drugs and I think all precautions should be taken in the beginning to ensure a smooth journey. Hope all goes well. Blessings
Patti

[Jan W.]

I spoke with the vet the other day about starting with one capsule per day for a couple of days and she was ok with it. So I will start with 1 and if no problems I will increase as I feel she is doing.
I already gave Cinder the first pill about an hour ago and I keep looking at her and asking her if she notices any difference yet!!!??? She doesn't answer me but she is looking back at me like I'm nuts. As soon as the sun peaks out I'll take my girls for a walk and then my son (the priest) should be coming and she gets pretty excited when he comes. I'm not sure why because he always brings his "bratty" little kid (Westie) and Cinder and Chamois aren't sure they like the whirling, white tornado called Sophie. Actually his Sophie is pretty good too she's a terrier and they have different personalities than labradors. Sophie is used to being an only child and thinks she should be the Queen Bee over my two big Labradors. And she is. Fun to watch.
I'll keep you posted - so far so good!!! Jan W.

[Squirt's Mom]

I am partial to the Terrier breeds and one thing you must keep in mind with all those breeds is this - Terriers were created to rule the world! Just ask any one of them and they will tell you that is the absolute truth. :p

[Jan W.]

I think you are right - Sophie does rule the world. She is jealous of my one yellow lab and does not like her being close to me so she will jump up and try to squeeze between us on the couch. My yellow lab is jealous of the white tornado and purposely will jump up and lay down next to me with her head on my legs so Sophie can't get to me as easily. Otherwise, she hardly ever wants to be next to me anymore. She prefers her own space usually. They are strange creatures.
So far Cinder (the black lab) is doing good on the trilostane. She is still thirsty and still hungry. She always drinks up the white tornadoes water when she comes even though she has her own. She did this today as well.
I realize this is extremely early in the regime, but I am watching her every move. Poor thing. Jan W.

[addy]

Good, watch closely, larger dogs can sometimes be more sensitive to the drug, not to scare you off or anything. Depending when you start the full dose you might want to re explore when you are going to do the first ACTH test.

[doxiesrock912]

Jan, Daisy was super sensitive to the Trilostane in the beginning. She also has flare ups of IBD. Her IMS doc prescribed 1/16th of Tylan powder sprinkled on her breakfast and dinner. We haven't had a problem since.

Since Tylan powder is naturally derived, the specialist said that it can be used indefinitely.

[Jan W.]

I don't think Cinder has IBD she just got into some really bad compost full of parasites I think, but the Tylan did a wonderful job of clearing the bowel infection up.
I decided to go ahead and give her a second dose of the trilostane this evening as she did so well all day. She has shown no signs so far of problems and is still begging me for food. I don't have to be anywhere this week so want to be able to move forward with the Q 12 hour dose as the vet ordered originally and it is a low dose anyway so HERE WE GO!! On that roller coaster again - I'm on the uphill side about to go over the top!!! Jan W.

[molly muffin]

You can do it! I am just very optimistic that with the dosage you have started with and the plan you have in place that everything is going to be fine for Cinder.

hugs,
Sharlene and Molly Muffin

[Jan W.]

I feel pretty good about this whole thing so far. But remain ever watching. Being a nurse I know how things can go south fast. So 3 doses is nothing yet.
I could not have done this correctly without you guys - I will keep you posted. Jan W.

[goldengirl88]

Jan:
You can do this there is not a doubt in my mind. I know all is going to be well with you and your baby. You are very vigilant and that is what is needed. You are taking things slowly and that is the very best approach. Blessings
patti

[Jan W.]

Just to update you all - So far Cinder is taking the trilostane twice a day since Tuesday and she had one dose on Monday - so far so good. The only thing I have noticed is that she has decreased her water intake. Don't know if that is good or not as this early in may or may not be a good sign. She also will walk further out into the grassy area to urinate sometimes where as before she would only go a short distance away from the house. So is she able to walk better or just hold the urine a little longer before she needs to release. This might also indicate that she isn't feeling any increased arthritis type pain yet.
I haven't noticed any lethargy yet. I took my girls outside yesterday and tried to do some AKC advanced teamwork obedience training and Cinder was still very attentive and wanting badly to get all the treats. I think they enjoyed the stimulation and we had fun. I had stopped all of Cinder's training some time back because she was refusing to do jumps and certain pieces of agility equipment so felt she had some arthritis, but now we know there was more to all that.
Will keep you informed. Jan W.

[addy]

Sounds pretty good Jan. Just keep watching and the ACTH test will tell us where she is.

[Jan W.]

Cinder was doing well on the Trilostane, but had a small amount of digestive upset with gas and maybe 30cc of loose stool and possibly discomfort. I have never seen her act like she was uncomfortable before -- ever --- even when she had that parasite problem recently. She's had no vomiting or decreased appetite or lethargy. I do think I noticed she might be feeling a little less anxious to walk because of the decreased steroids. This happened Friday night.
So I think you guys were right in that she might get digestive upset from the trilostane so I will back off the trilostane for now and restart the tylan for a few days and see what happens. She had a normal BM Saturday morning and today. Maybe restart the Trilostane with the tylan at same time. I just don't want to put too many things into the fire so I can determine what the trilostane is doing to her.
It was nice that she wasn't constantly into the water or needing out to pee frequently. I will let you know how things are going later
Jan W.

[goldengirl88]

Jan:
I know some use the Pepcid when giving the Trilostane as their babies get stomach upset. Have you tried that? I cannot use it as it makes Tipper feel worse. Some dogs just can't take it so I went to the Slippery Elm bark. Maybe that would be worth a try. Blessings
Patti

[Jan W.]

Someone mentioned the pepcid before and I may think about that also. I gave her a pepcid years ago when we were going through a lot of digestive problems and she was bringing up bile, but it didn't seem to help then but this is a different thing going on. I eventually changed her diet to raw after having one vet tell me he thought she had Myasthenia Gravis and doing an GI series and finding that she had either slow emptying of the stomach or slow bowels - I just don't remember - Anyway after a lot of diet changes, she has done very well on raw for years with no problems until she got into rotten garbage in my compost pile this summer. We got that cleared up. OR DID I!!! I guess I will have to look at the actions of the trilostane and see why it affects the bowels. Within a couple days after starting the trilostane, I noticed that she had some gas problems starting in and then the small loose bowel turned up.
Anyway, for a dog that was supposed to have Myastenia Gravis - she sure has done well for 10 more years. I think he was young and eager to solve our problems and threw that possible diagnosis out there to impress us with his knowledge. Of course she didn't have that disease, but look where we are now. Jan W.

[doxiesrock912]

Jan,
Cinder sounds just like Daisy when we began the Trilogy. The gas episodes were absolutely FOUL.

Tylan is effective in very small doses and can be used long term. Daisy weighs 13lbs and takes 1/16th sprinkled on breakfast and dinner. It has worked wonders.

[Squirt's Mom]

Jan,
Cinder sounds just like Daisy when we began the Trilogy. The gas episodes were absolutely FOUL.

Tylan is effective in very small doses and can be used long term. Daisy weighs 13lbs and takes 1/16th sprinkled on breakfast and dinner. It has worked wonders.

Not sure what "Trilogy" is...I imagine Valerie meant "Trilostane". Autocorrect from using a phone? :) Some of those are hilarious! :D

Also, the Tylan is an antibiotic and the information states that it can cause resistant bacteria if used long-term so it would be fine from time to time as needed IF your vet recommends. Bear in mind it is not approved for canines...but then neither is Lysodren. ;) Tylan has apparently helped Daisy so it's hard not to want to pass the good news on to everyone. Just do your research and discuss things with your vet before trying them.

Hugs
Leslie and the gang

[doxiesrock912]

I would never use anything without a vet's concentration. Haha..stupid autocorrect. I meant Trilostane :-)

I mention the Tylan so that you can run it by your vet. It is milder than many of the others..

[Squirt's Mom]

:p:D:p Not near as bad as some of these autocorrects I've seen! :D:p:D I get the biggest kick out of reading those things! LOL

[Jan W.]

I am a nurse so I am pretty much on top of over use of antibiotics. And too many do use antibiotics willy-nilly. I have also been a victim of vet misdiagnosing another puppy we had with bowel problems. So I tend to do as much as I can without involving them unless I need to. I found out about Tylan from another site that deals with major canine bowel problems. It is a natural antibiotic, but it also has anti-inflammatory properties and is used in dogs more for this property to soothe the bowel and for the most part can be given more long term if needed.
I am still not sure if we have Cinder's bowels cleared up and this just stirred it all up again or not. As someone on this site said the Cushings med caused their dogs IBD to flair. If I take her in to see the vet they will just want another stool sample which we have already sent in several and find nothing and then they might want to put her on flagyl again which has some neurological adverse effects I do not want. (been there with another dog). So I put Cinder on a small amount( more for the anti-inflammatory properties) of Tylan for a short time and stopped the Trilostane to see if it clears up. If not I will consult the vet besides my neighbor is a vet and he will let me know if he doesn't approve of what I do. Not that I listen to him sometimes as he does a lot of the same things I do. I was very glad to hear that Trilostane can cause really awful gas problems as that is what she had. Since I stopped the trilostane the awful (I use the term awful loosely) has stopped. I stopped the tylan a couple days ago and she had normal bowels since Saturday I think. I'm losing track of time. I want her to be good and clear again before I decide to restart anything.
Since I stopped the Trilostane, Cinder seems to have a lot more energy and more than she had even before the Trilostane. Not sure why. Her hunger never changed and her water consumption is still a little lower than before the Trilostane but has picked up some. I'm sure all this will be short lived as the cortisol levels increase again.
I just want to say one thing in favor of our vets - I personally think they have a hard job - Just look at all the different critters they have to treat - dogs, cats, turtle, birds, fish, horses, cows, etc etc. All with different diseases. Then there are a bazillion different breed types within each category. I realize they all have hearts and brains, but not always in the same place nor do they function the same. Physicians only need to study one - the human race - . Then the vets have to put up with a lot of neurotic critter parents much like pediatricians do with human parents of babies/kids. And I am speaking for myself - I probably can be a little neurotic when it comes to my "kids". As well as being a nurse and neurotic, the vets have their problems trying to sort out all that I am trying to tell them and what "I" think is wrong with my babies. Even with some misdiagnoses on their part, I still have much respect for my vets. Some are better than others at sorting all out and some are better at listening to me.
I will let you all know when I am ready to restart this whole thing. Jan W.