My 8 year old Boston, Comet, just diagnosed

[Goldenboi75]

Hi,
My name is Rob and I’m new to the group. It has been so helpful. My little boy Comet, an 8 year old Boston was just diagnosed with Pituitary Dependent Cushings.*

I’ll give a little background info on our journey up to this point. In July 2012 we moved to new area about 1 hour from my old Veterinary that treated Comet ever since he was a puppy. After much hesitation, reluctance, and tiring of an hour drive, in November 2012 I found local Vet and had an initial visit for some immunizations and decided to do a Senior Profile to get a baseline of current health as a preventative measure. The blood work results came back with elevated liver enzymes. We discussed the possibility of Cushings disease due to Comet’s age. The Vet suggested an ACTH test or liver ultrasound down the road. I decided to wait until after the holidays to do any testing as the enzymes were only slightly elevated. In February 2013 – ACTH test done and I was told it was negative. March 2013 - Next round of blood work shows elevated ALK Phosphatase at 740 and 1+Protein in urine. Vet recommended a low protein diet and switching dog food to Science Diet prescription for liver functions. I did not want to switch, I prefer a more all natural product. I found a comparable natural food with very similar nutrition as the Science Diet brand and started Denamarin supplement. June 2013 - new round of blood work, 1.5 lb weight loss and ALK phosphatase jumped to 1853, Cholesterol went up slightly 315 to 330, and 3+ protein in urine. Vet recommended changing foods again! as might have been too much starting Denamarin and changing food and advised that more than likely progression toward Cushings. Based on some things I noticed and picked up on, I really didn’t have the comfort level and trust in this new Vet. So July 2013 I decided to go to my old Vet just for a 2nd opinion. I ultimately decided I will continue my care with my old Vet until I can find another local Vet that I am comfortable with and can trust. My old Vet spent a considerable amount of time with me discussing all Comet’s labs and Cushings in general, what next steps and tests to do. At this point Comet’s only symptoms are the elevated liver enzymes, a hearty appetite (but every Boston I know is that way), and I noticed he is panting a little more than usual. No hair issues, not drinking or urinating more, no accidents. He is still very energetic, strong, and playful, and people can’t believe he is 8!. One day late July or early August I went to pick Comet up and he yelped in pain and for the first time ever, he snapped a little at me. His abdomen seemed to be a little sensitive and he does have a few cysts (which the “new Vet” said were checked and were benign) I was concerned and decided to do the ultrasound and xray of abdomen. They told me it came back that Adrenals were slightly enlarged everything else was normal. They are suspecting Cushings still and we decided to do the Low Dex on September 24, 2013. The test came back and suppressed first 4 hours then rebounded at 8 hours.* My Vet went over case with an internal medicine specialist that they consult with and then came back with recommendation to start Vetoryl at a reduced amount of 30mg and Comet’s weight is about 35-37lbs.*
*
I discussed treatments with Vet:
I asked about Anipryl because it sounded a lot safer and I was told that it doesn’t have a high success rate and it only would treat the symptoms and not decrease the cortisol levels and that since Comet didn’t show many of the symptoms the disease would still progress. I decided against that.

Ketaconazole is not recommended for long term use.
*
Lysodren too risky and Vetoryl sounded like the best choice.

This brings me back to the Vetoryl.* I did ask the vet to see if we could start at 20 mg to be more conservative and he agreed and felt that was a good starting point.* I still feel very reluctant and scared at that level.*
*
The general consensus is start very low, am I being too cautious? Would the 30 mg be a safe and realistic starting point?* Or would say 10mg be a good start? It’s a tough balancing act to give the best and most cost effective treatment. There is quite a difference in cost with 10mg and 30mg, and not realizing my recommendation for 20mg is quite expensive since there is not 20mg pill. It’s so confusing because some people don’t treat until the symptoms are bad.* But I’m concerned with his liver.* The Vet said that the liver enzymes can go down once the overproduction of cortisol is under control but he said sometimes they do not.*

Thanks for listening and for this site.
*

[Roxee's Dad]

Hi Rob and welcome to you and Comet,

Many will be stopping by to welcome you and to share their knowledge and experiences. :)

It would be great if you could post the actual results of the Cushing's test including the normal range and values. (LDDS and ACTH )

As for the right dose, yes, most here recommend starting at a lower dose. I believe the newest recommendation is about 1 mg per pound on the low end.


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[molly muffin]

Hello and welcome Rob and Comet. :)

30 would be an okay starting point at the 1lb/1mg ratio. You'd be a bit under. You can do alternative dosages than what vetroyl (the brand name comes in), you would just need to use a compounding pharmacy and it is actually cheaper than the brand name. However, starting off, you might want to use the vetroyl.

A lot of knowledge can be gained just from reading in the back ground on the forum. Glad you decided to come out and say hello.
Most of continue to give a liver supplement even when under treatment, as liver support is always a good option. If you are feeding a good food now, more natural and that is what Comet is use to then that is probably a good thing to stick to. You basically will want a moderate protein, lower fat side of the diet, as pancreatis is a risk with dogs with cushings, but like I said, you don't want to do any changes just going into a treatment plan, so you will know if any changes you see can be attributed to the medicine and not a diet change.

I'm sure some of the others will be by to say hello

Welcome
Sharlene and Molly Muffin

[Budsters Mom]

Hello and welcome Rob and Comet:)
I am so sorry for the reason that brought you here, but so glad you found us. The more information that you're able to share with us regarding highs and lows on blood work and tests etc, the better we will be able be help. Please ask for copies of test results of anything you don't already have. It is a good idea to have those in a file, just in case you need to see another vet down the line. The tests are very expensive as it is, you don't want to have to pay for them more than once. Most of us don't even want to pay for them once.;)

You are in great hands with our heavenly bunch of angels. Comments, concerns and questions are always welcome. Again welcome both of you.

[LtlBtyRam]

I want to welcome you to the forums as well. I will second the comment about being sorry for the reason responsible for bringing you. I hope you have already figured out the folks around here are PAWSOME! I'll be watching for what happens with Comet. I'm fairly new to all of this too.
Angela

[Goldenboi75]

Thanks everyone for the warm welcome. I don't exactly want to rush into this treatment without really thinking it through. I will be getting all the records and tests to date from both Vets that I saw. Then I can share the levels with the group. I wanted to run something by the folks here that have much more experience with this than I do. I tend to be overprotective and a worrier when it comes to my fur-baby. I am concerned a little bit with the distance between us and the Vet that I'm comfortable with that is an hour away. They are totally supportive of me finding a local Vet and they are more than willing to consult or handle the Cushings treatment. I have researched and asked around about a Vet that is about 30 minutes away that I hear wonderful things about. I had 5 recommendations from different coworkers that currently use or have used this Vet. They all have highly recommend them and the stories about care and treatment are in line with what I expect. I did call and they do have several Cushings patients. This sounds very promising. My thoughts are before I start treatment that it might be a good idea to do this closer to home. Any thoughts? the other option is to get him stable with the current Vet even though with all the testing it's going to require some time missing work and hefty travel time.

thanks again

[Roxee's Dad]

Hi Rob,

One thing most of us will recommend if your vet is using Vetoryl (Trilostane) is to start off on the lower end of the recommended dosage and work your way up if necessary. and to make sure your vet gives you a rescue dose of predisone... just in case Comet goes too low.

Edited to add: If your vet is going to use Lysodren, we have plenty of Lyso mom's on board here to help you through that too. :)

[Goldenboi75]

The "far away Vet" recommended Vetoryl at 30mg for comet who is about 35-37lbs. I was suggested 20mg to start. But everyone seems to agree that the 30mg is still on the low side. My concern was whether to start treatment with a highly recommended local Vet, just in case of an issue plus convenience or continue with my hour away Vet until we have him stabilized. With all the testing it's going to be a little rough. I may have to miss a little work here and there and for appointments it's a 30-40 minute drive home from work to pick up Comet and then an hour to the Vet then an hour home. I just went back to the far away
Vet because I just didn't feel comfortable with the local Vet I selected.

[Roxee's Dad]

Oh I completely understand. When I lived in rural TN, there were not many vets that had any experience. I interviewed every one in my area. One vet who I really liked told me his own dog had cushings and died because he didn't fully understand cushings and the treatment. :eek: One vet took his book out and started reading it to me LOL.. crossed him off the list.

So I picked a vet that was an hour drive each way and had only treated about 5 or 6 cush pups with 3 of them doing well. I had the help and support of the great people here in this forum. I was taught to stand my ground and not follow blindly what was recommended by the vet. I was Roxee's only voice and advocate. I learned, I read, I listened to the experience here. The vet and I had a few disagreements and discussions LOL but and this is a big but... he was willing to listen and work with me :) Roxee never went too low or had an Addison crisis.

We did well, I only wish I had found this group a few years earlier.

You have a decision to make and I know it's hard, but I can tell you that in the beginning, it will take more visits but as Comet symptoms get under control the vet visits become further and further apart.

After the first day of treatment, you will be going for an ACTH Stim test in about 10 to 14 days.

If Comet needs a dose increase based on cortisol still being high... it should be another visit in 10 to 14 days after the dosing change.

If her symptoms are controlled, the next visit is about a month, still controlled and doing well then about 3 months and on to 6 months.

Any set backs pretty much brings us back to the beginning. Cahange the dose, check in 10 to 14 days and so on...

[grapey]

Hi Rob, I'm also a Boston owner. I love all Bostons. :) I am just barely starting this journey, but I can already tell that Comet is lucky to have you. You will find a wealth of knowledge on this site.

[Goldenboi75]

Some testing results:
3/5/13 bloodwork and ACTH
Alk phosphatase-740 (Lab range 5-131)
Urine tested +1 for protein
All other test in range

ACTH
Pre - 1.5 g/dL (lab range 1.0-5.0)
1 hr post-12.2 g/dL (lab range 8-17)

6/29/13
Bloodwork
Alk phosphatase 1853
Cholesterol 330
Urine + 3 protein

Still need to get ultrasound report and low dex test results.

I got to do a phone interview with the local Vet that came highly recommended. It was impressive that the Vet even called me and had a lengthy discussion about treatment before Comet even became a patient. So with that I set up an appointment for 10/14/13. I have good feelings about this one!

[frijole]

? I don't have time to read the whole thread but when was that acth done? Because it is not positive for cushings. Thanks Kim

[Squirt's Mom]

Looks like the ACTH was done in March? And I agree - that is not indicative of Cushing's since it's in normal range. But we can't always rely on one test so I'm looking forward to seeing the LDDS and comments from the ultrasound on all the organs seen.

I hope you and Comet like the new vet!
Hugs,
Leslie and the gang

[molly muffin]

Well you did say that the March ACTH test was negative for cushings and it is. It will be interesting to see what the LDDS result is.
I hope this new vet works out for you, so you don't have to make that long drive. I'm curious if they will want to do another ACTH test before starting treatment, so you know where you are at with the cortisol level. Once you start treating with vetroyl, the ACTH is the monitoring test that you have to have to know what is going on with the drug and interaction within the body.

Sharlene and Molly Muffin

[molly muffin]

Hi Rob. How are things going with Comet? did you go see the new vet?

Sharlene and Molly muffin

[Goldenboi75]

Hi Sharlene,
Thanks for asking. Oh where to begin. I saw the new vet. I have mixed feelings. It wasn't the best experience.
1-The check in staff were not the friendliest. No big deal I can overlook that.
2-waiting room had dried feces under a chair. I'm starting to have my doubts.
3-stuck in an exam room that was not really air conditioned with poor comet just panting away. By now I'm furious I had to open the door to get some air.
4-the actual doctor that saw us was very nice, she was also the one that called me and talked to me on the phone prior to even being a patient there. She looked over everything and at first she was not inclined to start treatment yet. We continued talking and then decided since comet is drinking a little more in the evenings when I'm home and now getting me up often twice in the night to go out it might be a good idea to start treatment. Her opinion was it would be ok to wait on treatment because often once treatment is started symptoms are quickly reversed. She seemed to prefer lysodren which i immediately said no. I kept asking about the Vetoryl and she didn't seem familiar with it. I said it was recently approved by the FDA etc. She started talking about what she referred to as a really expensive drug called trilostan. It just wasn't clicking that they were one in the same. (I just thought with her being the Dr. she should have known both names) She said she would research it and get me some cost estimates etc. She also talked about the importance of having prednisone on hand and she talked about other dogs she successfully treated. She was to call me back within a few days and I still have not heard back.

I know I sound crazy picky about things. I just have so many mixed feelings. I have received 4 recommendations of how wonderful this practice and group of Vets are. I'm just not impressed. Maybe it was an off night, they seem to be a high volume practice. I'm on the fence with this.

These were my thoughts prior to the bomb that got dropped on my family on Tuesday. My significant other had back pain since July and a recent MRI suggest it could be Cancer. This is just completely overwhelming at this point. Hopefully by next Tuesday after some more Dr. visits and tests we will know and I can put more concentration back on Comet.

Right now, I am considering working with both the Vet I'm not fond of and the Vet I love. The Vet I love said they often will be primary Vet over a condition and direct a local Vet do the periodic testing and also routine care. It doesn't hurt to ask to see if the Vet i'm not as fond of would be willing to do that. I just need to get my head cleared and start thinking more clearly.

thanks again for checking in.

rob

[molly muffin]

Oh Rob I am so sorry to hear the news about your significant other. That is scary I am sure it just leaves you in a muddle emotionally. I'm sure it is hard to concentrate on Comet and your partner's health problems all at the same time. :(

Well, lets just hope that this isn't cancer after all. If they think it is then I highly suggest a PET scan. Those things are really good about finding cancer. My sister had them with her breast cancer and a friend who had lung cancer.

As for Comet, gosh, I'm sure that you had higher hopes for this vet. It doesn't sound like the building is all that great, if it doesn't have Any ventilation in the exam rooms. yes trilostane and vetroyl are the same. Lysodren was use almost exclusively prior to trilostane being approved in the US, so some of the older vets have more experience with that. Any drug is only as safe as the doctors knowledge that administers it. If this one is more experienced with lysodren than trilostane, then you might have to school this vet in testing protocols, etc for trilostane. No worries, we have information in the Resource section that you can print out and take in to the vet. ;)

Take care, our thoughts and prayers are with you, Comet and your significant other
hugs,
Sharlene and Molly Muffin

[Squirt's Mom]

Don't be afraid of Lysodren. It is no more risky than Vetoryl/Trilostane. Both drugs are very powerful, both have the same risk factors, both are life-savers. If the vet is more familiar with one over the other, that is the one to choose in most cases. Personally, I wouldn't be comfortable with my baby being the guinea pig for a vet to start using a drug they are unfamiliar with. ;) The big difference between the two when there is a problem from overdose is the length of time the drug stays in the body - Vetoryl (Trilostane) is leaving the body within 2-12 hours while Lysodren is just reaching its peak at 48 hours. So IF there is a crisis, the Vetoryl is leaving the body sooner than Lysodren.

Your experience with the vet sounds a bit like mine when I looked into a Banfield Pet Hospital once, and ONLY once. The place was filthy, the staff was either rude or had this clueless confused look on their faces with anything I asked, the doc was nice but sloppy looking and his hands weren't clean. ~~shiver~~

I am so sorry to hear about your partner's scare and pray it turns out to be nothing major. Keep in touch and let us know how things are going for you all.
Hugs,
Leslie and the gang