Please help, I am frightened! (7 y/o Pekingese)

[Lola]

Hello everyone,
My name is Nadia, and my baby's name is Lola. She is a 7 years old Pekingese.
She was diagnosed with Cushing's disease two days ago. She was perfectly healthy up until a year ago when she started gaining weight and eating like crazy. I took her to the vet and we found out after several tests were performed that she had hypothyroidism. The vet put her on Soloxin 0.1mg twice daily, I changed her food to Wellness Core, grain free, reduced fat dry food. Her symptoms have improved over the following 3 months, she started loosing the extra weight (her maintenance weight now is 19lbs, down from 22lbs). At the three months marks, we redid the test, her thyroid levels were within normal range and her liver enzymes went down as well. The doctor maintained the same Soloxin dose.
She was due for her yearly blood work next month, but I started noticing some new behavior changes and some other symptoms, so I called the vet and moved her appointment up. She had symptoms such as: starving constantly even though she would have just have finished her bowl, hair loss in some areas on her neck, skin lesions on her elbows, drinking a lot or water.
The vet saw her two weeks ago, we did a bunch of tests. Her thyroid levels were all jacked up again, her liver enzymes were as well. I asked the vet to have her checked for Cushings after reading a lot about the symptoms, she told me that she doubts that it is Cushing since Lola was only 7. So we did the dilute urine test, came back positive, we then proceeded to doing a low dex suppression test, that was a clear cut and the vet confirmed that she in fact had Cushing's on Friday.
The vet recommendation is to start Lola on a low dose of Trilostane and go from there.
I am so confused after reading about the treatment and the side effects. Should I start treatment, should I wait? What if I wait and her conditions get worse? My baby is only 7 years old, and I want to make a decision that is in her best interest.
Please let me know what you think. Should I get a second opinion?

thank you all so much, I was so relieved when I found this forum.

[lulusmom]

Hi, Nadia, and welcome to the forum.

I'm so sorry for the reasons that brought you here but I'm glad you found us. In order for us to try to help you figure out what is going on with Lola, we'll need more information. It would help us greatly if you would please round up all of the recent testing that was done and post the results here. With respect to blood chemistry or complete blood count, you need only post the highs and lows, and please include the normal reference ranges. T4 (thyroid hormone) is usually included in blood chemisty but if your vet did a special thyroid panel, please post the results of that too.

Take a deep breath and just know that you have plenty time to figure things out before starting treatment. Cushing's is a very graded disease, progressing at a snail's pace so it's much better to make sure you have a correct diagnosis before starting treatment. Did your vet mention whether Lola has pituitary or adrenal dependent cushing's?

Looking forward to hearing a lot more about your precious girl. You're not alone on this journey. You'll now have a gang of us holding your hand, helping you learn and guiding you on your way to becoming an excellent advocate for Lola.

Glynda

P.S. I manually approved your membership so there is no need to respond to the email we send for membership validation. I also deleted the duplicate thread you posted. You are off and running now so everybody can now see your post. I promise others will be by to welcome you and ask their own questions.

[goldengirl88]

Welcome and sorry for your Lola's troubles. You said you vet performed an LDDS test. Did you have an ACTH test done also. This is a hard disease to diagnose and there are several tests that need done to confirm it. ACTH, LDDS, Urine, Blood Panel, Ultra Sound. First you need to make sure your dog has Cushings, then try and determine the type, if it is adrenal or pituitary dependent. There are 2 treatments for those Lysodren and trilostane. If you get a diagnosis and treat with trilostane start with a low dose no matter who tells you to go higher. There will be less likelihood of problems by starting low. Lysodren in cheaper than trilostane. What are all the symptoms your dog is having, and did you have any blood work? If so were the ALT and ALK Phos high? If you have blood work with abnormal results please post the abnormal ones along with the normal values indicated by the lab that did them as all are different. That way we are better able to access your situation. Not trying to confuse you but there is a third type called atypical also that has to do with the hormones. Please try not to worry so much as this is a treatable disease that when managed well will allow your dog to possibly live out it's natural life. We are all scared, crying etc. when we get this diagnosis, we have all been thru it too. We will be right here to help you along this journey. Educate yourself as much as possible, as you will be the only advocate for your baby. We are always here to answer any questions and help support you thru this. God Bless You and Lola
Patti

[Lola]

Hello everyone,
My name is Nadia and my baby's name is Lola.
First of all, I would like to thank everyone who takes time to post in here, it's a great source of information for concerned pet parents.
My baby was diagnosed with Cushing's two days ago and I have been going crazy researching it, and trying to make the best decision for her. She is only 7 years old and has mild symptoms (I think), so I am afraid if I start her on Trilostane the side effects would be worse than the symptoms. On the other hand, I am afraid if I hold off on the treatment, she may get worse and more organs will be damaged!
About a year ago she was diagnosed with low thyroid and has been on Soloxin ever since. I have been monitoring her very closely and periodic tests are ran. But about two months ago, I started noticing some hair loss on the back of her neck and under her armpits, I also noticed two skin lesions on her elbows in addition to the begging for food and water. I researched it and read a lot about Cushing's so I asked my vet to test her for that. She sis all the tests: first liver enzymes came back high, then did urinalysis, came back positive and lastly did a LDDS which confirmed the diagnosis: it is Cushings!
Can you please help me get some clarity to make the best decisions for her, I love her so much and I don't want to loose her!

thank you all for your input, it is very much appreciated

[Lola]

Thank you so much for taking time to reply. As you can see, I am freaking out, I started another thread not knowing that this one has already been approved.
I will get the lab results from my vet tomorrow, she did not jumb into the diagnosis as she was the one telling me that it's most likely not Cushings. We did complete blood panel first, then urinalysis (positive) then LDDS, that's when she confirmed that it was Pituary Cushing's.
Lola is otherwise perfectly healthy and happy little dog, true she is so attached to me that she would stress like crazy when I leave the house to go to work, but I can't help it, she is my baby and I treat her like one.
I will post the results as soon as I get them, do you suggest I ask my vet to do an ultrasound?

thank you

[frijole]

Hello. first off - take some deep breaths because your dog can lead a very normal healthy life with treatment. Most important is to make sure that the diagnosis is correct. There is no rush to treat the disease - better safe as it can be tricky to diagnose.

The test you had done (LDDS) is a good one however it can have false positives when other diseases are present so doing either an ultrasound or an acth test can validate the findings and give you greater comfort prior to starting the meds.

What dose is your doc recommending and how much does your dog weigh? We'll check the dose to make sure it is within recommended dosing ranges.

Glad you found us. Again, deep breaths! We all came here the same way you did and you are in great hands. Kim

[Budsters Mom]

Hello and welcome from me too.:)
The majority of us freaked out also when we first found out about the possibility that our dog may have Cushings. That is just those of us who admit it. The others probably did too, but are too cool to admit it.;) You are in good company here. In my case, I was up searching the web at 4 o'clock in the morning crying, when I stumbled upon this forum.

First take a deep breath and let it out very slowly. Now do that another three or four times. The more that you learn about Cushing's and how to deal with the day by day stuff, the more empowered you will become and the fear will start to drain away.:) We will help you with all of this. We need test results and anything you have either highs and lows from blood work etc., in order to be of most help.
Others will be dropping by to welcome you also. So again, welcome Nadia and Lola. Hugs,

Kathy

[Lola]

Thank you Kim, I really appreciate your advice. I am meeting with the vet tomorrow morning to discuss the next step. I will get the lab results and she is supposed to prescribe Trilo, I will let you know the dosage. Lola weighs 19lbs, I am trying to bring her back to her normal 16lbs, but the weigh management is the least of my concerns now:) I think I will do an ultrasound just to be sure.

Thank you


Hello. first off - take some deep breaths because your dog can lead a very normal healthy life with treatment. Most important is to make sure that the diagnosis is correct. There is no rush to treat the disease - better safe as it can be tricky to diagnose.

The test you had done (LDDS) is a good one however it can have false positives when other diseases are present so doing either an ultrasound or an acth test can validate the findings and give you greater comfort prior to starting the meds.

What dose is your doc recommending and how much does your dog weigh? We'll check the dose to make sure it is within recommended dosing ranges.

Glad you found us. Again, deep breaths! We all came here the same way you did and you are in great hands. Kim

[Lola]

thank you so much for your kind words.
I will hold off on the treatment for now until I am educated enough to deal with it. I will probably get a second opinion (not that I don't trust my vet, she is a sweetheart and she loves Lola and treats her like her own), but just to have a fresh set of eyes and ears. and I will also do ultrasounds.

thank you everyone for your support



Hello and welcome from me too.:)
The majority of us freaked out also when we first found out about the possibility that our dog may have Cushings. That is just those of us who admit it. The others probably did too, but are too cool to admit it.;) You are in good company here. In my case, I was up searching the web at 4 o'clock in the morning crying, when I stumbled upon this forum.

First take a deep breath and let it out very slowly. Now do that another three or four times. The more that you learn about Cushing's and how to deal with the day by day stuff, the more empowered you will become and the fear will start to drain away.:) We will help you with all of this. We need test results and anything you have either highs and lows from blood work etc., in order to be of most help.
Others will be dropping by to welcome you also. So again, welcome Nadia and Lola. Hugs,

Kathy

[Budsters Mom]

An ultrasound is an excellent choice because it allows you to see the adrenals, liver, etc. Make sure the machine used is high resolution and should be read by a specialist if possible. Most of the time our vet's offices don't have a high-resolution ultrasound machine, so you have to go elsewhere. I had to go to a nearby emergency vet hospital in order to have Buddy's ultrasound done.

If you do decide to treat with trilostane, the starting dosage is approximately 1 mg per pound. It is better to start low and increase if need be. There are fewer serious complications that way.

Are you taking those deep breaths? Do it now!;) Hugs

[doxiesrock912]

A rule of thumb is 1mg Trilostane to 2mg per pound (dog's weight).
Our Daisy weighs 13lbs and she is on 12mg twice a day.
We started lower but determined that the Cushings isn't controlled well enough.

I know that you're scared, I suspect that your vet is knowledgeable since she also recommended starting with a smaller dose. Getting the ultrasound is a good idea. We got one done for Daisy and they determined that she has pituitary Cushings. She's doing well
.on the Trilo.

We were scared too. Now that Daisy has improved and we know more about Cushings, feeling a bit better.

Please keep us posted but it does sound like your vet has done the right thing so far.

[Lola]

thank you so much for the encouragement, reading all your stories has given me more reassurance and knowledge. I am glad Daisy is doing well on Trilo. I will definitely get an ultrasound done first just to be sure and then start the Trilo if we are 100% it is Cushings.
Lola was on Innova for years up until a year ago when she was diagnosed with hypothyroidism, I researched all kinds of foods and found that Wellness Core Grain Free Reduced Fat dry food was the best for her case, with hypothyroidism she is susceptible to getting pancreatitis very easily, the grain free and low fat helps her a lot.


I will keep you all posted, thank you



A rule of thumb is 1mg Trilostane to 2mg per pound (dog's weight).
Our Daisy weighs 13lbs and she is on 12mg twice a day.
We started lower but determined that the Cushings isn't controlled well enough.

I know that you're scared, I suspect that your vet is knowledgeable since she also recommended starting with a smaller dose. Getting the ultrasound is a good idea. We got one done for Daisy and they determined that she has pituitary Cushings. She's doing well
.on the Trilo.

We were scared too. Now that Daisy has improved and we know more about Cushings, feeling a bit better.

Please keep us posted but it does sound like your vet has done the right thing so far.

[doxiesrock912]

You're welcome. Paying it forward. I was petrified when Daisy was diagnosed. I learned enough on her to prompt me to change vets because the one who diagnosed her was way off on the treatment plan and I changed vets asap.

That was in May.

[labblab]

Hello, and welcome from me, too! Did your vet tell you whether Lola's LDDS results pointed towards the pituitary form of Cushing's? If not, it is possible that her Cushing's is instead caused by an adrenal tumor. And if so, at her young age, she might be a candidate for surgery which could actually cure the disease. If this was not discussed with you, I am guessing that the test result pointed instead to a pituitary tumor (the more common cause). But I just thought I would ask, because this is another way in which an ultrasound can be very helpful -- distinguishing between the two types of the disease.

Re: trilostane treatment, I will encourage you to ask your vet to stay closer to the 1mg. per pound initial formula. If your vet wants to use brandname Vetoryl, at her weight of 19 pounds, Lola falls right between the two smallest capsule strengths: 10 mg. and 30 mg. Your vet may be tempted to go with the higher strength so as to make it easier (and less expensive) to start with only one capsule. But I'd encourage you to first start out with two 10mg. capsules instead, at least for the first couple of weeks until you see how Lola is responding to the drug. You can then make dosing adjustments later on if an increase seems safe and warranted.

Once again, welcome to you and your sweet girl.

Marianne

[goldengirl88]

Just checking in to see how you and Lola are doing today. I hope all is well. Are you going to do the Ultra Sound? I think it is a good idea to find out what type she has, and to see if any other organs are having problems. Blessings
Patti

[Lola]

Thanks everyone for checking. I talked to the vet yesterday, I also got the lab results which I will be posting later. I will have Lola checked by a specialist on Thursday morning, and ultrasounds done as well. The vet is recommending to start with 18mg/day Trilo, which I believe to be a good start for her weight, however I don't want to start the trilo until after the ultrasounds and specialist checks.

I will keep you all updated


thank you

[goldengirl88]

Glad you are getting the ultra sound. It will give you a much better picture of all that is going on. Blessings
Patti

[Harley PoMMom]

She was due for her yearly blood work next month, but I started noticing some new behavior changes and some other symptoms, so I called the vet and moved her appointment up. She had symptoms such as: starving constantly even though she would have just have finished her bowl, hair loss in some areas on her neck, skin lesions on her elbows, drinking a lot or water.
The vet saw her two weeks ago, we did a bunch of tests. Her thyroid levels were all jacked up again, her liver enzymes were as well.

Hi Nadia,

From this post I see that Lola's thyroid levels were elevated, has her thyroid levels been rechecked? Hyperthyroidism can cause increases in drinking, urinating, and appetite.

Hugs, Lori

[Lola]

Yes, her thyroid levels were rechecked as well, we are still trying to stabilize those as well. That were the reason she had her follow up with the vet.

here are the test results:

Cortisol Pre Dex: 2.4, normal range: 1.0- 6.0 ug/dl
Cortisol 4hr Post Dex: 3.6 ug/dl
Cortisol 8hr Post Dex 2.1 ug/dl

Urine Coortisol 46.7 ug/dl
Urine Creatinine 167.1 mg/dl
Urine Cortisol/Creatinine Ratio: 87

please let me know what you guys think.


Thank you

[lulusmom]

The results of the LDDS are consistent with cushing's but they do not indicate whether it is pituitary or adrenal dependent disease. Can you please post the normal reference ranges for the urine creatinine ratio? Also, can you tell us if Lola's thyroid levels are too high or too low? As Lori said, if too high, it can cause polyuria (excessive peeing) and polydipsia (excessive drinking).

Glynda

[Lola]

Please pray for Lola, she is having her ultrasounds and specialist check up tomorrow morning. I will update you as soon as I get back.

Thank you all

[doxiesrock912]

Always, prayers coming your way!

[goldengirl88]

Saying an extra special prayer for you and your precious Lola. I hope all goes well, we will be waiting to hear. Don't feel alone we are all there with you in spirit. Blessings
Patti

[spdd]

Thinking and praying for you today.

[molly muffin]

checking in to see how things went with Lola today!

hugs,
Sharlene and Molly Muffin

[Lola]

thank you all for checking on my baby.

So I went to see a specialist this morning, she did a full abdominal ultrasound, and looked at Lola's blood test results over the past 12 months.
All her organs are fine, the adrenal glands are clean, liver, kidneys, spleen, heart rate, all is good, she said that she suspects that Lola has had Cushing's for some time, a year at least that I started noticing these symptoms. Last December's blood work show some abnormalities that should have raised some red flags. Our regular vet focused on the thyroid levels, which were low, but ignored other things that, if put together, should have prompted Cushing's testing. The IMS told me not to worry because Lola looks very healthy and even her number are not very alarming. she also suspects that the Hypothyroidism is one of Cushing's symptoms and is not a problem on its own, we may have to stop the Soloxin but we will se how the treatment goes first.
She sent me home with 10mg/twice a day Trilostane (Lola is 19.5 Lbs)as a starter dose, ACTH is scheduled for Monday 25th.

now I am starting to think that I already lost a year while my baby has had Cushing's this whole time:( I hope all is going to be well with the treatment.

thank you

[molly muffin]

Don't be too distressed. Cushings is a very slow progressing disease. Once treatment is started and they get back to normal levels, they can live out a normal lifespan. Most of us on here didn't know about the cushings until after quite a long time, just like you. You don't know early usually or not very early at least, because you usually have to see symptoms and then they advise (they being people like the world expert Dr. Peterson) not to treat till symptoms show up.

Hang in there, you're doing great!
hugs,
Sharlene and Molly Muffin

[addy]

Dont fret about it, I waited a year to start treating my pup.

[frijole]

Seriously every case of cushing's is discovered by accident! I guarantee you my Haley had it for many years before she was diagnosed... as a result of blood panel for teeth cleaning. We see this all of the time. So don't feel bad - sounds like you have a sound plan to treat and then your baby will be just fine. Kim

[Lola]

What do you guys think of the dose? 10mg twice a day for her 19.5 lbs weight, is that ideal? is taking the meds in two separate small doses better than one big dose once a day? Based on you experiences, which is better? are there any foods I can give her to help absorption of the medication or help with associated upset stomachs?
I know it's two many questions, but I just want to be as much educated as I possibly can about this Vetoryl before I feed it to my baby:)
thank you

[molly muffin]

It's NEVER too many questions. Yes, if you go by, which we do, the 1mg/1lb then 10 x2 is fine and a good place to start. Some vets start right out at twice a day dosing and some start at once a day then might eventually go to twice a day if once a day doesn't control symptoms for the whole day. Some pups have more problems at night with urinating, etc.
I would say starting at twice a day is just fine and the dosage is right.
You just want to keep an eye out to see how she is going to react to it. You should start seeing a decrease in symptoms at about the first 7 - 10 days, but some do take longer.
Every dog can potentially react differently to any drug, so even though you starting right where you should, stay vigilant till you know how she reacts to it.
Give the medicine with a bit of food, like cream cheese or something with a bit of fat (not a lot) to help with the absorption.
You're going to be okay! We'll be right here with you, only an email away.
I've taken my mobile with me when I've ever had to go to the ER and been known to post from the waiting room if I need any information for any reason. So you Know you will never be alone on this journey.

hugs,
Sharlene and Molly Muffin

[Lola]

thank you so much Sharlene, you're very kind.

I wont start the Vetoryl until Sunday, I'll be home all day and will make sure I'll be watching her like a hawk:)
The first ACTH test is scheduled for Monday the 25th so I think it will be okay.

thank you



It's NEVER too many questions. Yes, if you go by, which we do, the 1mg/1lb then 10 x2 is fine and a good place to start. Some vets start right out at twice a day dosing and some start at once a day then might eventually go to twice a day if once a day doesn't control symptoms for the whole day. Some pups have more problems at night with urinating, etc.
I would say starting at twice a day is just fine and the dosage is right.
You just want to keep an eye out to see how she is going to react to it. You should start seeing a decrease in symptoms at about the first 7 - 10 days, but some do take longer.
Every dog can potentially react differently to any drug, so even though you starting right where you should, stay vigilant till you know how she reacts to it.
Give the medicine with a bit of food, like cream cheese or something with a bit of fat (not a lot) to help with the absorption.
You're going to be okay! We'll be right here with you, only an email away.
I've taken my mobile with me when I've ever had to go to the ER and been known to post from the waiting room if I need any information for any reason. So you Know you will never be alone on this journey.

hugs,
Sharlene and Molly Muffin

[molly muffin]

I don't think you'll have any issues at all on Sunday and you'll such relief when the day is over. One under your belt is great for your confidence levels. :)

Sharlene and Molly Muffin

[Lola]

i just wanted to update you all on Lola's treatment.
I gave her her first dose of vetoryl this morning at 8am. So far so good: it's been 8 hours and she hasn't vomited and I don't see any immediate side effects. She is still begging for food though:)
I will keep you posted on the progress.

Hugsssss

[addy]

You will be fine, just remember if you are ever in doubt withhold the pill and someone is usually hanging out here so you can talk.

[goldengirl88]

So glad all is going well with the Vetoryl. Just keep up the good work and things will be fine. Blessings
Patti

[Lola]

Update after day 1 of Vetoryl:
Lola is doing great after the first two doses. However, she almost did not sleep at all last night. she kept going in and out of bed all night, every time she jumps out I sit up expecting her to throw up or want to go out to pee, but all she did is change spots all night. She did that before but she would only jump out of bed two or three times and she would fall asleep fast.
I gave her her morning dose about an hour ago with food, she is sleeping now. No diarrhea or upset stomach so far, thank god:)
It may just be me, but I started noticing her pot belly more now. Can Vetoryl cause the belly to swell more? it could be just me because they shaved some hair off of it for the US and it's more exposed now.

Thank you all for your support

[goldengirl88]

You are doing great! I am very happy your baby is doing well. Keep up the good work. Blessings
Patti

[addy]

It might be that you notice her tummy more with the hair gone or maybe she is having a bit of tummy bloating from gas.

Sometimes they may feel a bit icky from the cortisol starting to drop so that has to be considered as well.

I know it seems like a lot to know and watch for but it will get easier.

You are doing great!

[Lola]

Is there something I can do to relieve the bloating?

Thank you

[thecoz]

Hi there! I'm very new here too, with a 20lb Boston that has just begun Vetoryl about 10 days ago. How has Lola been doing today so far?
KJ & Cosmo

[Lola]

Hi KJ, thank you for checking on Lola.
She is doing fine, I think. She didn't get much sleep last night, neither did I.
Apart from some bloating I think she ok, she is sleeping now. She played a little this morning, she followed me while I was long some yard work outside. The vet told me to pay closer attention to her around day 4 or 5, watch out for any lethargy, lack of appetite... She is due for her first ACTH on Monday the 25th. I am keeping my fingers crossed and hope the treatment doesn't hurt her.

You said Cosmo started Vetoryl 10 days ago, how is he doing? Any improvements or side effects?

Hugs to you and Cosmo:)

[Harley PoMMom]

Is there something I can do to relieve the bloating?

Thank you

I would ask the vet about giving her Gas-X, here's a handy link that has information on human drugs that can be given to dogs: Safe Human Medicines for Dogs and Cats (http://www.petresearch.net/content/safe-human-medicines-dogs-and-cats)

Hugs, Lori

[thecoz]

I'm happy to say, no bad side effects. Cosmo is, however on a low dose (10mg once a day) and he's about 20lbs. We just wanted to be extra careful to start with because he's been through a lot lately. I think he's both looking and acting better the past couple of days!!

[molly muffin]

That is great to hear! Starting low and going up as needed, really is the safer route I think.

hugs,
Sharlene and Molly Muffin

[Lola]

Lola weighs 19.5 lbs and is on 10mg x2 day. She doing fine so far (fingers crossed:)), her doctor is confident that her numbers will be very good.

Thank you

[molly muffin]

I think she will be fine too, but as always, we watch because there is always that off chance of sensitivity to any drug.
I'm glad to hear that she is doing good.
Her avatar is just so cute. Love it. She's beautiful.

hugs,
Sharlene and Molly Muffin

[thecoz]

I'm pretty much expecting to have to increase Cosmo's dosage of Vetoryl at some point. If need be, I'd be fine with 20mg per day, as Lola is on. That seems like a logical dosage for dogs of Lola and Cosmo's weight.
KJ & Cosmo

[goldengirl88]

What a darling you baby is. Her avatar is the cutest. I am so happy for you that she is doing well. Low and slow is the best way to go! Blessings
Patti

[Lola]

Thank you guys for your support. Isn't she just adorable:)
today was day 3 of the treatment. The only thing that I have noticed so far is the restlessness during the night. She seems to be uncomfortable in one place after 5 min, she keeps moving all night.

Nadia

[goldengirl88]

That well may be the cortisol still surging in her. It may take a few tweaks to get it under control fully. You are doing a great job. Blessings
Patti

[Lola]

Hi everyone, I hope you all are having a great weekend and are excited about the holidays as much as I am:)

As you all know, Lola is due for her first ACTH test this Monday, do you have any tips or things I should do or not do prior to the test? How can I make sure I get the best result possible (not skew the test)? what does the ACTH consist of?
two many questions I know:) your help is very much appreciated.

Nadia

[goldengirl88]

Just remember to feed her a small meal with a little fat so she absorbs her Vetoryl before going to the test. Remember it must be completed by 4-6hours later. It will be fine, just keep a good watch on her afterwards. They are usually pretty hyper when you get them from being at the vets, so she will be glad to see you. Good luck and don't worry. Blessings
patti

[AnnG]

Hi Nadia. Your Lola's case sounds a lot like my Buddha. She was super hard to diagnose in the beginning, and her ACTH results were just out of the normal range. We took a while before starting treatment, and consulted with several vets. Our vet recommended Selegiline (Anipryl brand which isn't being made currently). It treats the symptoms, but doesn't have the side effects of Trilostane and Lysodren. I've heard theres mixed results with this med but it worked for Buddha for over a year. We are now considering starting her in trilostane. Anyhow, you may want to ask you vet about Selegiline to start. Good luck! Happy thoughts!

[Lola]

I have been feeding Lola Wellness Core Reduced Fat Grain Free dry food for a little over a year now because of her thyroid and now Cushing's. the only supplement she takes is fish oil. all her treats, crunchy or soft, are grain free. I feel like something is still missing and I feel like I am not giving her a completed diet daily. what do you guys suggest I feed her to make it a balanced diet, and how do you supplement the food? Just picking your brains a little:)


Nadia

[addy]

Nadia, Wellness Core should meet the nutrional guideliness of a "balanced" diet so I am not sure what you mean. Are you discussing supplements other than fish oil that may be beneficial to a dog?

Patti (Tipper's mom) has a good list if supplements she uses for Tipper. She would be happy to discuss any of them with you.

[Lola]

Addy, my apology, I misspoke:) what I meant is supplements that may be beneficial at her age and considering her condition.

thank you

[goldengirl88]

Nadia:
I use many supplements with Tipper.
S Adenosyl for liver support.
Glycoflex for her legs and trachea
Renal Support by Vetri Science for support of the kidneys etc.
Cardio Strength for her heart murmur and function.
Manuka honey as she sometimes gets acid reflux.
Cold Pressed Fish oil by Kronch for high triglycerides
Hawthorn for heart support and function.
Vitamin E for her coat and skin- only 200mg a day no more that that , I use 150.
Hope this starts you off on the right foot. Blessings
Patti

[Lola]

I received today Lola's ACTH stim test results:

Sample 1: 1.5 normal range 1.0- 5.0 ug/dl
Sample 2: 7.7 normal range 8.0- 17.0 ug/dl

T4- post pill 4.1 normal range 3.0- 5.0 ug/dl

The IMS kept her on the same dose of trilostane (20mg/day) for another month, and same dose of Soloxine until we test again next month. I will take her back for her next ACTH in 3-4 weeks per doctor's order.

What do you think of these numbers? The doc told me its great news!

Also, on the bottom of the lab paperwork it says: post trilostane: pre and post cortisol levels between 1.5 and 9.1 ug/dl indicate optimal control

Nadia

[molly muffin]

Those are Very good numbers. You just don't want the pre to drop any lower. It's right at the bottom of the range. How are Lola's symptoms now? If they are controlled then that is great and I certainly wouldn't up the dosage either.
You're doing great!! Good on the T4 too!

hugs,
Sharlene and Molly Muffin

[addy]

I would not change her dose right now. Wait and see where you are on the next test.:)

[goldengirl88]

Glad to see Lola's numbers are good. Is she experiencing any symptoms? As Marianne said you have to be careful of the pre number now that it does not drop any more. Blessings
Patti

[Lola]

thank you all for your input.

Lola's symptoms are improving, I think. she doesn't drink as much as before and she eats her food slowly now:) she seems happier, we can go for longer walks now whereas before she wouldn't go farther than a few yards from the house. Overall she is improving. The hair and skin I guess will take longer to bounce back.
I know that her pre number is right at the bottom of the range, that's what concerns me, it may drop even lower. any recommendation on how to avoid that from happening?

thank you and Happy Thanksgiving

[goldengirl88]

I would just keep her at the same dose until the next ACTH and watch for signs she may be going too low. Happy Thanksgiving to you and Lola. Blessings
Patti

[addy]

Ditto from me:):):)

[Lola]

Thank you all for you good advice.
I am watching her more than ever:) she is not exhibiting any signs of low cortisol right now, thank god- but I will keep a close eye on her until next ACTH.

Happy Thanksgiving

[molly muffin]

Happy Thanksgiving! It sounds like Lola is doing pretty good. That is wonderful that she wants to get out and take a walk again.
Happy Thanksgiving
Sharlene and molly muffin

[Lola]

Thank you Sharlene, I hope you had a great thanksgiving as well.

Nadia

[goldengirl88]

Great to hear Lola is doing well, hope you had a nice Thanksgiving. Blessings
Patti

[Lola]

Thank you Patti, Lola actually celebrated her 7th birthday yesterday:)

[Squirt's Mom]

Happy 7th Birthday, Lola!


And many more!

[molly muffin]

Happy Birthday Lola!!!!

You got many many more coming your way dearie :)

hugs,
Sharlene and Molly Muffin

[goldengirl88]

Yikes i forgot happy 7th birthday lola and many more

[Roxee's Dad]

:):):) Happy Yappy Birthday Lola :):):)

[Lola]

Thank you all so much, you're very sweet:)

Nadia

[Budsters Mom]

HAPPY BIRTHDAY SWEET LOLA!! xxxxx

[doxiesrock912]

Lola! L_O_L_A Lola! (It's a song, can't remember by whom though).

Happy Birthday girly!

[Lola]

Thank you all for your birthday wishes, that's very sweet of you.

Update on Lola's progress: she is doing fine so far, drinking less, eating normal but still begging for food:). She now enjoys longer walks as opposed to before when she was pulling on her leash to go back home after she's done her business. the lesions on her elbows are healing, still a little pink but better, the hair on her back still hasn't grown back but I guess it will take a little time.
I think she gained a little weight, about half a pound or so.
I also think that the meds are making her a little constipated, not a lot but her stool seems to be harder, do you have any recommendations to help soften her stool al little?
we have an appointment with the IMS on the 19th for her second ACTH, fingers crossed:)

Nadia

[goldengirl88]

You can give her a very small amount of pumpkin, or maybe a 1/4 teaspoon of quality fish oil or olive oil to loosen her bowels up. Is she drinking enough water? If not that could be it. What kind of a diet do you have her on? I am glad she wants to go for her walks now, that shows she is improving. Blessings
Patti

[addy]

Hopefully the ACTH will be good, paws and fingers crossed.

Every time I come here to catch up on Lola, I always think of "what Lola wants, Lola gets" was that a song?:):):)

[Lola]

Addy, yes that's a song:) and that's the motto Lola lives by:) she always gets her way somehow, even when we go for a walk, we go where she wants to go.:)

Patti,
I am feeding her Wellness Core Reduced Fat, Grain Free dry food, sometimes I add a tablespoon of Merrik real chicken canned food, but just to alter the taste a little and make it appetizing to her so she wont get bored with the kibble. I give her one soft gel/day of fish oil.
I weighed her last night, she gained over a pound and a half, she was 19.7 now she is 21.2 and it freaked me out. I can't reduce her food intake, she only gets one cup a day as it is.
what could be causing the weight gain?

Nadia

[goldengirl88]

I know exactly what you mean. Tipper weighed 17.6 for the last 2 years. All of a sudden we are up to 18.5 and it had to come off because her legs are not as strong as they were form muscle wasting. That is why I opted for the nutritionist as I tried everything possible to get it off her. I even count her dog food nuggets. She only gets 1 cup a day total of dog food and chicken too. It is hard to believe, but I think the Cushings may mess with their metabolism too. Blessings
Patti

[molly muffin]

Good memory Addy.

Whatever Lola wants was one of the tunes in "Damn Yankees" , also done by Sarah Vaughn.

Careful with the pumpkin, it works both ways, for constipation and for diarhea, but too much and it can swing the other way. so just a bit. Plain pumkin, not pie filling.

Glad she seems to be doing so well.

Sharlene and Molly Muffin

[Renee]

If I may humbly offer my advice on the food... having worked in pug rescue, and being owned by pugs, some of the most notoriously obese dogs are pugs, I have learned a lot along the way. I've worked with pugs that were DOUBLE their recommended body weight. It takes patience and diligence.

For a dog that is maintaining weight between 18-24 pounds, it is perfectly acceptable to go with 2/3 cup a day of kibble, not a full cup. It doesn't look like a lot, but really, it is enough. You can supplement their diet with green beans. Canned or fresh. They are super low calorie, good in fiber, and help your baby feel fuller and more satisfied. We joke in rescue that all the overweight dogs are going on the green bean diet when they come in. It really does work!

[Lola]

Thank you Renee for the good advice. I will definitely reduce the kibble to 2/3 cup a day and add the green beans, I did that before and she loved the vegetables: carrots, green beans, anything:)
I know I am a little guilty here, with crushing's symptoms it's hard to say no when she begs for treats, poor thing she goes to the cupboard where her food and treats are stored and starts to bark, it breaks my heart:(

I will cut the food intake starting tomorrow, I will get fresh green beans and cook them for her tonight.


Nadia

[Renee]

Thank you Renee for the good advice. I will definitely reduce the kibble to 2/3 cup a day and add the green beans, I did that before and she loved the vegetables: carrots, green beans, anything:)
I know I am a little guilty here, with crushing's symptoms it's hard to say no when she begs for treats, poor thing she goes to the cupboard where her food and treats are stored and starts to bark, it breaks my heart:(

I will cut the food intake starting tomorrow, I will get fresh green beans and cook them for her tonight.


Nadia

I completely understand. My girl pug (unconfirmed cushings at this point), seems soooo miserable and hungry all the time. She scratches the refrigerator door throughout the day. I feel super guilty and usually end up giving her a treat. The best way to combat this is to keep fresh / frozen veggies available for her, so I don't feel so bad. Carrots are fairly high in sugar, so don't overdo those. You can do cucumbers or asparagus too.

[Lola]

Hello everyone,

here's Lola's latest ACTH test results:
Pre: 2.6
Post: 10.5

the IMS is saying that we are not in the control zone yet, and recommended that we up the dose from 20mg/day to 30mg/day, test again in 2 weeks and go from there.

What do you think about these numbers?

Thank you

[Roxee's Dad]

That is great and certainly an improvement. :) Lola's numbers are still a wee bit on the high side but how are her symptoms?

[Lola]

She is actually improving slowly: the eating is normal now, the drinking too. she didn't have a lot of symptoms to begin with. She was loosing some hair on the back of her neck, dark spots on her belly and lesions on her elbows. The hair still hasn't grown back, the black spots are still there, but the lesions have healed a lot, they are no longer inflamed, they look more like calluses now.
She more active now, and is willing to go on longer walks, which she didn't do before we started the Vetoryl. so overall, I think she is improving, we just need to reach that control zone.

Nadia

[Lola]

Can you please tell me where you get your Trilostane/Vetoryl? I buy mine at the Vet's office and it's turning out to be more expensive than some websites I have checked.

thank you for your help

[labblab]

Since Lola has now been taking the Vetoryl for thirty days and her ACTH result is still a bit higher than desired, I think your vet's recommendation to increase from 20 to 30 mg. is reasonable. Plus, if you are using brandname Vetoryl, an added benefit is that you will likely find that 1 box of 30 mg. capsules will cost somewhat less than 2 boxes of 10 mg. capsules.

And yes, many of our members have found that they can get better prices on Vetoryl when they buy online as opposed to buying directly from their vet. I'm sure that people who are buying the brandname product online will soon be stopping by to give you some suggestions.

Marianne

[addy]

Lola was 1.5 pre and post 7.7 I think last time so I agree. It it were me I would increase.:):):) Hopefully 30 mgs will be the magic number.;)

[Lola]

You're right Addy, those were Lola's last ACTH numbers. The IMS thinks that she not too far out of range and want to bring her post number to 3-4 range.




Lola was 1.5 pre and post 7.7 I think last time so I agree. It it were me I would increase.:):):) Hopefully 30 mgs will be the magic number.;)

[addy]

3-4 is a good range to try for:)

[goldengirl88]

Sounds good you are doing an excellent job with sweet Lola. Keep up the good work mom. Blessings
Patti

[Lola]

It has been a hectic weekend for us. Lola has ruptured her knee ligament on Saturday. After a trip to the ER, Vet and Orthopedic surgeon, it is confirmed. She doesn't seem to be in any pain, but she just keeps that leg hanging and won't bear any weight on it. I know that surgery can ultimately fix this, but the recovery time is so long. Are there any conservative ways to restore the ligament without surgery, is that even possible? I don't know anything about this condition. I have surgery scheduled for Friday but I may postpone just so I can gat a good handle on all the options and repercussions first.
Does any of you have any experience with similar condition? Anything will help

Thank you

Nadia

[Roxee's Dad]

Hi Nadia,
We have experienced both. My Roxee had the surgery and our Rozee went conservative management.

Roxee's knee surgery was about 8 years ago and was a bit over 2500 dollars, required a few weeks of complete down time and only allowed short potty walks. No running no jumping, had to be on a leash at all times. Completely healed in about 6 weeks.

Rozee went conservative management about 3 years ago. She sprained one knee then damaged the other knee when she was trying to get around on 3 legs. We purchase a doggy wheel chair and went the conservative route which included swimming and non weight bearing exercise, took about 5 months to completely heal.

[Squirt's Mom]

Yahoo group for canine conservative management -

http://groups.yahoo.com/neo/groups/ConservativeManagement/info


And, if you are on Facebook, they have a page there as well (since Yahoo messed up their groups, many have set up discussion pages on FB)

https://www.facebook.com/CanineConservativeManagement?filter=2

[addy]

I'm so sorry to hear about Lola's injury. Hope the Vetoryl increase is put on hold for awhile.

Thinking of you both

[JoannH]

I have always purchased Daisy's meds through Drs. Foster and Smith. It's about $60 for thirty 30 mg capsules. There may be less expensive online pharmacies, but I trust them.

[molly muffin]

Awww, poor little Lola. I think it depends on how bad the tear is, but many people will try limiting mobility and see if that helps to create the scar tissue before surgery. The surgeon and vet can talk to you about whether or not this is an option or chances of success.
You literally have to carry her everywhere, not let her jump on anything or even walk far. Many will get a pen area that they stay in to keep them from running around the house, jumping on furniture etc.

I hope that 2014 is a good year and that you have a merry christmas
hugs,
sharlene and molly muffin

[goldengirl88]

Sorry to hear this about Lola. I hope you have a Merry Christmas with your sweet baby, and that she gets better from this. Blessings
Patti

[Lola]

Is anyone here using liver supplement Denamarin? What do you guys think about this supplement in helping lower liver enzyme numbers?

I read somewhere online that some people are using this on their Cushinoid dogs and nothing else, and have noticed improvements in their symptoms!

Any input would help


Nadia

[frijole]

This is frequently given to cush dogs and I used it. My issue wasn't the drug itself it was the fact the pill was huge and my dog wouldn't eat it. No way to hide it. There are variations out there so you may luck out. Kim

[Junior's Mom]

I give a milk thistle supplement to Junior. It's specifically for dogs, and available a few different places on line. It has brought his liver numbers down.

[molly muffin]

I use Heppato Support supplements and the numbers did go down, but are now going back up.
It is commonly used with cush pups who are and who are not on treatment. It won't help with the cortisol production, that still has to be treated separately from liver support supplements.

Happy New Years Eve
hugs,
Sharlene and Molly Muffin

[Lola]

Thank you Sharlene, Happy New Year's Eve to you too!



I use Heppato Support supplements and the numbers did go down, but are not going back up.
It is commonly used with cush pups who are and who are not on treatment. It won't help with the cortisol production, that still has to be treated separately from liver support supplements.

Happy New Years Eve
hugs,
Sharlene and Molly Muffin

[frijole]

I forgot to mention when I switched from Denamarin I too went with milk thistle. I just bought it at drug store and poured it over her food. Though no scientific studies have been done my cush dogs alk phos levels went from near 2000 to 800! So I kept giving it to her.

[Lola]

I forgot to mention when I switched from Denamarin I too went with milk thistle. I just bought it at drug store and poured it over her food. Though no scientific studies have been done my cush dogs alk phos levels went from near 2000 to 800! So I kept giving it to her.

Thank you Kim.
What brand do you get and what dosage? Please bear with me if I'm asking too many questions, I am new to this and there's a lot to learn

Thank you

[molly muffin]

There is no such thing as too many questions. One must learn and knowledge is your friend. :)

Happy New Year

hugs,
Sharlene and Molly Muffin

[goldengirl88]

Happy new Year to you and sweet Lola. Hoping the new year brings better health for Lola, and less stress for you. Blessings
Patti

[Lola]

Happy new Year to you and sweet Lola. Hoping the new year brings better health for Lola, and less stress for you. Blessings
Patti

Thank you Patti, you're so sweet:)
Same to you my dear.

Nadia

[Lola]

I am sorry to have been away for so long. Lola has had so many issues, and with her torn ACL, I can't keep her still and I'm thinking that the CM won't work:(
We did another ACTH Stim test on Thursday, here are the results:
Pre: 5.1
Post: 6.8

The IMS said that Lola is improving, and upped the Vetoryl from 30mg/day to 40mg/day. She thinks that this is most likely the maintenance dose. We will be doing another Stim test in two weeks, along with a full blood/urine panel.

What do you guys think of these numbers?

Nadia

[molly muffin]

These numbers are good, but remember that you've upped the dosage now by 20mg over the course of a few weeks, so keep an eye out that she doesn't go too low. Lola didn't have many symptoms to begin with so, I would actually be fine with those numbers if her symptoms are controlled. It's not always the numbers but the symptoms that are the strongest suggestion of how she is doing. The post number can be up to 9.0 with symptom control according to Dechra.

Sorry that it has been so difficult to keep her quiet. Limit the number of things that she can jump onto or off of, if you have to put her on a leash attached to you, then that might work too.

hugs,
Sharlene and Molly Muffin

[frijole]

I agree - probably would have held off on upping the dose so quickly. We have seen over and over that there is a 'cumulative effect' that takes place and suddenly cortisol goes lower after being on a dosing regime for several weeks. When you increase the dose you run the risk of lowering the cortisol too much so please be on the look out for any signs of distress and check in with us so we don't worry too much ok? Thanks, Kim

[Lola]

What would some signs of distress be? She's been on 40mg for 2 days now and she seems to be fine. The symptoms are improving, hair is growing back, she still begs for food but I think that's more of a behavioral issue now.

Thank you guys for your input

Nadia

[goldengirl88]

Nadia:
Thanks for all the info you sent me on the ACL. First off I wanted to day her numbers were pretty good, but I myself have learned to go by Tipper's clinicals symptoms. To me it is the biggest indicator as to whether or not she is controlled. I am a bit scared about the higher dose you went to so quickly. Please watch for the vomiting, no eating, diarrhea, lethargy, having trouble standing. I am praying she does not go low. I think maybe a more conservative approach would have been better as in using a compounded trilostane in a lesser mg with the Vetoryl. It just seems like 40 is an awful lot for a small dog to handle without problems. I hope everything turns out alright for both of you. Blessings
Patti

[doxiesrock912]

Nadia,
I agree with others, and seeing that your seeing improvement so quickly I am super concerned about the high dosage. Usually, it can take a week or longer to really see improvement in symptoms.

[labblab]

For all our benefit, I decided to quickly check back to see Lola's dosing and testing history. I was glad I did, because she it may help make better sense of the increase at this point. I don't believe Lola had a diagnostic ACTH performed prior to starting treatment (Nadia, please correct me if I'm wrong). So this is the history I have:


Started 10 mg. twice daily on 11-16

ACTH on 11-26: 1.5 and 7.7 (Continued on same dose)

ACTH on 12-20: 2.6 and 10.5 (So cortisol actually increased and dose was therefore also increased to 30 mg. daily total)

ACTH on 1-4: 5.1 and 6.8 (Daily total increased to 40 mg.)

One big question that I have is, did you continue dosing twice daily when you increased to 30 mg. total, and are you dosing twice daily now? If you are switching back-and-forth between once and twice daily dosing, this could affect the predictability/consistency of the dosing results.

But that issue aside, Lola has now been on the trilo for six weeks now with her cortisol continuing to hang up there with a "post" result of approx. 7 or higher. When you add in the ACL tear, your IMS may be particularly anxious to get her cortisol lowered since elevated steroids can inhibit the desired healing process (and also leave her more vulnerable to injury to her other joints).

So hopefully this increase will indeed do the trick and if Lola remains behaviorally well, I don't think you need to worry unduly. But as the others have said, all owners giving trilo should always be watching for signs of low cortisol (no matter how long the dog has been taking the drug): vomiting, diarrhea, unusual lethargy, loss of appetite or thirst.

Marianne

[goldengirl88]

Marianne:
Thanks for going back thru the history that does explain some things better. Blessings
Patti

[Lola]

Thank you Marianne for taking time to look back at Lola's test history and for being so thorough:)

""[QUOTE=labblab;134662]For all our benefit, I decided to quickly check back to see Lola's dosing and testing history. I was glad I did, because she it may help make better sense of the increase at this point. I don't believe Lola had a diagnostic ACTH performed prior to starting treatment (Nadia, please correct me if I'm wrong). So this is the history I have:""

NO, we didn't do an ACTH during diagnosis, we did an LDDS and full blood count and urinalysis.

""One big question that I have is, did you continue dosing twice daily when you increased to 30 mg. total, and are you dosing twice daily now? If you are switching back-and-forth between once and twice daily dosing, this could affect the predictability/consistency of the dosing results.""

Yes, I am still doing twice daily doses, 20mg in am and 20mg in the pm.

""But that issue aside, Lola has now been on the trilo for six weeks now with her cortisol continuing to hang up there with a "post" result of approx. 7 or higher. When you add in the ACL tear, your IMS may be particularly anxious to get her cortisol lowered since elevated steroids can inhibit the desired healing process (and also leave her more vulnerable to injury to her other joints).""

you are right, the IMS consulted with a colleague ortho, he recommended surgery as soon as Lola can handle it. IMS thinks that we are not there quite yet, a couple more weeks of CM would help, until the Cushing's symptoms are fully under control.


""So hopefully this increase will indeed do the trick and if Lola remains behaviorally well, I don't think you need to worry unduly. But as the others have said, all owners giving trilo should always be watching for signs of low cortisol (no matter how long the dog has been taking the drug): vomiting, diarrhea, unusual lethargy, loss of appetite or thirst.""

her symptoms are improving, although she still has the few extra pounds, hunger and excessive peeing, her hair is growing back at least.
I will be watching for any low cortisol side effects over the next couple of days. However, I think that Lola may have a UTI, she licks herself more often lately, not obsessively but more. it may be nothing, it could be just me watching her more closely since the diagnosis:)

Nadia

[molly muffin]

Okay so what Marianne and then your reply makes perfect sense. Always keep an eye on her though, because you know how us nervous mother types can be :)
With the hair growth and symptoms better, it does sound like her cortisol is into a good place currently and that may help to get her to a good place for surgery.

hugs,
Sharlene and Molly Muffin

[Lola]

Nadia:
I use many supplements with Tipper.
S Adenosyl for liver support.
Glycoflex for her legs and trachea
Renal Support by Vetri Science for support of the kidneys etc.
Cardio Strength for her heart murmur and function.
Manuka honey as she sometimes gets acid reflux.
Cold Pressed Fish oil by Kronch for high triglycerides
Hawthorn for heart support and function.
Vitamin E for her coat and skin- only 200mg a day no more that that , I use 150.
Hope this starts you off on the right foot. Blessings
Patti

Hi Patti,

where do you get the Hawthorn, and what brand do you get?

thank you

[goldengirl88]

Nadia:
Were you emailing me? I was afraid to open it, but if I know it's you I will. I get the Hawthorn form Mountain Rose Herbs and Cush dogs cannot have alcohol so get the glycerized kind it I s not processed with alcohol. This is a very good organic brand. The Cardiologist told me to keep giving it to her. Also I wanted to tell you the hospital messed up Tipper's leg after it was getting better and she needs more laser therapy. The laser therapist told me her small min pin tore hers and she got it back to good as new with the cold laser, and it is now the top agility dog in its group in the US. I have noticed a big difference in Tipper's since she is getting this every week now. Maybe you could try it if anyone does this near you? How is Lola doing now? Blessings
Patti

[Lola]

Thank you Patti for the excellent advice, I will definitely be looking into the cold laser therapy for Lola's knee problems. I haven't done much about it really other than CM and restricting activity as much as possible (which is not very easy with her, it has been a challenge:)).
We did a complete blood work, urine analysis, ACTH Stim and blood pressure on Thursday. the number were excellent, liver enzymes went down from 1200 to 490, all the numbers were outstanding EXCEPT for the blood pressure reading, 180!! the doctor is not too concerned, she told me that Lola was very anxious and stressed while the reading was made and that caused a false high, we will redo it in 6 week using a different technique that will make Lola more comfortable, take multiple readings and calculate the average.
I asked about the Hawthorn because I though I might as well start it now, it wont hurt her, I think.
Her ACTH test results were pretty good too: Pre 2.7 and Post 3.9. I am also switching from the name brand Vetoryl to a compounded Trilostane, she will remain on the same dose for the next 6 weeks until we test again, 20mg x 2 day.
Now that I think I got the Cushing's under control, somewhat, I will focus on her knee and her blood pressure. Any advice you can give me about the blood pressure?

Thank you and god bless!

[molly muffin]

ACTH
pre 2.7
post 3.9
is Excellent and just where you want to be! Congratulations! This is no small feat and we couldn't be happier for you. :)
Fabulous about the liver enzymes, I think was the ALKP coming down so much too. Really, really good news there.
You are obviously doing a fabulous job with Lola and I Know you will get this leg issue righted too.

BIG HUGS to you!
Sharlene and Molly Muffin

[goldengirl88]

Nadia:
I just wanted to tell you I ma very conservative with Tipper's care and would never opt for an operation where they cut the bone etc. This cold laser therapy is doing the trick for her so I highly recommend it for Lola. Also the hawthorn will not hurt her. It opens up the vessels of the heart making the heart work easier and better. Hoping for Lola to get healed soon. I know Tipper wants to run and jump and play it is a full time job looking after her. Looks like Lola has some good numbers too. Good Job Mom! Blessings
Patti

[Harley PoMMom]

Many health issues can cause high blood pressure, Cushing's is definitely one of them. With my boy, Harley, I found that having the first am appointment at the vets for taking his BP was the best time. Also, his rear legs gave lower readings than his front ones.

There is also a non-health issue that can attribute to high blood pressure which is called "white coat syndrome." White coat syndrome is when a dog's BP is elevated in a clinical setting but not at home.

The three medications that are commonly used for high blood pressure are, Enalapril, Benazepril, and Amlodipine.

Hugs, Lori

[Lola]

Thank you all for the follow ups and good advice.

I will be starting the Trilostane tonight. Should I be watching for any side effects just switching from Vetoryl to compounded Trilostane? The pharmacy I am using is very reputable and has delivered very consistent product in the past so I don't think dosage should be an issue, just the fact that we will be using a different chemical is concerning me. What do you all think?


Thank you

[labblab]

The active ingredient should be exactly the same chemical. The difference is the production and sourcing of that chemical. The producer/supplier of the active chemical for brandname Vetoryl is documented with and approved by the FDA. A compounding pharmacy can purchase the chemical made by whomever they choose and can change suppliers at any time.

Having said that, consistency in dosing is likely the biggest question mark. As long as your dog looks well and exhibits comparable ACTH results, you should be able to relax.

Marianne

[goldengirl88]

Nadia:
I am hoping your sweet Lola does well on the trilostane. Blessings
Patti

[Lola]

Thank you for checking Patti.
I think she's doing good, although last night she couldn't breath well around 2am. I was up all night watching her and deciding whether or not I need to take her to the ER. she finally fell asleep around 4 and so did I.
I took her to the vet first thing in the morning, she told me that this is not likely to be related to the switch from Vetoryl to Trilo, it could just be allergies. We are having some weird whether out here in California, and several fires are burning, heat, ash in the air...I myself am having breathing issues because of this:)
Lola has been fine all day, normal activity level, eating drinking normal, playing and all, that breathing episode didn't happen again, thank god! we are having another ACTH again in 6 weeks, hopefully Trilosatne will work:)

Thank you and god bless

[molly muffin]

Yes I bet it is the air quality and ash in the air that affected Lola and you. It's hard on their little lungs too.

What about an air purifier or something for the bedroom? Might help both of you.

hugs
Sharlene and Molly Muffin

[goldengirl88]

Nadia:
Sure hoping Lola is breathing better today. I know how scary that is when they are breathing badly. It may be allergies too. Tipper has had some really bad breathing through out her Cushings and it has really worried me. I am hoping the switch to trilostane is going smoothly. Blessings
Patti

[Lola]

Hello everyone,

Sorry to have fallen off the face of the earth :) just been busy with work and life.
Lola is doing great, her coat has never looked better, the hair on her neck is growing back, it's about 2 inches now (the rest of her hair is about 5 or 6 inches long). Her appetite and water intake are ok. Her ACL is healing very slowly, she's now walking without a limp inside the house, I still take her out on a stroller for her "walks", she is still not allowed to jump up or down furniture or stairs, even though she tries, trust me:) I will start researching cold laser therapy in my area, and will probably start that next month.

Thank you all and god bless

[molly muffin]

Life does have that habit of getting busy doesn't it :)

Glad to hear that Lola is doing well and the ACL is slowly getting better. That does take a long time it feels like.
I completely sympathize with the trying to keep them settled and not jumping as I am going through that currently with my molly too. (due to a disc injury) It's Hard! They just want to go and go, and they can't.

Molly is doing the series of laser therapy for her back currently and she is responding well to that plus the anti-inflammatory med. I definitely recommend it. My vet does it so that makes it easier I think.

hugs,
Sharlene and Molly Muffin

[goldengirl88]

Nadia:
So glad to hear that Lola is doing well. I hope she continues to improve. How is she managing with her leg? Is she walking on her toes or flat footed? I am glad that things have gotten better for you both. Tipper has one more intense laser session, she is fairing pretty well on her leg. Blessings
Patti

[Lola]

Hi Patti,
Lola is still not walking flat on the injured foot, we had a little setback this morning when she slipped on the hardwood floor :( it's practically impossible to keep her quite!
I am hoping to find a good laser therapist close by, hopefully that'll speed up the healing- it's been 8 weeks already

Thank you

[goldengirl88]

Nadia:
Maybe after you get her the cold laser therapy as that has done wonders for Tipper. They are never really the same, but are able to navigate way better. I am hoping as Tipper walks more she will strengthen it. Blessings
Patti

[Lola]

Patti,
when did Tipper injured her leg, and how often do you do laser therapy? how long after the injury did you start it?

thank you for your advice

[goldengirl88]

Nadia:
Tipper injured her leg about 3 weeks ago. I got her to the therapist and started the very next day. I does work wonders. I am hoping you can find one to take Lola to. Blessings
Patti

[Lola]

Hello everyone,
sorry to have fallen off of the face of the earth, just been busy with life.
Lola had her routine ACTH yesterday after 6 weeks on the new dose of 20mgx2 day Trilostane. Pre 0.8 and Post 3.8.
The IMS was very optimistic and said that this is great news, we are keeping her on the same dose and testing again in 3 months.
I also started Lola on Physical Therapy and cold laser for her injured Knee. I am just trying everything possible to avoid surgery:(
The bad news is that now she has high blood pressure and the doctor put her on meds for a week until we test again next Thursday.
what do you guys think?

Thank you

[doxiesrock912]

Blood pressure can rise with an injury I think. So that could be part of it, Cushings can also cause high blood pressure but now that you're better controlled, hopefully that will help.

Overall, I'd say that it's good news :)

[Lola]

I just wanted to add that the doctor put her on Amlodipine not Enalapril for the blood pressure.

[doxiesrock912]

I'm not familiar with high blood pressure meds but I'm sure that others who are will be online shortly.

[goldengirl88]

Nadia:
Good to hear from you. How is Lola's leg coming along on it's own? Good you are going to laser therapy, Tipper is better. I don't want to ruin a good thing here, but I must caution you .8 pre is not good, it is bad and she needs her dose adjusted down. She has very little reserve at 3.8 and this just happened to Tipper that is how I know and she is lower than Tipper was. The vet must not know this is low. When the pre goes under 1.5 that is not good and the post will then follow- those are the exact words from Dechra. You need to adjust her dosage up a little as not to raise the post too high but to edge the pre up to or over 1.5. Sorry I know you were happy with this but is can get into a sticky wicket if not addressed. Please tell the vet to call Dechra and they will explain it to her. Hope everything else is fine. Blessings
Patti

[Lola]

Patti,

the doctor and the pharmacy are closed now, is it safe to wait until Monday? will I be causing any damage? How about the blood pressure medicine, what do you think about that?

thank you

[goldengirl88]

Nadia:
Just watch her closely, you know the signs of Addison's from being on the forum. I think she will be alright if you get her dose dropped a tad, but if it were me I would probably not give her the full dose. What is she on now? If it's one capsule, you cant lessen that. Tipper was on 27mg so I dropped down to 20 until talking with Dechra. Then we split her dose to 15 in the morning and 10 at note. She will get an ACTH next week to see where she is.Some would withhold giving any until you talk to Dechra, and I would probably be one of them. I don't know about the blood pressure meds. No experience with them yet thank God. When they are needed they are very important, as hypertension really affects their kidneys etc. Hoping all goes well. Blessings
Patti

[Lola]

Lola is on Trilostane 20mg capsule twice daily. I Can't lessen that unless I go down to 2omg once a day, and I don't want to drop her that much either. She was on 30mg 6 weeks ago.
I don't think she is displaying any Adison's symptoms, so I think if I wait until I talk to her doctor on Monday it wont be too bad, without changing anything until then. What do you think?

[Trixie]

If you have a copy of your test results it shows test range scale of the norm at the bottom and you look at the one for dogs on the medication.
I don't know so much about the numbers but my dogs last test was in November, her pre was 1.8 and her post was 2.7. she has been fine since that test. But again, all dogs are different so I guess it doesn't mean that much to see my numbers. It's your pre number that seems a bit low...but I'm no expert.
Maybe talk to your vet about the numbers as soon as you can and you can also call Dechra too and see if your vet and Dechra see eye to eye on your dogs numbers. It can't hurt to gather more info and in the meantime just watch your dog and if you notice any changes in her you can always just skip a dose.
Barbara

[maria]

I am new to this too. I did not freak out because Pumphrey had symptoms since she was 2.5 years old. I knew something metabolic was wrong with her. But I did freak out about the treatment when she was finally diagnosed a few months ago. We tried Trilostane which did not work on her (she has atypical) and now were are in the process of loading her with Lysodren. What I can tell you is this will all make sense and you will calm down when you understand it better. There is a steep learning curve but with the help of people who are one websites like this, you will get a handle on it. This has become a new normal for me and I accept it. You will not learn it all at once but in bits and pieces some of which might not make sense now but you will have an Ahha moment later on. We have all been down or are going down the road you are on. You are not alone.

[addy]

If the basal or ACTH-stimulated cortisol concentrations are below ideal at any time, trilostane administration should be discontinued temporarily and the dose decreased when resumed.

Ideal is 1- 5 ug/dl. That makes perfect sense if the post is also under 5 ug/dl but Tipper's is well outside the reference range. I don't believe I've ever seen a basal (pre) number so low with a discordant post stimulated cortisol. pre .7 and post 9 seems very unusual.

If Lola's pre is under 1 ug/dl that would be less than ideal and according to the updated guideline, her dose should be temporarily discontinued and then resumed at a decreased dose.

Our administartor Glynda posted this on Tipper's thread so I copied it here for you. I'm not sure if Glynda found it here but you should review this at any rate:

http://www.dechra-us.com/Files/dechraUSA/downloads/Case%20Studies/Clinicians%20Brief-trilostane.pdf

[Lola]

I am freaking out right now and don't know what to do!
the doctor's office is closed until Monday, and I need to consult with her before changing the dose, especially that Lola doesn't have any signs of low cortisol at all!
I want to wait until Monday to talk to the IMS and Dechra first before messing with the dose, but I want to know also that I am doing the right thing and not messing up what I've been fixing for 4 months!

All input is appreciated, god bless

[molly muffin]

okay, calm, calm. She is fine today right. How long has she been on this dose? It's been awhile right.

So, my suggestion is to give Dechra a call tomorrow, and find out what they say about the numbers. If they say, they think it is fine to give her doses till Monday, then that is what you can do, and if they say to withhold, then you just withhold the dose. Missing a dose or two of trilostane is not going to shoot her back up into a high range. That is one of the good things about using trilostane, you can stop and start it without any problems. Either way you'll know what you want to talk to the IMS and vet about on Monday.

That is a plan you can work with right?

Hang in there, hugs
Sharlene and molly muffin

[Lola]

Thank you Sharlene for your kind words.
Lola has been on this dose for 6 weeks, without any issues whatsoever, even now as I'm typing this message she is playing on the carpet and being her crazy happy self :)
I called Dechra, office hours are Monday thru Friday, no luck. I called the IMS office and spoke to a different internist, not Lola's treating Doctor, he told me not to freak out, and that the pre number is not as important as the post number. I will call her doctor on Monday anyway, but I am still confused about all the conflicting info out there!

Nadia

[molly muffin]

Right, she will probably be fine. I think that they use to think the pre number wasn't important and it's true that we didn't use to pay as much attention to it as the post number. It's only since Dechra has put out the information they have now and since they have been telling our members that the pre number does matter, that we've started to warn members that Dechra, who is the manufacuter doesn't want the pre to go under 1.45 I think it is now. There must be a reason for this and that is why we worry more now than in years past about it.
So do I think Lola will crash over the weekend, probably not, but if the cortisol were to continue to drop and Dechra seems to think that the post number will follow the pre number, that we worry about it more. Print out the new guidelines from Dechra, and use that in your conversation with them and with your vet.

So, okay, then you'll call them monday and then you'll talk to the vet about it. You'll just keep a close eye on her in the mean time. If you have any concerns though you stop the trilostane. It doesn't hurt them if it is stopped and restarted.

Sharlene and Molly muffin

[Lola]

I will be watching her like a hawk:)
So far, she has not exhibited any lethargy or signs of crashing. What else should I be looking for? What should typically trigger a trip to the ER or stopping the Trilo?

Thank you

[goldengirl88]

Nadia:
Sharlene gave good advice. As I said talk to Dechra and watch her like a hawk.That is the best thing about Trilostane you can stop and restart it. She will probably be OK for the weekend, just watch her. No one can make the decision for you so it is best to talk to Dechra and follow their instructions. If you feel something is not right stop the Vetoryl. Blessings
Patti

[Squirt's Mom]

What else should I be looking for? What should typically trigger a trip to the ER or stopping the Trilo?

The same things that would trigger at trip to the ER on Lysodren - loss of appetite, vomiting, loose stools / diarrhea, lethargy. IF you see any of this, stop the med immediately. Vetoryl has a very short life in the body so it is leaving the system quickly once the dosing is stopped. This is one of the good things about this drug - it can be stopped and restarted without losing ground like you would with Lyso.

Based on your description of Lola's behavior - playing, etc - I don't think an Addisonian crisis is currently an issue but with that low pre number watching like a hawk is an excellent idea. If you see anything that truly concerns you, stop the med til you can talk to the vet. It won't be a big deal to do that. ;)

Hope she is still going strong this morning and does what Squirt often does to me - makes you look like a goof for worrying! ;):rolleyes::D
Hugs,
Leslie and the gang

[addy]

Im sorry if I scared you:o I was just trying to arm you with info for your IMS.

Just like I am going to tell you that Enalapril should be used with caution when using Veotryl. I think a discussion of that should be had with your IMS so you know how it may possibly affect Lola. We have seen dogs on both drugs but you need to know the possible ramifications of using it and just how it could affect your Lola.


This is not to scare you but arm you with information, okay? So dont get worried and upset. Everything will work out just fine.:)

[My sweet Ginger]

My Ginger's been on Amlodipine for a little over 3 months and we get pretty consistent readings now. She weighs around 10 lbs. more less and her BP was over 250:eek: Her dr put her on 1/4 tab (0.625mg) Amlodipine 2.5mg daily, rechecked after one week. It was then 208 so her IMS doubled the dosage to 1/2 tab (1.25mg) and said no need to check Ginger's BP for many weeks.:rolleyes: By chance we checked her BP after 3 1/2 wks later and it was 70.:eek::eek: She was off Amlodipine for one wk and her BP went up to between 230 - 255. Started with 1/4 tab with a couple more rechecks and finally now seems to have stabilized.
What's Lola's dosage? I know she weighs about 19-20 lbs. and am wondering what her IMS had her started with. If her BP is going downward after one week but not yet her desired numbers give the drug one more week and recheck again. It may take a couple of weeks to know for sure whether the dosage is right for her unless the doses are too strong for her.

[molly muffin]

I absolutely agree with Leslie that we aren't talking about a crash this weekend, she's playing and having fun. We are talking about this dosage not being one that can be maintained going forward, as it is quite likely that the post number will start dropping in line with the pre number. No one wants that to happen.

Okay so, adding on to Mariannes previous review of dosage and I would suggest that this is a good way to see how you are doing, each time an ACTH test is done.


Started 10 mg. twice daily on 11-16-13

ACTH on 11-26: 1.5 and 7.7 (Continued on same dose)

ACTH on 12-20: 2.6 and 10.5 (So cortisol actually increased and dose was therefore also increased to 30 mg. daily total)

ACTH on 1-4: 5.1 and 6.8 (Daily total increased to 40 mg.)

ACTH on 2 - 27: 0.8 and 3.8 (Daily dose 20 mg x 2)

I know they wanted to get her ACL tear healed as much as possible and that was part of the reason for the larger increase in dosage. It also could be that the ACL tear, was causing more cortisol to be produced in reaction to the tear (pain) and now that is healing that the cortisol is not as high naturally. That is just a thought that I had so, not a definite but maybe something to ask your IMS about.

hugs,
Sharlene and Molly muffin

[goldengirl88]

Nadia:
I was not trying not alarm you, but rather making a cautionary statement. Sharlene explained it very well. This is for the dosage moving forward that you need to decrease. I am not telling you your dog is going to crash, but that this needs addressed. Have you talked to Dechra? The reason I am very careful with this is that Tipper has done this several times, and each time I spoke to Dechra so I was sure I was doing things correctly moving forward. I never make any dosage changes without consulting them. This is good too because they keep a record of all the dosage changes also. I always err on the side of caution when Tipper is involved as her safety is paramount to me. I have at times had to take her off the vetoryl, and restart her as she went to low. I am hoping you feel more comfortable now, and that Lola continues to do well. Blessings
Patti

[Lola]

My Ginger's been on Amlodipine for a little over 3 months and we get pretty consistent readings now. She weighs around 10 lbs. more less and her BP was over 250:eek: Her dr put her on 1/4 tab (0.625mg) Amlodipine 2.5mg daily, rechecked after one week. It was then 208 so her IMS doubled the dosage to 1/2 tab (1.25mg) and said no need to check Ginger's BP for many weeks.:rolleyes: By chance we checked her BP after 3 1/2 wks later and it was 70.:eek::eek: She was off Amlodipine for one wk and her BP went up to between 230 - 255. Started with 1/4 tab with a couple more rechecks and finally now seems to have stabilized.
What's Lola's dosage? I know she weighs about 19-20 lbs. and am wondering what her IMS had her started with. If her BP is going downward after one week but not yet her desired numbers give the drug one more week and recheck again. It may take a couple of weeks to know for sure whether the dosage is right for her unless the doses are too strong for her.

Thank you for the info.
Lola's BP was 180 6 weeks ago, we checked again last week, it was 190. Her IMS put her on Amlodipine 1/4 tab daily (the tabs are 2.5 mg), we will recheck in a week, I am hoping it will go down

Nadia

[My sweet Ginger]

Lola's BP is not near where Ginger's was so maybe she doesn't need higher doses like Ginger's. Even with the White Coat Syndrome which Ginger def. has her IMS said it should be under 200.
She's now between 130 - 150ish depends. I think Lola's BP is on a high side so hopefully 1/4 tab will bring it down nicely but not too low.
The IMS didn't tell me and I didn't ask(:o) why she prescribed Amlodipine over the others but it seems to be working fine without noticeable side effects so far.
I hope you will figure out Lola's correct dosage real quick and she will continue to do well.

[Lola]

Here's Lola's history with Vetoryl/Trilostane

- started on Vetoryl 10mg 2x day on 11/16 based on a positive LDDS

- ACTH#1 on 11/25
Pre 1.5
Post 7.7
IMS advised to keep dose the same (10mg x2day)

- ACTH#2 on 12/19
Pre 2.6
Post 10.5
IMS increased dose to 30mg/day (20mg in the am and 10mg in the pm)

- ACTH#3 on 1/2
Pre 5.1
Post 6.8
iMS increased to 40mg/day (20mg x2 day)

- ACTH #4 1/16
Pre 2.7
Post 3.9
IMS kept dose the same 40mg/day (20mg x2 day), and we switched from Vetoryl to compounded Trilostane

- ACTH#5 on 2/27
Pre 0.8
Post 3.8
IMS advised to keep dose the same at 40mg/day (20mg x2 day) and recheck again in 3 months.

What do you guys think?

PS: the ACL injury happened on 12/21

Nadia

[Harley PoMMom]

Here's Lola's history with Vetoryl/Trilostane

- ACTH#3 on 1/2
Pre 5.1
Post 6.8
iMS increased to 40mg/day (20mg x2 day)

- ACTH #4 1/16
Pre 2.7
Post 3.9
IMS kept dose the same 40mg/day (20mg x2 day), and we switched from Vetoryl to compounded Trilostane

- ACTH#5 on 2/27
Pre 0.8
Post 3.8
IMS advised to keep dose the same at 40mg/day (20mg x2 day) and recheck again in 3 months.

What do you guys think?

PS: the ACL injury happened on 12/21

Nadia

I have a question :eek: on 1/2 with ACTH stim results of pre = 5.1 and a post = 6.8, why was the dosage increased? Were Lola's symptoms under control?

[Lola]

The dosage was increased on 1/2 because the IMS initially wanted to go from 20 to 40mg in one jump, I opted for the 30mg first and then increase to 40mg.
The symptoms are somewhat under control, the hair is growing back, drinking and eating subsided a little but she is still begging for treats, which I think is just a behavioral issue.
She doesn't seem to have any Addison's symptoms, she sleeps through the nights unlike before, has more energy and more alert.
I still feel like her optimal dose is not 40mg, but somewhere between 30 and 40 a day, what do you think?

Nadia

[Harley PoMMom]

Dechra's product insert states when a dog is being treated with Vetoryl/Trilostane their cortisol can be as high as 9.1 ug/dl as long as the clinical symptoms are controlled. That's one reason I asked about that dosage increase on 1/2 when Lola's ACTH stim numbers were good.

We have seen dogs here have their cortisol drop lower on a dose that was being given over a period of time. I am a bit worried with her pre number being that low but since she is acting fine I guess there is no reason for my worry.

Hugs, Lori

[Lola]

I am calling the IMS tomorrow to discuss lowering the dose a tad. I can't keep the 40mg for 3 months, I know myself, I will drive myself insane worrying about a possible crash. I will ask for 36mg/day,
What do you think?

[Harley PoMMom]

One important thing I want you to remember is to trust your own instincts because only YOU know Lola best. All dogs are different and thus can have different reactions. You know your girl and are very aware of her actions. The good thing with Trilostane is that it has a short half life and will leave a dog's system rather fast.

I didn't mean to scare you, I just want you to be aware of what could happen, which does not mean that it will.

So, I say go with what your gut is telling you to do. ;)

Hugs, Lori

[addy]

The other factor to consider is that you switched from name brand Vetoryl to compounded Trilostane. Maybe Lola asborbs the compounded differently. I dont think anyone is saying that Lola is about to have an Addison's crisis. We are just concerned this dose is not good for her long term because of her low pre. I would ask your IMS to contact Dechra. I always pushed ours to call and she always learned something she did not know.

I would also give her the Dechra use update I gave you earlier.

What pharmacy are you purchasing the compounded Trilostane from?

[Lola]

Thank you all for your input.
I already called Dechra and they called me back but I was at work and couldn't talk:( I will be calling them back tomorrow morning, they offered to call the IMS.
I am buying the compounded Trilo from a local compounding pharmacy that has a pretty good reputation at delivering a consistent product.

Nadia

[goldengirl88]

Nadia:
I am glad you called Dechra, that is the best help you will get. I think I saw a study somewhere stating only like 38% accuracy in compounded trilostane.I usea combination with Tipper, 20 mg Vetoryl and 5 mg trilostane. Hope you are able to move forward with a dosage that will allow her pre number to rise, but not the post. It is a balancing act with Tipper which is often frustrating. Blessings
Patti

[goldengirl88]

Nadia:
How is it going? Just wanted to see what you decided to do on Lola's dosage? Blessings
Patti

[Lola]

I talked to Dechra, they said they can't make recommendations about dosage but what they can do is call and talk to the IMS, which they did.
The IMS just called me and explained why she decided to keep the dose at 40mg/day, I got her point but she also said if I'm going to drive myself insane it's better if we go back to 30mg/day and retest again in 3 weeks.
I am picking up the meds tomorrow.


Nadia

[Trixie]

Cushings can be so frustrating. I have to say I don't really understand the "pre" number, but I should educate myself on that. It's such a balancing act with the medication. It took many months to get the right dose for my dog.
I guess you will see now if you notice an increase in symptoms, then you'll do another test and see the new numbers...so maybe after that Lola will fall someplace in between 30mg and 40mg. My dog ended up at 28mg a day. I use both Vetoryl and Trilostane to make up that dose.
I think Lori's advice is really good. You know your dog, you're watching her and her behaviors, so when in doubt go with your gut and play it safe.

My dog is well controlled and her numbers have been good..(we're due for another acth in a month or so) but she still drinks more than she did before the diagnosis, but not even close to the excessive drinking a year ago which was crazy! She is always looking for treats and food. I almost can't remember "before" Cushings...I think she was always a big foodie so it's hard to judge that one. Her ALP liver number remains high...but steadily coming down each blood test.
She walks alot, wants to play like a puppy, sleeps well..so I use her behavior as my guide, but of course there's always the little doubts that creep in and make me worry...it's all part of dealing with this disease. Hopefully you will end up at the right dose after your next acth and Lola will continue to do well. :)

Barbara

[Lola]

Thank you Barbara for the kind words.
What were Trixie's last ACTH pre and post? what do you consider to be a "good number"?

Nadia

[goldengirl88]

Nadia:
You are doing them right thing. If it were Tipper that is what I would do. I would let her cortisol rise a bit with the 30 mg until the pre number is stable, but not let the post go to high. It is reallynhard I know I have had this scenario 4 or 5 times already with Tipper. It will work out, and everything will be OK. Blessings
Patti

[Lola]

Thank you Patti

[Trixie]

Hi Nadia,
The last acth we did was at the end of November. She had a pre of 1.8 and a post of 2.7. Everyone here told me that was good and the vet was happy with that too.
At the time her liver numbers were still high and the vet was concerned, since her Cushings was controlled her liver numbers should have showed more progress.

Since that time we've had two more blood tests and finally the liver numbers started to drop...in fact only the alkp remains abnormal. The other two were actually in the normal range! That was a surprise. The alkp is still high but has come down some on each test.
There's always plenty to worry about...Trixie had a major gastro upset last month that landed us at the Animal Med.Center ER at 4am. Now she has a small growth on her foot...hopefully a benign little bump...results due tomorrow. It just always seems to be something and it makes me so worried and stressed, thank goodness for this forum it really helps the nerves.
I always feel better in the morning when she wakes up and wants to get out and walk. She seems energized and fine each day so I try to concentrate on that instead of the not so great stuff, I'm not always successful. :rolleyes:
I hope Lola the 30mg will be just right for Lola.

Barbara

[goldengirl88]

Nadia:
Keep the faith, it is going to be fine, and you are doing a wonderful job with Lola. Every time I see her avatar it melts my heart. Blessings
Patti

[Lola]

Thank you Patti and Barbara for your encouragement.
Lola is doing alright, if it weren't for the ACL injury :(
we have an appointment later today for her BP reading as well as a session of cold laser therapy for the knee. Tomorrow, we are having the ears checked!
I have to do it al, my job is very demanding and stressful, it's a lot to manage all at once but I am doing my best to keep Lola my number one priority no matter what.

God bless!

[goldengirl88]

Nadia:
You will notice a big difference after Lola has her laser treatment. Tipper is walking, running and jumping!! I try to stop her, but it is useless. She is really doing well thanks to laser therapy. Lola may seem tired when she does a few sessions, the therapist told me this ahead of time, so don't think something is wrong with her if she is tired. Tipper goes every 3 weeks as a maintenance touch up. They have so many musculoskeletal issues see if the therapist will do all her legs and her back. Tipper gets her whole body done, and it keeps her pretty much pain free as her back has a dip in it from muscle loss. It is the same price if you just do the leg or the whole body here so I take advantage of the help for her and do the whole body. Hoping Lola is good as new before you know it. Blessings
Patti

[molly muffin]

The laser really helped Molly's back issues. So hopefully you'll see a big improvement there.

It's hard when you have a stressful, time consuming job and Lola to worry about. I know she is your priority, but I do understand how hard the juggling act can be. :(

hugs,
sharlene and molly muffin

[Lola]

Today was a very busy day for both Lola and myself:)
We had the BP checked, it did go down a tad :) :) from 190 to 160, slowly but surely, we don't want it to drop further fast so we are keeping the Amilodipine at the same dose, checking again next Thursday.
We did one session of cold laser therapy, and some physical therapy too:) the doctor said that she is improving slightly, recommended Dasuquin soft chews (she swore by them), in addition to the Adequan injection that we are doing every month. next session on Thursday.
Had the ears checked as well, the vet recommended an ear cleaning lotion, no big deal just needs "deep" grooming I guess, no infection thank god!
Lola is exhausted and so am I, we had to drive through rush hour traffic in LA at 5:30pm!!

Thank you guys for all your support and advice,

Nadia

[molly muffin]

Oh my goodness I'd do just about anything to miss LA rush hour. Lol. You're brave. Glad to hear the bp is coming along nicely.
Hmmm. Soft chews interesting. I might have to see if we can get that here.
Glad the ears aren't infected. I have dealing with that issue for over a month. Arghhh. It goes away it comes back.

Hugs
Sharlene and Molly muffin

[goldengirl88]

Nadia:
Great news on the blood pressure. You are a great cush mom going thru that traffic! Blessings
Patti

[Lola]

I have a question about Fish Oil supplements: Lola is 19lbs, I have been giving her one soft gel a day of the Nordic Naturals for pets, they are 1000mg each. Is it too much?
Her coat has never been softer, the physical therapist has also recommended fish oil supplements for her knee.
I am also feeding her Wellness Core Grain Free Reduced Fat dog food, which is the best reduced fat food there is, it has less than 9% fat. I don't want to be undoing the benefit of the reduced fat food by giving her too much fish oil, there is a balance I just don't know where it is right now. I don't want to give her pancreatitis by giving her an excessive daily dose of fish oil!
Any advice is very much appreciated

God bless

[Renee]

In regards to the fish oil, it's not actually the mg of the capsule that matter, but the mg of EPA/DHA provided by the fish oil capsule. For a 19 pounds dog, you would want anywhere from 170-500 mg of EPA/DHA.

[Lola]

Here's what it says on the bottle:
Each soft gel =1500mg/ 1 soft gel contains 1000mg fish oil- use one soft gel for every 20 lbs of weight- 1 soft gel contains 150mg EPA/90mg DHA/ 310mg total omega 3 fatty acids.

[Renee]

You are fine then. The 150 EPA plus 90 DHA (total 240) is within range. :)

[Lola]

Thank you :)

[Lola]

I emailed Dr Bruyette asking for advice about Lola's Trilostane dosage based on last ACTH test results, he just replied :)

Hi

The low resting cortisol is not too concerning since the post did go up to 3.8. I think its fine to do 15 mg twice a day and see what the next stim test shows. With trilostane we are only looking to control the symptoms so if the symptoms are controlled then we dont pay as much attention to the numbers on the ACTH stimulation test as long as the post is not dropping below 2 ug/dl.

Keep me posted

Dave


Nadia

[addy]

Interesting he says dont let the post drop below 2, just like Dr. Mark Peterson says. So now we have two endocrinologists advsing that.

Thanks for sharing the email.:):)

[Harley PoMMom]

Thanks so much for posting his response!!

[goldengirl88]

Nadia:
I hope all is going well with Lola. How is the leg coming along? Blessings
Patti

[Lola]

Thank you Patti for asking.
We've done two sessions of therapy/cold laze so far. I think there's a slight improvement: Lola doesn't limp any more when walking slowly, but when she tries to run she tends to lift the injured leg. We also hear this popping and clicking sound sometimes, the therapist said that she doesn't think there's meniscus damage and Lola doesn't seem to be in pain. I will continue therapy and hope to see bigger improvement.
She is so hyper and so active that's it's been a challenge:(

Nadia

[goldengirl88]

Nadia:
I know what you mean, Tipper is like a bulldozer to try and stop. When she starts putting her foot flat on that bad leg she is better. They walk on their toes when there is a problem. Tipper just recently started to walk flat footed. We have to leave in an hour for blood work on her thyroid. Blessings
Patti

[Lola]

I hope you hear great news on the blood work:)

Nadia

[Lola]

Hello everyone,
It's been quite a busy month since last time I posted any updates about my Lola.
After we went down to 15mg Trilostane x2 a day a month ago, we did a full blood panel, electrolytes, urinalysis and ACTH stim test yesterday. The doctor just called me and she said she was confused because she never seen such results.
The pre is 1.8, Post is 5.6 which she thinks are good since Lola is clinically fine, but the weird part is that two of her electrolytes came back low! We are doing another electrolyte test again on Thursday, the IMS said that if it's constantly low then we will have to go down to 15mg once a day instead and see what happens.
I am waiting on the doc office to fax over test results, as soon as I get them I will post them here.
What do you all think of this dilemma? Have seen this happen before?

thank you

[Lola]

QUICK UPDATE:

after I posted my last post, the lab called and said that their electrolytes testing machin is broken, they are replacing it and redoing the test :)

[goldengirl88]

Nadia:
Wow, good thing they called you. Now you don't have to worry so much. With her numbers everything should be fine. No wonder your vet was puzzled! Glad to see Lola is doing really good. How is her leg coming along? Blessings
Patti

[Lola]

Oh my god, I couldn't even think straight after she called me the first time. I didn't know what to do! Thank god they called again, because I was loosing my mind.
The BP is still fluctuating between 160 and 190, we are keeping the meds at same dose right now, we will re-measure again in a week.
The leg is almost like new again, the laser does miracles for her, it's unbelievable!
I am just trying to make the best of it all, juggling several conditions at once is hard. sometimes she is not herself, sometimes she is, we have some good days and some not so good!

Nadia

[goldengirl88]

Nadia:
You are doing a wonderful job. I am so glad you did the laser as it fixed my Tipper up good. Hope the bp comes down. So glad you don't have all these worries, and that they called you back. Most of these babies do have multiple issues so it is like a juggling act. Blessings
Patti

[molly muffin]

The laser worked wonders for molly's back too. So glad you tried that.

It would be weird for her electrolytes to be low, when her cortisol is not in a crash range. So I'm really glad the lab called!

Now you can breath a bit again. :)

hugs
Sharlene and molly muffin

[Lola]

The doctor called again this afternoon, the electrolytes test was redone and all the numbers were fine:):):)
Deeeeeeeeep breath! we are keeping all doses as is and retesting again in 3 MONTHS!
what do you guys think of the pre and post numbers and of the doctor's decision to keep dose the same?


Nadia

[doxiesrock912]

Those numbers are fine. :)

[molly muffin]

I think it is a good place to be. :) So glad that the electrolytes are fine. What a relief!

You can always test at any time that you have any worries. If everything remains going well, then 3 months is when the next one will be.
You will always be the one who knows how Lola is doing, even more so than the vet, so if you get worried, just call and schedule a test.

You're doing an excellent job! Really and getting her through the leg problem just fine too. Kudos to you.

hugs
Sharlene and molly muffin

[goldengirl88]

Nadia:
I think Lola is in a very good place thanks to your excellent care. Her numbers are good, and her leg is all better. I would just go on as usual, and if you see anything outside the norm get on it right away before it has a chance to get worse. I am taking Tipper for her ACTH today, and hate doing this as I know how it stresses her. If she has good numbers we will be ok for a few months I hope. Blessings
Patti

[Lola]

Thank you Patti, good luck to you and Tipper today, I hope you hear great news too:)
I know all about the stress the ACTH causes to our babies, Lola has become very popular at her specialty hospital. Since this all started, we've been there almost every week for one thing or another. I never leave her alone there though, I would stay with her no matter what she's there for. I take her stroller and we would go in and out for short walks. Sometimes we had to spend 8 hours there, I just would never leave her and go!
I hope you hear good news today.

Nadia

[Lola]

By the way Patti, the IMS told me to stop the VetriScience Renal Essential immediately because it has L-Arginine. I had only given her 1/2 a tab for 3 days, no big deal. The Cardio Strength is excellent!

[goldengirl88]

Nadia:
I never leave Tipper any where either. I stay right with her always. Did they say why the l Arginine is bad?? I would like to know about that one. Tipper is all done thank God. I swear I am not doing this before three months!! Blessings
Patti

[Lola]

Here are Lola's latest test results: I am only posting the out of range values.

AST (SGOT): 8 Normal Range 15-66
ALK Phosphatase: 336 Normal Range 5-131
BUN/Creatinine Ratio: 29 Normal Range 4-27
Sodium: 158 Normal Range 139-154
Chloride: 121 Normal Range 102-120
Triglyceride: 370 Normal Range 29-291

T4: 3.7

Urinalysis:
Specific Gravity: 1.054 Normal Range 1.015-1.050
Protein: 1+

ACTH:
Pre: 1.8
Post: 5.6

the values that concern me are the AST, the Urinalysis specific gravity, the sodium and the chloride. this is the first time they came back abnormal. The ALK has actually went down from 1195, to 490 and now 336, I think it's a good sign.

what do you guys think of these values?


Nadia

[goldengirl88]

Nadia:
The sodium and chloride are minimal increases and I would just keep an eye on them at the next blood work up. Do you give Lola fish oil? I noticed her triglycerides are high and need to get down. I give Tipper Kronch Salmon Oil, and it lowered hers significantly, but took a while. Sometimes it takes a while for the ast and all phos to come down. I am still working on Tipper's. You are doing a good job. I sit there for hours and analyze Tipper's blood work too. I try not to stress over anything minimally increased, and just wait until the next test to see if it goes back to normal.Blessings
Patti

[Lola]

Patti,
You're right, the triglycerides are still a little elevated, but they did go down from 502 in January. I am giving her Nordic Naturals fish oil.

Nadia

[Lola]

Nadia:
I never leave Tipper any where either. I stay right with her always. Did they say why the l Arginine is bad?? I would like to know about that one. Tipper is all done thank God. I swear I am not doing this before three months!! Blessings
Patti

L-Arginine has not been proven to lower BP on its own, but when taken with Amlodipine, it brings BP too low, and it's dangerous for Lola.
Typically, L-Arginine is always used with other medications to help several conditions, but never effective just on its own. you may want to make sure it's not interacting with anything else you are giving Tipper.

Nadia

[goldengirl88]

Good fish oil!! Tippers were so high I am surprised she never had pancreatitis. All of a sudden one blood test at the vets showed they dropped in half!!

[molly muffin]

I would monitor her and keep an eye out and compare the next set to this one. They did mention they had problems with their machine correct? So, unless they got a new blood draw to analyze, that is what I'd do. Did the vet mention anything about the results?

Are you giving Lola a liver supplement? If not I would add that to the daily supplement regime.

hugs
Sharlene and molly muffin

[Lola]

The vet said that the numbers are good considering everything that's going on with Lola. She was not too concerned with the couple electrolytes values that are a little out of range because they were only a point or two out, we will test again in 2 or 3 months and keep a close eye on her.
Yes I am giving her Denamarin daily, that's what brought down her liver numbers.
Any thoughts about the low AST? what might be causing that?


Nadia

[molly muffin]

My thought is that while AST is considered one of the liver enzymes, it also can be affected by other things, but you don't want it to be low, because each enzyme needs to be in balance in order to it's job, of basically filtering toxins out of the body. I would have a conversation with the vet about getting that in balance, because low hampers the possibility of function. Just as High can indicate it something is over working, low can signify, not working enough.

This is what I've sort of gotten out of the various sites I went to to try and look up low AST for Canines. Higher is seen more often.

One question is does her AST regularly run lower than normal, or at the low end of normal?

Sharlene and molly muffin

[Lola]

In January, the AST was 18 (normal range 15-66), so I guess it was normal but in the lower end of the range. I will ask the IMS on Monday as I have a BP appointment.

Thank you

[molly muffin]

I wonder if since it was already on the low side of normal, if the denamarin would have caused it to go a bit low. Maybe the IMS would want to look at the dosage of denamarin and lower it a bit, if they think that is a possibility. Are they the type that can be cut in half or something like that maybe?

It seems that everything is a fine balancing act these days.

hugs
Sharlene and molly muffin

[Lola]

I emailed Dr. Bruyette asking his opinion about Lola's latest test results. here's what he said:

"We don't look at AST in dogs. The other values look great !!!"

so I guess I need not to worry:)

Nadia

[molly muffin]

Awesome Nadia!!!

No wonder I was having such a hard time finding Any information on low AST in canines. Plenty about high AST but very, very little for low.

No, I wouldn't worry about it either. :) Good idea emailing Dr. Bruyette.

hugs
sharlene and molly muffin

[Lola]

Thank you Sharlene!
A huge sigh of relief!

Nadia

[goldengirl88]

Nadia:
You and your baby are all set for a while. It is nice to be able to take a breather knowing they are doing alright. Blessings
Patti

[Lola]

Hello everyone,

I am a little concerned about Lola's latest behavior.
about a week ago, she started scooting, she's never done that in the past, ever. so I took her to the vet on Friday for the Adequan shot, and had them check her anal glands. They said that they were pretty full and cleaned them. In her 7 1/2 years, we never had this behavior happen, and we never had issues with anal glands.
Now, my concern is this, she is still scooting and seems to be uncomfortable in that area. her diet have not changed, and this is making me very concerned because if it was just anal glands, the vet visit should have taken care of it. I checked her bottom, it's very nice and clean, no redness or sores or swelling.
What do you think it might be? Should I be concerned? Is there anything I can do at home to soothe her?

Thank you
Nadia

[lulusmom]

Hi Nadia,

Parasites can make dogs drag their butt. Did your vet do a fecal while you were there? If not and she continues this behavior, you may want to talk to your vet about possible parasites. In the meantime, take a good look at her poop. If she has worms, you can usually see them.

Glynda

[Lola]

Thank you Glynda.
Last time we did a fecal was in February and it came back negative. we didn't do one on Friday.
I have an IMS appointment tomorrow for blood pressure and laser therapy, I will ask the tech to do a fecal. I know it's going to be more expensive then the regular vet's but I don't care. I have a very hectic week ahead and don't really have too many options:(

Thank you

[goldengirl88]

Nadia:
Another possibility is she needs her anal glands cleaned. When Tippers get full that is precisely what she does! Good luck at your appointment. Happy Easter to you and Lola.
Patti

[Lola]

Patti,
That's what we did on Friday, we had the anal glands cleaned. and that's what makes me even more concerned because that was supposed to get the issue solved, but apparently it didn't.
how long after the anal glands are cleaned do you see improvement in Tipper? Is it immediately after or a few days later?

Happy Easter to you to and your babies

[goldengirl88]

Nadia:
After Tipper get her anal glands cleaned she does scoot for a few days. Maybe them working on her back there makes an uncomfortable feeling for a few days. Tipper does it after every cleaning. Once you clean them they need done from that point on every few months as they can get infected if left too long. Give her a few days and she may quit scooting.

[molly muffin]

Checking in to see how you and Lola are doing. Hope all is well.

hugs,
sharlene and molly muffin

[goldengirl88]

Nadia:
How is Lola, curious too know if she stopped scooting after a few days?? Hope all is well. Blessings
Patti

[Lola]

Hi Patti,
Sorry to hear that Tipper is having all these issues, I hope you will figure everything out and will do what's best for her, I'm sure you will:)
Lola is doing great:) I was out of town all last week for work, she was scooting the whole time, I had an IMS and a vet appointment scheduled for Wednesday afternoon. we did the PB reading, it was PERFECT this time, I couldn't be happier:) an average of 145, I can't ask for better. the knee has improved tremendously, the therapist told me that she is very impressed with the progress, we may now start introducing some light walking and exercise:) and I will stop leaser for now until we check back again in June.
We then went to see the regular vet for the scooting, her anal glands were perfectly clean, it turns out, she has an irritation in her vulva, the vet prescribed an ointment and she doing fine now:)
We wont be doing any tests or BP readings again until June, mommy can take a break now as well as her bank account:)

Nadia

[molly muffin]

That is so great!!! I'm glad you get a break for awhile from all the testing and everything going on. Good for you and Lola. Congratulations and way to go!
hugs,
Sharlene and molly muffin

[goldengirl88]

Nadia:
So happy to hear Lola is doing so well. You have done an exceptional job with her. Blessings
Patti

[Lola]

Hello everyone, I ma so sorry for having been away for so long, life has been a little too hectic in my household!
Lola has been doing good overall, the next ACTH test is due in a couple of weeks, hopefully no surprises this time because she's got a lot in her plate poor thing.
She is limping again, more when she stands from a sitting positing and it gets a little better as she walks but not a lot. She was doing so good until a couple days ago when we had this huge set back.
I believe she either re-injured her ACL, or it's the hip that's getting weaker. She lost a lot of muscle around the injured knee/hip. I am taking her for one more laser therapy session tomorrow (we stopped laser a month ago). I will set up an appointment with the orthopedic surgeon for next week. I have so many questions in my head that I can't think straight any more. My gut is telling me that there's no way around knee/and or hip surgery, but I will leave that for the Orthopedic surgeon to decide.
the questions that are eating me up are:
- how bad do you think her knee/hip has gotten because I decided to go the conservative management route?
- have any of you ever had to put their babies under surgery while on Cushing's treatment?
- in case we have to do surgery, will the trilostane be stopped, she needs cortisol to deal with all that stress!
- how soon after surgery is trilostane restarted?
- does Cushing's affect recovery time at all?
- if we had to stop trilostane for any period of time, will we be throwing away all the progress we've made in controlling her Cushing's symptoms and having to go back to square one?
- is it even a good idea to put her under anesthesia with Cushing's?
more and more questions cross my mind, and I can't sleep at night worrying if I'm making the right decisions by my baby!

please help me sort all this out and find a route, you all have been such a huge help in this journey and I am so grateful for that.


Nadia

[goldengirl88]

Nadia:
Being conservative is good with a Cush dog, especially a small one. Her injury has built up scar tissue by now and that is why small dogs can heal with activity restriction. Cushing's dogs do not heal as well as they did prior. I have read of many that do just fine. The surgeon should have to have a plan in place to allow for her cortisol to be at a level where it can handle the stress of the operation. I think starting the trilostane back again will be dependent on how well she does post op. It will not hurt her to stop and restart. She may show some symptoms dependent on how long she is off her meds. I do not think it will be long as she needs her cortisol managed to heal properly. You will have to go over all of this with her surgeon to make sure his plans meet your expectations, and that no details are forgotten. There are always risks with anesthesia even with a healthy dog. To minimize risk to Lola you will want an anesthesiologist with her during surgery. I do not ever let anyone put Tipper under without one. Your number one priority is Lola's safety, so make all your concerns known up front to your surgeon. You have done a great job with Lola, so you will do fine with the surgeon. Blessings
Patti

[Lola]

Hello everyone,
Lola had another ACTH stim test done yesterday, here are her latest numbers:
Pre: 2
Post: 2.7
The IMS is suggesting that we go back to 20mg/day (from 30mg). the post number is too border line.
Any thoughts?


thank you

[lulusmom]

Hi Nadia,

My two cushdogs were treated with trilostane and their pre and post stim tests results were consistently in the low to mid 2 range for two years. Their IMS was very happy with those numbers and so was I. Not all dogs feel good with cortisol that low but my dogs seemed to feel great. How is Lola feeling? How long has she been on 30mg?

Glynda

[doxiesrock912]

You're vet may be concerned that the Trilostane might be builing up in Lola's system. It can happen. Going back for a time won't cause any harm. Just watch Lola's symptoms.

[goldengirl88]

Nadia:
Tipper is one of the dogs Glynda is talking about. SHe does better with low cortisol, except when it storms I can tell she does not have enough to get her thru the stress and she becomes terrified easily. If you are not comfortable with going to 20mg, maybe you could do 20 vetoryl and 5 trilostane compounded? Or else it would have to be 25 compounded. Has she had her surgery yet as that needs to be considered to that she has enough cortisol for the stress of the operation, could that be why your Dr. wants it higher? Blessings
Patti

[addy]

If Lola is on twice day dosing, your vet may be following Dr. Peterson's thoughts. He has written a few times about his preference of keeping a dog no lower than 2ug/dl on 2x dosing, which may be why your vet is saying borderline along with the blunt response of the ACTH test, there is not much difference between the pre and post.


For my cases, I recommend maintaining a post-ACTH cortisol concentration between 2-7 μg/dl when tested 4-5 hours after the morning dose. So for a dog that was clinically improved but has a post-ACTH cortisol above 5.5 μg/dl but below 7.0 μg/dl, I would not recommend increasing the dose in those dogs. Many of those dogs will go on for months on the same dosage, without the need for a higher dose.



Most importantly is- how is Lola feeling?

[goldengirl88]

Nadia:
Are you on twice a day, somehow I thought you were once a day? What Addy says makes sense so I would check that also. Blessings
patti

[Lola]

Thank you everyone for your replies.
Lola's symptoms have improved tremendously. She has a beautiful coat and and is doing great. We had one single episode 2 weeks ago when she got up in the morning and was very weak and drowsy, which led me to believe that her cortisol was very low that day.
No we didnt do the surgery, she doesn't need it really.
She is currently on 15mg twice a day. I had email dr Bruyette before and he had recommended that the post should not drop below 2.
I will email him again today, my concern this time is that I'm not sure if the drop from 30mg to 20mg is necessary. But again, am willing to try it and test again in 2-3 weeks, just for the safety of my baby.
By the way, all her blood values are perfect, her AKLP is 189, from almost 1200 eight months ago!

Thank you

[lulusmom]

Hi Nadia,

I've gone back through your thread and have recapped the acth stim tests you've shared since Lola started treatment. I've posted those below.


Started 10 mg. twice daily on 11-16

ACTH on 11-26: 1.5 and 7.7 (Continued on same dose)

ACTH on 12-20: 2.6 and 10.5 (So cortisol actually increased and dose was therefore also increased to 30 mg. daily total)

ACTH on 1-4: 5.1 and 6.8 (Daily total increased to 40 mg.)

ACTH on 2-27: 0.8 and 3.8 (IMS advised to keep dose the same at 40mg/day (20mg x2 day) and recheck again in 3 months. Dr. Bruyette responded to Nadia's email saying not too concerned with .8 and that it would be okay to go to 15mg BID.)

ACTH on 4-?: 1.8 and 5.6 (15mgBID -Vet happy with these results as Lola is clinically fine; however electrolytes a little low.)

ACTH on 6/17: 2 and 2.7 (The IMS is suggesting that we go back to 20mg/day (from 30mg). the post number is too border line.)


If Lola is clinically well with resolution of symptoms, I still think these numbers are great. I'm not sure why your vet thinks a post of 2.7 is borderline, unless s/he is concerned that the post stimulated cortisol has dropped from 5.6 to 2.7 in the last 60 to 70 days. Was a stim test done between April and June? Have clinical signs resolved and is Lola feeling well on her current dose?

[Lola]

Glynda,
the last ACTH test was done in mid April, the post was 5.6. in 60 days, the post has dropped to 2.7, on the same dose of 15mg x2 day.
Lola is doing fine, the only concern I'm having the last dew days is that she is loosing her appetite little by little. She used to gobble up her morning bowl. now she wont even get near it, I have to hand feed her some so I can give her the meds. She even leaves some of it overnight, which I throw away in the morning.
That's the only odd behavior, other than that she is happy, and is somewhat her old self which makes me very grateful.

Thank you

[lulusmom]

Hi Nadia.

Loss of appetite is definitely concerning. Have you called the vet and told him about this? If not, please do that right away. I personally would not give Lola any more Vetoryl until her appetite normalizes.